State lawmakers hope to expand health insurance coverage among children to make sure all kids, particularly in communities of color, are enrolled. They aim to do this by increasing targeted outreach, and reducing costs and other barriers that have left 78,000 young New Jerseyans uninsured, including some without legal documentation.
Friday’s announcement of the initiative followed the release of the latest report from New Jersey Policy Perspective, a liberal research group, which noted the state’s uninsured rate for children has dropped to 3.5 percent in recent years. Some 800,000 youngsters now receive care under NJFamilyCare, which includes Medicaid and the Children’s Health Insurance Program, or CHIP, two subsidized insurance programs that are funded by a mix of state and federal dollars.
But the number of kids who were signed up for FamilyCare declined toward the end of 2018, resulting in the lowest enrollment in years, NJPP found. Its report urges the state to take action now to regain this ground and expand coverage to children who have yet to enjoy these protections; it also includes more than a dozen suggestions to close this enrollment gap, with an estimated price tag of $19 million in the first year.
Raymond Castro, NJPP’s health policy director and the report’s author, said he is troubled by the new downward trend in enrollment and the “enormous disparities” he discovered in coverage based on race, wealth, geography and immigration status.
“The good news is that we know the realistic steps that can be taken to fix these problems,” he said. “Because the cost to insure a child is so low — and the benefits are so many in terms of avoiding other much higher health and social expenditures — assuring affordable health coverage for all kids is unquestionably one of the best investments the state can make.”
Funding more community outreach
To address the gaps identified in the report, Sen. Joseph Vitale (D-Middlesex), said Friday he would introduce legislation to provide additional funding for community-based outreach around FamilyCare. He said his proposal would also eliminate the cost of premiums, now paid by more than 50,000 families in CHIP based on income; end a 90-day waiting period for coverage; and repeal eligibility restrictions tied to immigration status, he said.
“When we cover all kids, we take a huge step in securing a healthy and prosperous future for generations to come,” said Vitale, the longtime health committee chairman who led the effort in the late 1990s to create FamilyCare. “If we have found ways to make available and pay for public education for all kids, we can certainly do the same for health insurance.”
Research has shown that children with insurance are more likely to be healthy, avoid hospitalizations, and live longer; coverage has also been linked to positive school performance, higher graduation rates, and better jobs with higher pay, NJPP notes.
The federal Affordable Care Act, which took full effect in 2014, allowed the Garden State to expand its Medicaid program and other coverage. As a result, the uninsured rate among children fell from 5.6 percent to 3.7 percent between 2013 and 2015. (Overall, the law enabled more than 800,000 residents of all ages to obtain healthcare plans, which had previously been out of reach.)
These numbers suggest New Jersey is doing well, especially compared to some other states. A report released in November by Georgetown University’s Health Policy Institute shows that the nationwide rate of uninsured children is now on the rise — after declining following the implementation of the ACA — and has grown from a low of 4.7 percent in 2016 to 5 percent in 2017.
A lot better than Texas
New Jersey is among the 28 jurisdictions that fall significantly below this average, Georgetown found, using 2017 data. Twelve states had rates that were significantly higher than the national average, including Texas, which has nearly three times the percentage of uninsured children as New Jersey.
“Golly, I would hope we are doing better than Texas,” Castro said, noting that the Lone Star State declined to embrace the ACA in the way that New Jersey did.
Under Gov. Phil Murphy, the Garden State has taken a number of steps to expand and improve coverage for low-income residents and stabilize the insurance market overall, including creating a state-based individual mandate requiring people to obtain insurance or pay a tax, which helped drive down premiums for some consumers. Murphy also invested in a massive outreach during the annual enrollment period last fall, the first of its kind in New Jersey.
“Quality, affordable health care is a top priority for the Murphy Administration,” said Tom Hester, a spokesperson for the Department of Human Services, which oversees Medicaid and CHIP. “We will continue to make outreach and enrollment support to get New Jersey’s children covered a priority.”
Hester said the department participates throughout the year in local events in communities around the state, and it has partnered with a number of community-based organizations that can help reach and enroll underserved populations. The DHS also works through programs focused on low-income families, like the National School Lunch Program, to sign up eligible kids, he added. (FamilyCare enrollment is open all year, not just during a specific period.)
Preventing health problems later in life
Regardless of the progress — or how New Jersey stacks up against other states — the NJPP and other healthcare advocates said Friday that the state now has a unique opportunity to expand coverage even further.
“The un-insurance rate is now so low that New Jersey is in a position where it can realistically achieve a goal that would have been unheard of only a few years ago: universal health coverage for kids,” Castro wrote in the report. “This means more healthy children and lower cost to taxpayers by preventing costly health problems later in life.”
But, the average children’s uninsured rate (of 3.5 percent) in New Jersey masks some disturbing disparities. While just over 2 percent of white children lack coverage, the rate is more than 3 percent for Asian kids, greater than 5 percent for black youth, and well over 6 percent for Hispanics, the report notes. As a result, children of color make up nearly three out of four of those in the Garden State without health insurance.
“We know that these inequities not only harm people of color when they are children, but when they grow up as well,” Castro wrote, noting that black New Jerseyans die nearly five years sooner than their white neighbors, on average. Data shows African-American women and babies also have far higher mortality rates than their white peers.
NJPP also confirmed that income played a large role in coverage, with wealthier children — whose families earn more than four times the federal poverty rate, which is $21,330 a year for a family of three — more than five times more likely to be insured than kids in families below that official poverty line. Location also influenced the rates; in poorer, rural Cumberland County, 6.3 percent of the children lacked insurance, while only 1.5 percent of the kids went without in more prosperous Morris County.
‘…disproportionately from minority ethnic groups’
“These children come from marginalized communities and are disproportionately from minority ethnic groups,” said Assemblywoman Yvonne Lopez (D-Middlesex), who pledged to introduce a companion version of Vitale’s bill. “Regardless of location, ethnicity or income, every child deserves the right to healthcare.”
To address these shortcomings, the NJPP report called for the state to commit permanent funding to outreach concerning FamilyCare programs, and better coordination with community-based organizations that can connect it with kids who don’t have coverage. Castro estimated this work would cost about $2 million in total, but would also attract at least $1 million in federal funds.
NJPP also urged the state to eliminate the monthly premium charge — which can top $150, second only to the cost in Missouri — and is paid by families with kids in CHIP who earn over a certain amount. (Medicaid does not charge premiums and most families in CHIP fall below this income threshold. Castro estimates this would cost the state $28 million in lost fees, but would be largely offset by an additional $22 million in matching federal funds; Vitale said this would be part of his bill.
The senator said his legislation will also address NJPP’s recommendation to eliminate the 90-day waiting period for coverage, during which children must remain uninsured in order to qualify for FamilyCare — a situation the NJPP report said exacerbates health challenges and drives up costs over time. The report estimates this would cost the state less than $1 million in additional healthcare costs, but would attract more than $2 million federal dollars as a result of increased enrollment.
In addition, Vitale said he would seek to eliminate enrollment barriers linked to immigration status, an issue that NJPP has repeatedly flagged as a concern; the pool of uninsured kids in New Jersey now includes nearly 17,000 who lack documentation, nearly a quarter of all youngsters without coverage. While expanding coverage to include a quarter of these children — not all eligible families are expected to apply — could cost $10 million, Castro suggests the federal government would likely pick up some of the healthcare expenses incurred.
As it is, NJPP said FamilyCare covers some 150,000 young people who are legal citizens, but whose parents lack the same protections. Castro wrote that concerns about deportation — fueled by President Donald Trump’s rhetoric and policies — have likely contributed to the recent decline in enrollment numbers, as parents worry that getting their kids covered could lead to their families being torn apart.
In addition, the report calls for the DHS to revive a provision that would enable certain families who earn too much to qualify to purchase the discounted policies for their children at full cost; this option was suspended in 2010 by former Gov. Chris Christie. Reinstating it would cost the state nothing, NJPP notes, and could help extend coverage to some 14,600 youngsters.