Medicaid provides health benefits to 72 million Americans who cannot afford health care. The NJ Family Care Program includes Medicaid, Children’s Health Insurance Program (CHIP) and Affordable Care Act (ACA) and provides health care to 1.7 million lower-income adults and children — among them senior citizens in nursing homes and others who receive both Medicare and Medicaid benefits (and are known as dual-eligible).
Considering turnover among clients, almost 2.3 million people receive benefits at some time in a given year. Some are unemployed; others have jobs but are eligible because the programs cover individuals, families and children below a defined poverty level.
The passage of the Affordable Care Act dramatically impacted health care, allowing New Jersey to expand Medicaid eligibility to encompass more working people. For example, a family of four is eligible without premium or copays if their income is below $36,156 (138% of the poverty level). Further, children are eligible if the income of their families is below $93,012 (355% of the federal poverty level), with modest premium and copay requirements. Approximately 490,000 residents were added to the Medicaid roles via the ACA — many of whom had no health coverage.
A tale of three families
For the purpose of discussion, let’s assume Joe Jones and his family live in New Jersey. Jane Smith and her family live in Texas, and her cousin Frank and his family live across the border in Oklahoma. All have jobs: Each family of four earns about the same amount ($36,156), and each has some level of health insurance.
Joe, however, pays nothing for health insurance while the other two pay approximately $1,000 per month for insurance offered by their employer. Why? New Jersey accepted the ACA; Texas and Oklahoma rejected the opportunity. The federal government picks up 90% of the cost of the ACA (down from 100% for the first three years of the act).
But now, the families have lost their jobs as the result of the coronavirus. Joe in New Jersey still has coverage, but Jane and Frank are searching for coverage since their company only agreed to cover them for one additional week. Apply this story to the other 13 states, including large ones like Florida and North Carolina, that rejected the ACA and many families face similar problems.
Jane and Frank can apply for basic Medicaid coverage since they are now unemployed, but they could have had coverage under the ACA, as Joe does, with no cost since their income was below the poverty level. Unfortunately, these same states and the federal government are considering adding additional eligibility requirements, time limits and a block-grant concept to limit future benefits. Indeed, even in the presence of the coronavirus outbreak, the rise in unemployment and the resulting loss of employer health insurance, the Trump administration refuses to reopen the ACA enrollment period so more individuals and families can receive coverage.
Three cheers to former Gov. Chris Christie who was one of a few Republican governors who saw the need and was guided by his heart and fiscal prudence instead of politics. Gov. Phil Murphy has followed suit.
In my opinion, governors and legislators who failed to adopt the ACA are morally culpable for causing avoidable disease and death among their people.
People can easily apply for either Medicaid or ACA at New Jersey’s Medicaid website, which informs visitors of the income eligibility levels for each type of client — pregnant women, children, families or adults.
There are no out-of-pocket charges for enrollees for most services, and the program covers the gamut of traditional health care needs, including doctor visits, hospital stays and drugs. Not all doctors participate but most hospitals do.
The ACA is also available for higher-income families and individuals whose employer does not provide coverage or when the plan is too expensive. There are a variety of plans and levels, some with higher premiums and deductibles, but many folks can apply for a federal subsidy based on income and the size of the family. The subsidy can bring the monthly cost down considerably — sometimes to zero.
Also bear in mind: Family members under 26 can be added to any of the ACA plans; no one can be rejected because of any preexisting conditions; the range of services covered is comprehensive; and the program also pays for prescription drugs. This is most important because the use of drug therapy is a much cheaper alternative to keep people out of hospitals and other expensive venues.
Medicaid and the ACA are also an essential source of support for hospitals, health centers and much of the nursing-home sector. These institutions are a major source of jobs in New Jersey and other states.
But, unfortunately, our friends in Texas and Oklahoma and the other 13 states do not have these ACA options.
Medicaid and its sister program — the Affordable Care Act — are good for America. The current coronavirus pandemic is highlighting some of the problems of our current health care system, especially when people suddenly terminated from work lose both their income and their health coverage.
Even with these obvious benefits, the ACA is back before the U.S. Supreme Court in an attempt to terminate it. This is the third in a trilogy of cases that have threatened the law since President Barack Obama signed it in 2010. Without discussing the nuances of the case (it centers on the repeal of the financial-penalty provision for people failing to carry health insurance), suffice it to say that a group of Republican officials, led by Texas and joined by the Trump administration, are again challenging the constitutionality of the ACA with no alternative program to replace it. A truly amazing disregard for a critical health care program.
Behind the statistics and challenges are real people. Proper medical care improves the quality of life and all that goes along with good care. The ACA has made a significant impact on reducing the uninsured in New Jersey and throughout the country. Today, approximately 20 million people have health coverage under the ACA. That number would be higher except 15 states refused to participate.
Several adverse outcomes result when individuals and families do not have health insurance. First, they are reluctant to seek medical assistance in a timely fashion, often resulting in their health getting worse. Second, when they finally seek medical assistance it is often via more expensive emergency rooms. Finally, individuals without health insurance are vulnerable to the shock and disruption of their family budgets resulting from exorbitant medical bills.
Families and individuals who lose their jobs as the result of the coronavirus (or other maladies) will be thankful that Medicaid and the ACA exist.