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Poll: Is It Time for New Jersey to Revisit a State-Based Exchange?

Court decisions throw settled situation into turmoil for growing group of newly insured

Two U.S. appeals courts reached wildly contrasting decisions on whether the Affordable Care Act allows the federal government to subsidize health insurance for low- to middle-income residents. Now calls are already arising for the state to reconsider its decision to rely on the federal insurance marketplace rather than operate a state exchange.

Much depends on the U.S. Supreme Court, which earlier upheld the ACA while allowing states to make their own decisions about whether to expand Medicaid. If the decision by the U.S. Court of Appeals for the D.C. Circuit is upheld, it would affect the growing group of more than 120,000 New Jersey residents who are receiving tax credits. Without these credits, these people may rejoin the ranks of the uninsured.

What should New Jersey officials do?

  • Act now. The state should never have relied on the federal marketplace in the first place. The Legislature should start work immediately to pass a new bill launching a state-based exchange. The Supreme Court’s history on Medicaid expansion shows that states can’t count on the courts to protect the uninsured.

  • Prepare. Despite early mishaps, the federal marketplace wound up working well for many residents. New Jersey should only consider a state-based exchange if the Supreme Court invalidates the subsidies, which could take years.

  • Watch and wait. This discussion is premature. There is an entire open-enrollment period for the marketplace that will start on November 15, and it will only cause confusion for those shopping for insurance if the media and legislators focus on these court decisions.

  • Support the Supreme Court ending the subsidies. The sooner the court upholds the D.C. Circuit, the better. It was a poorly drafted law -- exactly the reason why courts should rule against the subsidies.

  • Call on Congress to repeal the ACA. The D.C. Circuit trained a spotlight on one of the many flaws in a terrible law. Let’s start from scratch and try to put the four years since the ACA was passed behind us, beginning with eliminating the subsidies.

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