Repealing the Affordable Care Act Would Devastate New Jersey

In county after county, the numbers are clear: repealing the ACA without an adequate replacement is a terrible idea.

Published on Feb 21, 2017 in Health


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Imagine, in 2019: 58,000 Hudson County residents losing Medicaid coverage. 19,000 Ocean County residents losing access to Marketplace insurance plans. 22,000 Bergen County seniors losing invaluable prescription drug coverage. $350 million in lost federal funds in Middlesex County. 48 deaths in Union County.

In county after county, the numbers are clear: repealing the Affordable Care Act (ACA) without an adequate replacement would devastate New Jersey.

The greatest harm would be caused by repealing the Medicaid expansion, which would terminate health coverage for about 550,000 low-income New Jerseyans and cost the state about $3 billion in federal funds each year. Despite threats by Congress and the President to end the Medicaid expansion, participation increased by another 12,000 in the enrollment period ending last month, demonstrating the urgent need for this coverage. In addition, up to about 300,000 New Jerseyans who signed up for a plan in the Marketplace would lose their coverage, and with it a billion dollars in federal funds that pay for premium subsidies to make insurance affordable. That is a total $4 billion loss to New Jersey which would result in an estimated loss of about 86,000 jobs and 84 deaths due to lack of insurance.

Both of those cuts affect mostly working New Jerseyans who are struggling to get by in a state with one of the highest costs of living in the nation, but the elderly would also be harmed by the proposed repeal of the ACA. For example, seniors have benefited from the closing of the gap in prescription drugs in Medicare, often referred to as the “donut hole.” Over 200,000 seniors would lose this assistance that enables them to pay for prescriptions that are often life-saving. If this benefit is eliminated the average senior would have to pay $1,241 more each year which would force them to choose between paying for their medications or rent.

Click here for the impact in each county:

Atlantic | Bergen | Burlington | Camden | Cape May | Cumberland | Essex | Gloucester | Hudson | Hunterdon | Mercer | Middlesex | Monmouth | Morris | Ocean | Passaic | Salem | Somerset | Sussex | Union | Warren


Medicare Donut Hole

Each county’s share of annual enrollment for all Medicare prescription drugs from The Centers for Medicare and Medicaid Services’ Yearly Medicare Enrollment Counts State and County (2015) was applied towards total persons receiving Medicare donut hole coverage in New Jersey and the total federal expenditures in New Jersey from the U.S. Department of Health and Human Services’ Compilation of State Data on the Affordable Care Act (2015).


Total enrollees taken from the U.S. Department of Health and Human Services’ Plan selections by County and Zip Code in the Health Insurance Marketplace (March 2016), and lost federal funds were calculated based on total subsidies received (adjusting for inflation) using the March 2015 and March 2016 Centers for Medicare and Medicaid Services’ Effectuated Enrollment Snapshot, applied towards the number of estimated participants in the Marketplace for each county.

Medicaid Expansion

Number of adults enrolled in the expansion taken from New Jersey’s Division of Medical Assistance and Health Services’ NJ FamilyCare enrollment website (January 2017), and the prorata share of enrollment in each county was applied towards the total federal funds for the Medicaid expansion estimated for state fiscal year 2019 by the New Jersey Department of Human Services in Discussion Points prepared for the Office of Legislative Services for the fiscal year 2016 Budget, adjusted to take into account higher enrollment in January 2017.

Jobs and Deaths

To estimate the number of jobs lost, the county share of total federal funds lost was applied to the estimated total jobs lost in The Commonwealth Fund’s Repealing Federal Health Reform: Economic and Employment Consequences for States (January 2017). The death rates for uninsured are based on Health Insurance and Mortality in US (December 2009), with the death rate applied to the total number of uninsured due to ACA as estimated in the same Commonwealth Fund report. Estimated deaths are over a 12-year period (consistent with the Health Insurance and Mortality in US report). Deaths for each county were calculated by applying the share of persons losing benefits in the Marketplace and Medicaid in each county applied towards the total deaths in the state.

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