Topic Category: Health

Medicaid Cuts Would Jeopardize Health Services for Students

Posted on by Raymond Castro

The Garden State gets fourth highest amount of federal funds for Medicaid services in schools

Medicaid-Kids 4-FacebookNew Jersey’s schools receive $143 million in federal Medicaid funds each year, the fourth highest of the states, according to data released today by the Washington, DC-based Center on Budget and Policy Priorities.

This funding pays for medical services for Medicaid-eligible students with disabilities, such as mental health and speech therapy. It also covers vision and dental screenings provided in schools to Medicaid-eligible children, and helps schools connect low-income children to other health care services that aren’t provided in schools, but are critical to a child’s development. But this aspect of Medicaid is not widely known, with the program being much better known for providing affordable and comprehensive health care coverage for millions of seniors, people with disabilities and children across the country.

House Republicans’ plans to dramatically cut Medicaid funding puts these crucial services – in addition to health care for nearly half a million New Jerseyans – at risk.

Medicaid funding helps schools pay the salaries of health care and other staff who provide important services to students, not just those with Medicaid coverage. In 2017, 68 percent of school superintendents reported that they used Medicaid funding to keep school nurses, school counselors, speech therapists, and other health professionals on staff. Any cuts to Medicaid could jeopardize the benefits these health care professionals provide.

Medicaid funding cuts also could squeeze New Jersey’s education budget, impeding efforts to help schools implement proven reforms such as hiring and retaining excellent teachers, reducing class sizes, and expanding the availability of high-quality early education — keys to helping all children thrive in school.

All but one of New Jersey’s bipartisan Congressional delegation has publicly opposed this push to repeal the Affordable Care Act and cut Medicaid, because of the harm it’d bring to their constituents. This new data makes it even clearer: policymakers in Washington should protect Medicaid – not cut it.

Nearly 4 Million New Jerseyans Have Pre-Existing Conditions

Posted on by Jon Whiten

While the latest Congressional Republican plan to repeal the Affordable Care Act is apparently dead (at least for the moment) as of yesterday, it has been reported that the proposal would have rolled back protections for the more than 130 million Americans – and 3.8 million New Jerseyans – who have a pre-existing health condition.

These New Jerseyans are found throughout the state, with hundreds of thousands in every Congressional District, according to a new analysis by the Center for American Progress (CAP).

In fact, a slightly higher share of Garden State residents in districts with Republican representatives (52.4 percent) have pre-existing health conditions than residents in districts with Democratic representatives (51.1 percent). And of the 3.8 million New Jerseyans total, nearly half a million (476,800) are children – including my own four-year-old son.

For more on the issue of coverage for Americans with pre-existing conditions, and what’s at risk, see an excerpt of the CAP report below the table.

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From the CAP report:

“Republicans are now discussing a provision that is effectively a sick tax on premiums: People with health conditions would be charged multiples more based on their medical history, paying above-standard rates for coverage. Even if the new plan preserved the ACA’s rules on guaranteed issue—meaning that issuers cannot deny coverage—consumers with pre-existing conditions could still be priced out of the market.

Prior to the ACA, insurers could discriminate against consumers based on their current health conditions and medical history. Consumers with common ailments, including asthma and high blood pressure, were charged higher rates. People with histories of serious conditions, such as cancer or heart attacks, were regularly denied coverage altogether.

About half of nonelderly Americans have one or more pre-existing health conditions, according to a recent brief by the U.S. Department of Health and Human Services, or HHS, that examined the prevalence of conditions that would have resulted in higher rates, condition exclusions, or coverage denials before the ACA. Approximately 130 million nonelderly people have pre-existing conditions nationwide …

Nationally, the most common pre-existing conditions were high blood pressure (44 million people), behavioral health disorders (45 million people), high cholesterol (44 million people), asthma and chronic lung disease (34 million people), and osteoarthritis and other joint disorders (34 million people).

While people with Medicaid or employer-based plans would remain covered regardless of medical history, the repeal of pre-ex protections means that the millions with pre-existing conditions would face higher rates if they ever needed individual market coverage.”

NJPP’s Ray Castro on Protecting Medicaid

Posted on by NJPP Staff

As the push to repeal the Affordable Care Act began its final unraveling Friday, New Jersey Policy Perspective senior policy analyst Ray Castro was a featured panelist at a NJ Spotlight conference on health care in New Jersey – and NJTV was there to talk to him and others about the impact of the GOP’s plans.

“We’re concerned about block granting the entire Medicaid program,” Castro said. “We’re even more concerned that they want to accelerate the repeal of Medicaid expansion [which in] New Jersey would have such an impact – we have half a million people in our state. About 10 percent of all adults in New Jersey get their health care from the Medicaid expansion.”

The ‘American Health Care Act’ Would Cause Nearly Half a Million New Jerseyans to Lose Health Coverage

Posted on by Raymond Castro

To read a PDF version of this report, click here.

As House Republicans rush to “repeal and replace” the Affordable Care Act (ACA), it has become clearer how much their proposal would harm New Jersey. The non-partisan Congressional Budget Office analysis of the American Health Care Act projects a major increase in the number of uninsured Americans, deep cuts to Medicaid, higher insurance premiums and tax cuts for the wealthy and corporations.

The best way to understand the American Health Care Act is to see it as a vehicle to shift income from working and poor families to the wealthy and as part of the plan to shift federal spending from a broad range of domestic services to the military budget.

In fact, the proposed cuts in the Medicaid expansion and the marketplace alone would reduce or eliminate health coverage for millions, including half a million New Jerseyans in just the next three years. Meanwhile, 250 New Jersey millionaires would see their federal taxes reduced by an average of $57,000 a year – a $14 million break, all told – while thousands of low- and middle-income New Jerseyans would face 30 percent tax hikes as support for their health care premiums would shrink or disappear.

Republicans are doing more than replacing the ACA with this legislation: Their plan is to enact a radical agenda that will dramatically change how Medicaid is funded, with the eventual result of big cuts to medical assistance for seniors, people with disabilities, working parents and children. 

Nearly Half a Million New Jerseyans Would Lose Health Coverage

By 2020 under the American Health Care Act, about 476,000 fewer New Jerseyans would have health insurance than in 2015, due to the almost-certain end of the Medicaid expansion and other changes in the insurance marketplace, like a one-third reduction in premium tax credits for low-income New Jerseyans. (2015 has the latest and most reliable data for the uninsured, as supplied by the U.S. Census.) If anything, using that year underestimates the numbers of uninsured by 2020 since marketplace and Medicaid expansion enrollment increased in 2016 and 2017.

The result would be more New Jerseyans lacking insurance in 2020 than in 2013, before the ACA began insuring more residents – because there are 172,000 New Jerseyans who were on Medicaid before the ACA but would no longer be eligible since the state is in no financial condition to replace federal funding for Medicaid expansion with state dollars.

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Number of Uninsured Would Spike in All Congressional Districts

CD table uninsured-01All New Jersey Congressional districts would see major increases in the number of uninsured residents under the American Health Care Act. But the largest percentage increases would be in districts currently represented by Republican Congressmen (New Jersey has no Republican Congresswomen).

Taken together, the number of uninsured constituents by 2020 would increase by 74 percent in New Jersey’s five districts with Republican Representatives, a significantly higher jump than the increase of 58 percent in the state’s seven districts with Democratic Representatives.

The largest percentage increase in the number of uninsured would be in District 3, where their ranks would almost double (94 percent increase). In that district, 34,350 additional residents would become uninsured by 2020 on top of the 36,539 residents uninsured in 2015. The smallest increase was in District 8.

The main reasons for this difference are:

  • Democratic districts tend to have more residents who live below the federal poverty line who were already covered by Medicaid prior to the expansion
  • The marketplace includes more residents who work and have modest incomes who are disproportionately in Republican districts
  • Republican districts have lower uninsurance rates than in Democratic districts, so they see a bigger percentage increase when their residents are dropped from Medicaid and the marketplace 

New Jersey’s Successful Medicaid Expansion Would Be Jeopardized

The latest House Republican plan to replace the ACA includes drastic cuts in federal funding for the Medicaid expansion. This cut would likely result in many New Jerseyans losing their health coverage. If New Jersey’s economy and financial condition were stronger, the state could continue the expansion starting in 2020. However, if it were to maintain it at current eligibility levels, New Jersey would be on the hook for an additional $8.8 billion over the next decade. By 2027, New Jersey’s annual match would be five times higher ($2.1 billion instead of $461 million) than it would if the Affordable Care Act were continued. And these estimates are conservative since they assume no increase in enrollment over that time, such as would occur with the onset of another recession (inflated health care costs are factored in).

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Radical Restructuring of Medicaid Funding Would Harm New Jersey

New Jersey would also lose additional federal funding under the proposed Medicaid per capita cap. The bill would establish a dollar-amount cap on each person enrolled in Medicaid. The cap would be different for different types of enrollees (aged, disabled, children, and adults in the Medicaid expansion in 2016) and it would be adjusted annually by the federal index for health services prices (CPI-Medical).

The index’s increases will likely fall below what high-cost states like New Jersey need, helping to generate the federal savings needed to offset revenues lost by tax cuts to the wealthy and corporations. Most states will likely fall below the index in some years and above it in others. The Congressional Budget Office projects that the index for health costs will increase on average by 3.7 percent annually from 2017 to 2026, compared to a 4.4 percent increase for Medicaid costs – or a 19 percent higher rate. From 2000-2011, average per capita increases in New Jersey exceeded the CPI-M level for adults (7 percent) and children (5.1 percent). Using national averages almost always puts high-cost New Jersey at a disadvantage.

Since this is a national price index, it would not respond to state-specific health crises and patterns, like an infectious disease outbreak like Zika, a medical breakthrough or an opioid addiction crisis. In addition, while federal funding under a per capita cap would increase when additional residents were served – such as during a recession ­– the rate of federal reimbursement would be lower than a state would receive today. In other words, if more residents needed services during a recession it would still cost the state more ­- at the very same time when federal payments to states would be reduced.

Since states will not know their level of federal funding until the year before, long range planning will be very difficult, if not impossible. The federal government could also decrease the caps at any time. With federal Medicaid funding uncertain, states would likely spend less to stay within the caps, or cut services and/or reimbursement rates when the caps are exceeded. Because the caps are based on 2016 federal Medicaid expenditures, states would likely curtail Medicaid expenditures as soon as the bill is signed into law to avoid exceeding the caps in 2020 when they take effect. For example, if the state continues to expand services to opioid addicts, it runs the risk of increasing the average per capita cost for adults covered by the Medicaid expansion. Thus, by 2021 the state might easily exceed its cap with the state on the hook for all additional costs.

Currently there are more federal optional services (28) than required services (15). New Jersey has very comprehensive benefits and has opted for nearly all the services that are permitted. Some of these optional services that could be eliminated to reduce per capita costs include:

  • Prescription drugs
  • Home and community based services
  • Private duty nursing
  • Dental
  • Case management
  • Physical therapy
  • Hospice
  • Institutional services for the developmentally disabled and children

Reduced access to services

If a state decides to make up for steadily declining federal grants, it may focus its cuts on the most costly enrollment groups, thus putting New Jersey’s seniors and the disabled in the crosshairs since these two groups generate about three-quarters of all the state’s Medicaid spending. On the other hand, if the state decides to make the cuts based on the largest enrollment groups, children would be put at disproportionate risk, as they comprise over half of total enrollment.

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Instead of viewing Medicaid as an investment, the state would view it as threat to the budget and other priorities. Since total Medicaid funding would in effect become a shrinking pie, different groups in Medicaid would have to compete with each other for diminishing resources.

In addition to eliminating services, the state could also reduce reimbursement rates for services, some of which are already some of the lowest in the nation despite New Jersey’s health costs being among the nation’s highest (it should come as no surprise that just 38.7 percent of New Jersey doctors accept Medicaid patients, the lowest rate in the nation).

New Jersey would be penalized for its efficiencies in Medicaid

Proponents of capping federal Medicaid funding claim that states would have more flexibility to initiate efficiencies that would absorb any loss in federal funds. However, any additional flexibility in Medicaid in New Jersey would probably not help, because the state already implemented the most promising efficiencies under the flexibility of the current Medicaid program. Unfortunately, the federal dollars New Jersey has saved will be subtracted from the 2016 base year that will be used to calculate the state’s Medicaid funding in the future. In other words, the state would permanently lose those funds because it tried to make Medicaid more efficient and effective.

The following are some of the efficiencies that have been implemented—many with waivers approved by the federal government– which might not be available to New Jersey to absorb any future loss in federal dollars due to Medicaid caps:

  • New Jersey saved $2 billion in federal funding over five years under a comprehensive waiver that, among other things, placed the elderly in communities rather than nursing homes.
  • New Jersey is ranked sixth highest nationally in the percent of it Medicaid population in managed care (95 percent).
  • New Jersey operates three Accountable Care Organizations that focus on patient-centered quality and cost of care for Medicaid participants, one of the highest numbers in the country.
  • New Jersey is ranked 49th lowest nationally in fees to providers (mostly primary care physicians).
  • New Jersey is ranked ninth nationally in medical home participants.
  • New Jersey spends only about seven percent of its Medicaid dollars for administration, far lower than in the private insurance sector. 

Methodology

Increase in the uninsured

The estimated number of uninsured in New Jersey in 2013 and 2015 is from the American Community Survey. The 2020 estimate assumes that the state would not opt for the Medicaid expansion because of the high cost to the state and that, therefore, all of the 550,000 New Jerseyans currently enrolled in the expansion would lose their Medicaid.

The estimate that 172,000 of those New Jerseyans were participating in New Jersey Family Care prior to the Affordable Care Act is based on the New Jersey Department of Human Services’ response to the Office of Legislative Services for the 2017 budget. It is assumed that they would all become uninsured if made ineligible for Medicaid.

For the remaining individuals in the expansion it was estimated that 51 percent of them would not find alternative health coverage and therefore would become uninsured consistent with a 2015 RAND study (Trends in Health Insurance, 2013-2015) which estimated the number of individuals in the Medicaid expansion who did not have insurance prior to the Affordable Care Act.

To determine the number of the uninsured resulting from proposed changes in the insurance marketplace, New Jersey’s share of the national marketplace is applied to the Congressional Budget Office (CBO) national estimate for the number of individuals who will lose their coverage in the marketplace in 2019 and 2020. That number was reduced on the assumption that half of them would be able to find coverage elsewhere. The CBO national estimates of the number of uninsured from the marketplace decreases by 2027 which would also lower the number of the uninsured in New Jersey in that year. The projected increase in uninsured New Jerseyans is conservative because it does not take into account the likely decrease in employer-based coverage and other changes in the House Republican plan.

Congressional district impact

The share of adults enrolled in Medicaid in each district was calculated based on enrollment data for public insurance in the American Community Survey, which was applied to the number of persons statewide that would become uninsured as a result of the House Republican plan as described above. The share of adults in the marketplace in each district was calculated based on data provided by the Kaiser Family Foundation, Interactive Maps: Estimates of Enrollment in ACA Marketplaces and Medicaid Expansion, February 28, 2017 which was applied towards the statewide total of uninsured due to changes in the marketplace caused by the House Republican plan as explained above.

State cost for new Medicaid expansion

To determine the cost to New Jersey of maintaining Medicaid expansion should it elect to maintain coverage for those enrolled via Medicaid expansion, the total cost of the Medicaid expansion as estimated by the New Jersey Department Human Services for state fiscal year 2018 was increased by 4.4 percent annually as projected nationally through 2027 by the Congressional Budget Office cost estimates, American Health Care Act, March 13, 2017. Federal funds were calculated based on the 90 percent matching rate under current law. To determine federal funds under the House Republican plan, the federal funds were reduced to take into account the attrition rate for all individuals that were grandfathered in the expansion based on the attrition rate estimated by the Center and Budget and Policy Priorities. The remaining federal funds were calculated based on the 50 percent federal matching rate. The state matching rate under current law and the proposed House Republican plan were compared to calculate the additional state cost.

As written, the American Health Care Act appears to require that if New Jersey wants to continue receiving a higher federal match for individuals in the Medicaid expansion as of 2020, the state must also accept all newly eligible individuals at the lower match of 50 percent. Our cost estimates assume that scenario. However, if the state decides that it cannot afford the lower match it could also decide not to elect the Medicaid expansion in which case everyone would become ineligible in 2020 and the state would lose about $3 billion annually it currently receives in federal funds.

However, the current interpretation is that the intent of this legislation is to allow the state more flexibility in this option and allow it to 1) not accept any new enrollees and let the grandfathered cases remain in Medicaid at the 90 percent federal match until they leave; or 2) accept a narrower category of new enrollees. For example, New Jersey could make eligible the 172,000 parents and childless adults who were eligible for Medicaid prior the ACA. However even with this more liberal interpretation, it would cost the state hundreds of millions of dollars depending on how they define this new eligible category.

Blueprint for Economic Justice & Shared Prosperity

Posted on by NJPP Staff

From the President

For more than 20 years, New Jersey has been on a downward economic and financial slide. Our middle class is shrinking. Poverty is rising. The state government is effectively bankrupt. We’re dangerously close to hitting rock bottom.

The next governor is New Jersey’s last, best chance to slow the state’s collapse, restore its stable financial foundation and rebuild its enterprising, job-creating, wealth-producing economy.

How did we get here?

The Jersey Slide began with a familiar false premise: cut taxes, and the savings will stimulate economic activity and increase state revenues. Hence a 30 percent cut in income tax rates in 1994, which produced immediate declines in state support for property tax relief and set off a two-decade chain reaction of gimmicks to hide the damage.

Gimmicks like slashing the state’s payments for public employees’ pensions and retiree health benefits enough to make up for revenues sacrificed to the tax cuts. Like granting local governments a pension payment “holiday” to keep property taxes from spiking.

And, in a damning blow, borrowing almost $3 billion to cover the state’s share of pension costs for two or three years – sticking unknowing future taxpayers with the very large repayment bill.

Along the way, a bipartisan cast of governors, legislators and justices ignored the urgent warnings of financial experts, and violated state constitutional protections intended to safeguard against precisely these types of abuses. Because the constitution is clear: you can’t spend money in the annual budget that isn’t raised in the same year, and you can’t borrow money long term without voter approval.

Now the chickens are coming home to roost. The games and gimmicks must stop. It’s time for truth telling, and courageous action.

I understand the challenge. I’ve run for office five times and participated in numerous campaigns. Not once has someone come up and asked: “Gee, my taxes are pretty low, can you do something to raise them?”

But people’s concerns about the taxes they pay often mask concerns about how their taxes are spent:

• “Potholes cost me $800 for new tires.”
• “I thought public colleges were supposed to be affordable.”
• “The high school cut my kid’s band class.”
• “The district said it’s not safe for my kid to drink water from the tap.”

These complaints lay bare a fact that’s been too-long neglected by our political leadership: Residents want New Jersey’s enviable assets to be properly maintained. People understand that investments in the assets we all share are paid for by the taxes we all pay – taxes that should be levied in a fair and equitable way.

The idea that the state needs to protect and invest in its assets is what drove New Jersey’s thriving economy from the 1960s into the early ‘90s. Those were the years when the state invested strategically in public transportation; in public colleges and universities; in preserving open space; in protecting the environment; and beyond. The state’s robust opportunities and vibrant communities attracted striving immigrants from around the world, who in turn fostered further economic growth. The result: New Jersey transformed itself from a fading industrial state into an enterprising, prosperous and stable state with a robust middle class and a plentiful opportunity.

That was then. The picture is starkly different now. After ten credit downgrades in seven years, New Jersey ranks 49th among the 50 states for creditworthiness. Our once robust biotech and pharmaceutical industry is being lured to states that are accelerating – not slashing – public investments in innovation centers like university hubs. Inequality is at historic highs. In this high-cost state, which never bounced back from the Great Recession, New Jersey’s working families are finding it harder than ever to make ends meet and give their children opportunities to advance.

Here’s the good news: New Jersey still has enviable assets. And it’s not too late for new leadership to stop the state’s downward spiral. No candidate should promise that it’ll be easy or painless to restore New Jersey as an engine of enterprise and opportunity. Nor should anyone suggest that one term as governor or as a legislator will be sufficient.

But big ideas, carefully planned and plainly explained, are the starting point.

That is the work of New Jersey Policy Perspective, and specifically, this Blueprint.

– Gordon MacInnes, President

To read the Blueprint, click here.

Ray Castro Explains Damage of ACA Repeal

Posted on by NJPP Staff

Last night, NJTV News turned to NJPP’s latest report and our senior policy analyst Ray Castro to help explain to viewers the damage that repeal of the Affordable Care Act would inflict on New Jersey:

Over 1 million residents would lose benefits, according to the report. The state would lose over $4 billion a year in federal funds; 86,000 jobs would be lost and, most dramatically, the report says almost 800 would die as a result.

“This is what would happen if they repealed and did not replace it,” said Castro. “Unfortunately, we don’t know what they’re going to be replacing it with, but what we’ve heard so far is that it’s not really going to help. In fact, it could make matters worse. For example they’re talking about block granting Medicaid, so Medicaid served a lot of different people including children and seniors in nursing homes, so all of them would be vulnerable to further cutbacks in this replacement, so we’re very concerned about that.”

Repealing the Affordable Care Act Would Devastate New Jersey

Posted on by Raymond Castro

 

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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

Methodology

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).

Marketplace

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.

Don’t Take My Son’s Life-Saving Health Care Away

Posted on by Jon Whiten

This op-ed appeared in the February 5, 2017 edition of the Star-Ledger. 

As Congress inches toward repealing the Affordable Care Act with no apparent replacement, the health and lives of tens of millions of Americans hangs in the balance. My 4-year-old son is one of them, and I urge New Jersey’s four congressmen who recently voted to advance repeal to hear his story, to think about his future and to explain why they want to take away his affordable and life-saving coverage.

They are U.S. Reps. Frank LoBiondo (R-2nd Dist.), Chris Smith (R-4th Dist.), Leonard Lance (R-7th Dist.) and Rodney Frelinghuysen (R-11th Dist.).

In 2015, when he was just 2, my son Michael wasn’t doing well. He was lethargic, he was eating a ton but not gaining any weight and he was urinating excessively. Imagine our shock when we found out he had Type 1 diabetes, and was not just under the weather but nearly dead — his life saved only by the quick and decisive actions of our family pediatrician.

Before we get much further, let’s clear things up: Type 1 diabetes is not the same as Type 2 diabetes. Michael will have Type 1 diabetes forever, unless a cure is found. No amount of “diet and exercise” will make his chronic condition go away.

And no, Michael’s Type 1 diabetes wasn’t caused by him being overweight. It’s a genetic and autoimmune disease that about 40,000 children and adults are diagnosed with each year. In all, nearly 1.3 million Americans are living with Type 1 diabetes.

In other words, in the parlance of the Affordable Care Act, my 4-year-old son has a “pre-existing condition.” And he will forever.

This condition, I should note, is really expensive. Michael is kept alive by a vial of insulin, since his pancreas doesn’t produce a drop of the stuff. The insulin that flows into his little body through a mechanical pump has nearly tripled in cost in the past decade, according to the Journal of the American Medical Association.

Just last week, a class-action lawsuit was filed accusing three manufacturers of this life-sustaining drug of conspiring to drive up the costs of insulin.

Whether or not that’s true, the fact remains: This drug — and the laundry list of other drugs and supplies we have to keep to ensure our 4-year-old son stays alive — is not affordable without excellent health insurance. Luckily, we have been able to find affordable and comprehensive coverage for Michael on the ACA’s health insurance exchange.

In the past, insurers could discriminate against people like my son; their pre-existing conditions often led to higher premiums, or denial of coverage altogether. Thanks to the Affordable Care Act, that’s no longer legal.

As he gets older, and potentially faces a variety of serious medical complications from his diabetes, he’ll become a less and less “attractive customer” to health insurers whose primary concern is protecting their bottom lines. If the Affordable Care Act is no longer there to protect him from the vagaries of an industry with a long track record of putting profits before people, he will face enormous bills for health coverage. And that’s if he’s lucky enough to even be approved for coverage.

Make no mistake: Michael is not alone. In fact, over 52 million non-elderly Americans — including 1.2 million New Jerseyans — had declinable pre-existing conditions in 2015, according to the Kaiser Family Foundation.

Also unmistakable is the fact that, overall, Michael is very lucky. His parents (my wife and me) are middle-class professionals able to pay for his nonsubsidized insurance on the exchange. He’s not among the 14 million Americans — including more than half a million New Jerseyans, of whom about 100,000 are children — who have obtained coverage due to the ACA’s Medicaid expansion, people whose coverage will likely disappear after repeal takes effect.

And he’s not among the other 60 million low-income Americans (and 1.3 million New Jerseyans, of whom over 600,000 are children) on “pre-expansion” Medicaid (and NJ FamilyCare) who face grave threats to coverage, in the form of “block grants” that would lead to devastating cuts in service or eligibility as the federal government reduces spending on Medicaid by $1 trillion or so over 10 years.

As members of Congress move to repeal the Affordable Care Act, they need to be clear of the consequences. Repeal without an adequate and robust replacement will take affordable coverage away from my 4-year-old son and millions of others just like him. Putting their lives in jeopardy in order to score political points is not only a terrible way to make public policy, it’s immoral.

Our congressional leaders must stand up against this destruction.

GOP Governors are Standing Up for Obamacare

Posted on by Raymond Castro

This op-ed appeared in the Sunday, January 15, 2017 edition of the Star-Ledger.

With this week’s late-night Senate vote, lawmakers in D.C. have begun their attempt to repeal the Affordable Care Act and Medicaid expansion. As the prospects of repeal have become more realistic, some courageous Republican governors are pressing Congress to protect the health coverage of millions of their constituents.

Time’s running out, and Gov. Chris Christie should join them now to make the urgent case to Congress and President-elect Trump to protect the most certain piece of his legacy: expanding Medicaid for over half a million low-income New Jerseyans.

In the State of the State address, Christie emphasized the critical role that the Medicaid expansion played in the state’s efforts to treat New Jerseyans addicted to opioid drugs. Over three-quarters of the funding for the governor’s major behavioral-health and substance-use disorder initiative this year was from federal Medicaid dollars. It is that very guarantee of federal matching funds for an unforeseen health crisis that Republicans in Congress want to eliminate. Yet while the governor spent the bulk of his State of the State on what he sees as the urgent need to fight addiction, he has thus far remained silent about protecting his best vehicle to fund that fight. That needs to change.

As a Republican with close ties to the Republican Party and the President-elect, Christie is in an excellent position to advocate for 530,000 struggling New Jerseyans who are at risk of losing the only health insurance if the Medicaid expansion is repealed. At the very least, the governor should tell New Jersey’s Republican Congressmen that it would be the height of irresponsibility to repeal Obamacare without replacing it at the same time.

In addition to preserving health care for hundreds of thousands of New Jerseyans, Christie has a lot riding on this issue because his decision to opt for the Medicaid expansion could arguably be considered his most important legacy as governor. The benefits to New Jersey have been stunning and unprecedented. Over a half million low-income, mostly working, residents have obtained health coverage, the primary explanation for the historic one-third decrease in the state’s uninsurance rate.  His decision has generated over $3 billion annually in federal funds for health care, which has helped create thousands of good jobs; and it has saved the state about $700 million each year, helping to balance the state budget.

The governor – one of 16 Republican governors who expanded Medicaid – is aware of the benefits to New Jersey, and in the past has enthusiastically defended his decision. Now, with the threat to health care access rising to new heights, it is time for him to do so again. By doing so, he’d be joining some of his fellow Republican governors from around the country, like Doug Ducey from Arizona, Ohio’s John Kasich and Rick Snyder from Michigan, who have already pressed Congress to spare their programs from repeal.

Christie’s case would be especially compelling because losing the Medicaid expansion would cause much greater harm to New Jersey than most other states. New Jersey saw the ninth largest increase in Medicaid enrollment in the nation due to the expansion. Taking away health coverage from hundreds of thousands of New Jerseyans could create a health care crisis of historic proportions, while a loss of up to $3 billion loss in federal funds would also wreak havoc in the state’s health care industry and its fragile budget and economy.

These are arguments that New Jersey’s Republican Representatives should listen to – especially if they are made by a fellow home-state Republican. In addition, they know the tremendous harm that such a loss in health care would mean in their districts. In fact, 145,000 New Jerseyans who are now covered under the Medicaid expansion live in their districts.

Christie also should urge New Jersey’s Congressional delegation to not repeal the ACA without first replacing it with something better. This goes far beyond the Medicaid expansion and includes the fate of the health insurance market, consumer protections and even Medicare improvements. A recent poll found that three in four Americans either do not want the ACA repealed or repealed without a replacement at the same time.

But that is not what the Republicans in Congress are planning; they want to repeal now, and then figure out how best to replace later. Since Congressional Republicans haven’t been able to agree on a replacement for the last six years, even though they have voted to repeal the ACA over 60 times, a healthy dose of skepticism regarding their interest in, or capacity to, enact a replacement is warranted.

And the proposals they have discussed – like more tax breaks for the wealthy, high deductibles for bare- bone plans, and reducing essential insurance benefits – would all be bad news for struggling New Jerseyans only making matters worse. The most damaging idea is a Medicaid block grant, which would permanently cap funding at a sharply reduced level. Medicaid is the major health safety net for 1.8 million New Jerseyans. This plan would not only threaten the working poor in the Medicaid expansion, it could result in devastating cuts to health care for seniors, people with disabilities and children for generations to come.

In his final year in office, Christie has a chance to do what’s right and clearly beneficial for New Jersey. Will he seek to protect essential health care for struggling residents of his home state, or will he sit on the sidelines while his party destroys a lifeline for millions of Americans?

Lawmakers Act to Defend the ACA After NJPP Report

Posted on by Raymond Castro

New Jersey Policy Perspective is gaining traction in the fight to defend the Affordable Care Act – and the thousands of New Jersey residents who rely on it for health care coverage.

Last month, NJPP released a groundbreaking report that showed the devastating impact repealing the Medicaid expansion portion of the Affordable Care Act would have on New Jersey residents.

That report is getting results.

This week, the New Jersey legislature acted on one of NJPP’s key recommendations: It passed a resolution urging Congress and the President not to repeal the Affordable Care Act. The resolution, which was overwhelmingly passed in both houses, cites many of the key findings of NJPP’s report.

On Tuesday, U.S. Rep. Bill Pascrell cited NJPP’s findings in a letter to Gov. Christie, in which he urged the governor to make clear to Congressional leaders (who are soliciting feedback from governors nationwide) that repealing the health care law – and particularly the Medicaid expansion – “would have a disastrous impact on our state.” Using NJPP’s report, the Congressman’s letter makes a compelling case that protecting the Affordable Care Act and the Medicaid expansion is good for New Jersey’s low-income families, its state finances and economy, and its hospitals and health care providers. 

This report is the first of many steps that NJPP plans to take to oppose efforts by Congress and the Trump administration to return to the days when most New Jerseyans were either uninsured or underinsured. These steps will include a series of reports on the devastating consequences of repealing the ACA without an adequate replacement, public forums on the most pressing issues, and other actions.

To learn more about how you can support NJPP’s work on this front, please email Carly Rothman Siditsky at carly@njpp.org.

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