Topic Category: Health

Prohibiting Reporting Medical Debt to Credit Reporting Agencies Would Help Protect New Jersey’s Most Vulnerable Residents from Financial Ruin

Posted on by Brittany Holom-Trundy

Good morning Chairman Freiman and members of the Committee. Thank you for this opportunity to provide my testimony on A3861, the Louisa Carman Medical Debt Relief Act. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.

NJPP supports A3861, which would prohibit the reporting of medical debt to credit reporting agencies and ensure that patients are protected from financial ruin just from seeking medical care.

These actions are crucial for the well-being of the state’s families, especially those with lower incomes. Health care researchers have long recognized that poverty and the resulting inaccessibility of health care in and of itself can lead to a greater likelihood for medical emergencies and chronic illnesses because residents with low incomes or who lack insurance do not have access to needed resources and may avoid preventative medical care due to costs and time restrictions.[i] This means that those with the least means to pay for medical emergencies are also the most likely to face them — and with medical emergencies come extremely high bills, requiring money beyond what the individuals and families can afford. This worsens health inequities that we already see in the state; for example, we know that residents of color are twice as likely to have medical debt in collections.[ii]

Even for those with insurance coverage and up-to-date preventive medical care, unexpected medical emergencies happen and affordability remains a critical issue.[iii] People often have to go to the nearest emergency room, regardless of their coverage, and face bills of thousands of dollars simply because they were in an accident or woke up one morning with a failing organ.

It is important to note that this bill does not necessarily address the root issue of high costs in our health care system nor does it eliminate medical debt altogether. However, this will at least provide families with the knowledge that medical debt will not pervade their lives and create obstacles to other basic necessities. This bill is crucial to addressing calamities and the ways that our expensive health care system currently cripples families for life. In prohibiting the reporting of debt to credit reporting agencies and ensuring that patients are protected, we can bring more humanity to our health care system and promise residents that medical debt will not control their future.

We hope that the Committee will agree and release this bill with the adoption of the proposed amendments suggested by the groups here today.

Thank you for your time.

End Notes

[i] U.S. Census Bureau, Most Vulnerable More Likely to Depend on Emergency Rooms for Preventable Care, 2022. https://www.census.gov/library/stories/2022/01/who-makes-more-preventable-visits-to-emergency-rooms.html

[ii] Urban Institute, Debt in America. https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=34.

[iii] Commonwealth Fund, The Cost of Not Getting Care: Income Disparities in the Affordability of Health Services Across High-Income Countries, 2023. https://www.commonwealthfund.org/publications/surveys/2023/nov/cost-not-getting-care-income-disparities-affordability-health

Arbitrary Time Limits on Emergency Assistance Prevent New Jerseyans From Receiving Supports They Need

Posted on by Brittany Holom-Trundy

Good afternoon Chairman Sarlo and members of the Committee. Thank you for this opportunity to provide my testimony on the proposed extension of Emergency Assistance eligibility. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.

NJPP strongly supports the eligibility extension proposed in S3960, which continues an exemption from the 12-month lifetime limit of Emergency Assistance — which, notably, is only ⅕ of the lifetime limit for other Work First New Jersey assistance — for residents who are disproportionately harmed by economic and health crises. This includes WFNJ participants and Supplemental Security Income (SSI) beneficiaries who have disabilities, who are full-time caretakers of dependents with disabilities, who are over 60 years old, who chronically face barriers to employment.

When the original bill passed in 2018, OLS estimated that thousands of families each year would benefit from the relief that this exemption provides. This means that, without this exemption, thousands of New Jerseyans who are most in need and living in the most devastating conditions would face homelessness; only arbitrarily set time limits would prevent them from receiving help, despite regular reviews of their need for the assistance.

The 2018 law was estimated to cost $5 million per year to help these families remain in their homes as they navigate crises. As this exemption from arbitrary cutoffs is limited to particular groups and the average grant amount in Emergency Assistance overall (across all participants, not just those with this exemption) only makes up approximately one month’s worth of rent at a time, the cost remains a relatively small investment for the state — but one with important, life-changing results.

The state should never let itself slip backward in its support for families, and the law’s sunsetting demands urgent action. We have not met the goals laid out when this exemption was first introduced — we continue to see an affordable housing crisis and devastating homelessness — and therefore, it does not make sense to let this exemption sunset and punish the participants who rely on this assistance. We should not force people with disabilities, people with dependents who have disabilities, the elderly, and other families faced with crisis out of their homes and onto the street.

While the Work First New Jersey programs need significant reform to avoid these urgent legislative demands in the future, this bridge remains critical for maintaining progress for families until those larger changes are made.

We hope that the committee will advance the extension of these crucial services today. Thank you for your time.

Extending Emergency Assistance Would Help New Jersey Residents Avoid Hunger and Homelessness

Posted on by Brittany Holom-Trundy

Good afternoon Chairwoman Jimenez and members of the Committee. Thank you for this opportunity to provide my testimony on the proposed extension of Emergency Assistance eligibility. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.

NJPP strongly supports the eligibility extension proposed in A5549, which continues an exemption from the 12-month lifetime limit of Emergency Assistance — which, notably, is only ⅕ of the lifetime limit for other Work First New Jersey assistance — for residents who are disproportionately harmed by economic and health crises. This includes those who have disabilities, who are full-time caretakers of dependents with disabilities, who are over 60 years old, and who chronically face barriers to employment.

When the original bill passed in 2018, OLS estimated that thousands of families each year benefit from the relief that this exemption provides. As that was a pre-pandemic evaluation, it can be estimated that even more families need this help today. This means that, without this exemption, thousands of New Jerseyans who are most in need and living in the most devastating conditions would face homelessness and hunger; only arbitrarily set time limits would prevent them from receiving help. Because crises are unpredictable, these time limits back families disproportionately at risk into a corner whenever they face disaster: they end up either pressured to decide whether to use some of their very limited assistance time or they are cut off from aid simply for facing greater hardship than allowed.

The state should never let itself slip backward in its support for families, and the law’s sunsetting demands urgent action. While the Work First New Jersey programs need significant reform to avoid these urgent legislative demands in the future, this bridge remains critical for maintaining progress for families until those larger changes are made. We hope that the committee will advance the extension of these crucial services today. Thank you for your time.

Building on Existing Programs Will Help Support New Jersey’s Families

Posted on by Brittany Holom-Trundy

Good afternoon, Commissioner and DHS team. Thank you for this opportunity to provide testimony on the FY 2025 budget for the Department of Human Services. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.

The Department of Human Services provides crucial support for individuals and families in the face of rising costs and instability. The past year’s successes, including the expansion of All Kids health coverage, have served as essential bridges for families facing ever-changing economic, health, and political landscapes. Building on the strong foundations that these policies have provided will help to eliminate the continuing daily uncertainty that many working families, immigrants, and low-income residents still face.

In order to do this, here are four priorities for the Department to consider for next fiscal year.

1. All Kids Coverage: Building the Final Bridges
We have seen the success of All Kids in enrolling already-eligible and newly-eligible children with the expansion this past January. The Department’s support of this initiative has been key to its success thus far, and continued prioritization of full implementation remains the only path toward universal coverage.

NJPP urges DHS to continue its commitment to this effort by ensuring that the expansion remains fully funded in FY 2025 and that the final bridges for uninsured children who are not income-eligible for NJ FamilyCare (NJFC) are built. This means making sure that state funds continue to cover the approximately 35,000 newly eligible, enrolled children (approximately $105 million), as well as providing funding to open buy-in options at least for the estimated 2,000 children who are not income-eligible for NJFC and yet do not qualify for GetCovered NJ coverage due to immigration status.

2. Reforming Work First New Jersey (WFNJ) to Work for Families
Low-income residents consistently face daily economic insecurity, and yet the state’s main program helping to lift families out of deep poverty remains outdated and subject to the punitive stereotypes of 1990s welfare reform. NJPP encourages the Department to consider how to improve the WFNJ program and make it truly work for the state’s poorest families.

By investing at least $28 million, the Department can begin the process of gradually increasing the monthly grant amount to at least 50 percent of the Federal Poverty Level (FPL) over the next three years. With $95 million, this grant increase to 50 percent FPL could be achieved in the first year, setting participants on better supported paths for the future immediately. Maintaining current Emergency Assistance funding is also crucial. Finally, additional funds can help to improve off-ramps, reduce work hour requirements to better meet families’ realities, eliminate barriers for immigrants, and ensure that children and parents are lifted out of deep poverty.

3. Supporting Child Care as an Essential Building Block for Families’ Futures
NJPP urges the Department to continue or expand successful program changes from the past few years and to increase state support to fill any gaps left by the loss of federal funding. Child care providers need stability in subsidy payments, and a long-term solution to ensure pay-by-enrollment, rather than by attendance, is critical to the health of the system. Low staff salaries and insufficient data systems also require continued attention and creative solutions.

4. Welcoming New Jersey’s Newest Residents
New Jersey’s diverse immigrant communities deserve to be welcomed to the Garden State with the same enthusiasm and empathy for their families’ needs as do all New Jersey residents. To do this, the Department should ensure that funding is available to codify the Office of New Americans and to support the continuation of services like the Deportation Detention Defense Initiative, legal services for unaccompanied minors, and fee waivers and assistance for refugees and asylum seekers.

Thank you so much for your time and consideration.

The Best Medicine: How the Drug Affordability Council Can Advance Future Drug Pricing Reforms in New Jersey

Posted on by Brittany Holom-Trundy

Every New Jersey resident deserves access to affordable medicine. Yet, the burden of high and rising drug prices has put essential medications out of reach for many, harming their health, well-being, and financial stability. To combat this crisis, New Jersey lawmakers recently enacted a number of prescription drug reforms, including a law establishing the Drug Affordability Council.

Even with these new laws, however, more actions are needed to fully address the prescription affordability crisis in New Jersey. This analysis highlights the significant role of the Drug Affordability Council in advancing future drug pricing reforms, and includes four recommendations for the council so it can reach its full potential.

New Reforms Take Important Steps But Leave Many Behind

During the 2023 state budget negotiations, lawmakers advanced several significant initiatives to address prescription drug affordability. A package of bills signed by Governor Murphy include measures to increase transparency in the pharmaceutical market, better regulate pharmacy benefit managers (the middlemen of the pharmaceutical industry), and cap prices for a few essential drugs (insulin, EpiPens, and asthma inhalers) in certain insurance plans.[i] One of these bills, S1615, also established the Drug Affordability Council. Together, these reforms complement actions taken at the federal level in the Inflation Reduction Act, which took steps to improve drug affordability for Medicare enrollees.[ii]

Yet, like a rope bridge with weak and missing planks, the reforms still leave a significant amount of work to achieve affordable prescription drugs for all who need them. Many of these reforms only help residents enrolled in particular insurance plans: the federal Inflation Reduction Act, as mentioned, focuses on Medicare enrollees, while many of the state-level reforms focus on individuals insured through certain state-regulated plans or, at their broadest, help those with insurance coverage that includes extremely high copays for medicines. This leaves many people without meaningful assistance, including those who are enrolled in employer self-funded plans as well as those who are uninsured.

The Drug Affordability Council Can Help Advance Future Reforms

Addressing this affordability crisis for all residents requires addressing the root causes of high drug prices that harm everyone, regardless of insurance coverage. Fortunately, the new Drug Affordability Council holds enormous potential to address these root causes and transform the lives of countless patients who have struggled to access life-saving treatments. While the Council cannot unilaterally enact and implement new reforms, it can provide policy and regulatory recommendations to state lawmakers and administrative officials to stop pharmaceutical companies from inflating drug prices, thereby holding them accountable and curbing unjustifiable cost hikes that hinder patients’ access to life-saving treatments.

The Council will also have access to data collected through newly enacted transparency measures, as well as any information gathered through its own research and convenings. With this unprecedented level of data access, its members will be able to produce detailed recommendations for legislative and executive measures for effectively lowering pharmaceutical costs. These reports mark a crucial step in prioritizing the needs of patients over corporate interests.

Recommendations for the Drug Affordability Council

State leaders must set a strong foundation for the Council as it gets up and running to ensure it fulfills its potential in meaningfully addressing high prescription drug costs. This starts with thoughtful appointments to the Council, including those with a patient/consumer perspective, and by setting clear expectations on the need for transparency, community input, and bold recommendations based on best practices from other states. Below are four recommendations that the Murphy administration should consider over the coming months.

1. Appoint Members Who Represent the Interests of Patients, Not the Pharmaceutical Industry

Members of the Council will play a crucial role in setting the prescription drug reform agenda, informing data collection and analyses, and communicating recommendations to legislative and executive leadership. This requires a high level of knowledge of the pharmaceutical industry and relevant policy, as well as a critical eye for research. Ensuring that these roles are fulfilled not only by people with experience in the health care profession but also by those who can represent the patients’ perspectives is crucial for the Council’s work.

The Governor, Senate President, and Speaker of the Assembly should carefully review candidates’ expertise and backgrounds when considering their appointments, always remembering that this Council is meant to work for New Jersey residents. The law requires that the Council’s membership be established within 180 days of the bill’s enactment, providing a deadline of January 6, 2024 for the appointments.[iii]

2. Establish a User-Friendly Website to Communicate the Council’s Work

Transparency and accountability must be prioritized in the Council’s research, data collection, and reporting on its own activities. Drug affordability boards in other states have created websites that quickly and easily guide visitors to an explanation of their work, any reports issued, and ways that the public or other interested stakeholders can reach out to discuss priorities.[iv]

New Jersey’s Drug Affordability Council and the Department of Law and Public Safety, the department that will house the Council, should follow the lead of other states by establishing an easy-to-navigate site that can keep the public informed and involved.

3. Build Relationships With Communities Early in the Process

Once the Council’s membership is confirmed, those members should quickly establish a regular schedule of meetings with community organizations to gather input on their work. An in-depth understanding of the major issues facing consumers, and a willingness to incorporate those experiences into the Council’s work, will be essential to conducting successful research and making sound recommendations.

The law requires that the Drug Affordability Council hold open meetings and accept public comments, and that the first of these meetings be held within 30 days once its membership is confirmed.[v] While the public’s involvement in these meetings is a good step for transparency, truncated comments at busy meetings will not be enough to understand the complex landscape of affordability obstacles. Members should incorporate residents’ input even more effectively through regular conversations with community partners throughout the Council’s work.

4. Consider Major Policy Recommendations With Guidance From Other States

The Council will not have to start from scratch, as several other states are many steps ahead in their boards’ and councils’ work. While New Jersey’s Council will approach drug affordability through a Garden State-specific lens, that does not mean that complicated policies explored in detail in other states should be ignored. Instead, the Council should consider major reform recommendations made by other boards, including policies with fully developed frameworks, such as upper payment limits.[vi]

By working with already-existing policies and research from other states, the New Jersey Drug Affordability Council can move quickly to recommend significant reforms and finally help Garden State residents struggling with exorbitant prescription drug prices.

End Notes

[i] Office of Governor Phil Murphy, Governor Murphy Signs Legislative Package to Make Prescription Drugs More Affordable for New Jerseyans, 2023. https://www.nj.gov/governor/news/news/562023/20230710a.shtml

[ii] Kaiser Family Foundation, Explaining the Prescription Drug Provisions in the Inflation Reduction Act, 2023. https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/

[iii] P.L.2023, c.106, section 10b. https://pub.njleg.state.nj.us/Bills/2022/S2000/1615_R2.PDF

[iv] Example websites: Colorado Prescription Drug Affordability Board and Advisory Council (https://doi.colorado.gov/insurance-products/health-insurance/prescription-drug-affordability-review-board), Maryland Prescription Drug Affordability Board (https://pdab.maryland.gov/), Oregon Prescription Drug Affordability Board (https://dfr.oregon.gov/pdab/pages/index.aspx).

[v] P.L.2023, c.106, section 10d-g. https://pub.njleg.state.nj.us/Bills/2022/S2000/1615_R2.PDF

[vi] Three states have empowered their prescription drug affordability boards to set upper payment limits (Maryland, Colorado, and Minnesota). While New Jersey’s Council does not have the power to set upper payment limits itself, it can research potential limits and make recommendations based on that research. Helpful resources from Maryland and Colorado with background research on this policy include: Jane Horvath, Presentation for Maryland Prescription Drug Affordability Board, State Prescription Drug Upper Payment Limits Explained, 22 March 2021. Available at: https://pdab.maryland.gov/documents/presentations/Horvath_Health_Policy_Upper_Pymt_Limits_03222021.pdf or on file with author; State of Reform, Maryland’s Prescription Drug Affordability Board to soon publish draft plan for establishing upper payment limits, 2023, https://stateofreform.com/featured/2023/05/marylands-prescription-drug-affordability-board-to-soon-publish-draft-plan-for-establishing-upper-payment-limits/; Program on Regulation, Therapeutics, and Law (PORTAL), presentation to Maryland Prescription Drug Affordability Board, Cost Reviews & Upper Payment Limits, 22 May 2023. Available at: https://pdab.maryland.gov/documents/meetings/2023/havard_med_sch_prst.pdf and on file with author; Colorado Prescription Drug Affordability Board, materials on UPL Methodology. Available at: https://drive.google.com/drive/folders/159F04Zi8bWLkRgXrP_uEfsu-uSf4nSJv and on file with author.

What The Dobbs Decision Means for Abortion Rights in New Jersey and Beyond

Posted on by Brittany Holom-Trundy

On June 24, 2022 the U.S. Supreme Court overturned the constitutional right to abortion care, significantly scaling back access to reproductive health care across the country. This explainer breaks down the impact of that decision both nationally and here in New Jersey.[i]

 

What does the Dobbs decision mean for abortion rights in the United States?

The U.S. Supreme Court’s 6-3 decision in the case of Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion as recognized for nearly 50 years since the landmark cases of Roe v. Wade and Planned Parenthood v. Casey.[ii] With federal protection gone, the legality of abortion at all stages of pregnancy will now be decided by individual states, putting the futures and lives of millions of people and their families at risk.

The right to an abortion is essential to the health, safety, and well-being of individuals who are or can become pregnant. The radical decision by the conservative court turns a blind eye to the individual needs of people who are pregnant and the many reasons they may seek an abortion.

Who will be most impacted by this decision?

The Dobbs decision will most impact those who live in states that ban abortion and do not have the financial means or time to travel to states where abortion care remains legal. Those who seek abortion care disproportionately earn low wages and, due to the nation’s legacy of slavery and exclusionary policies, that means Black and brown residents face the greatest barriers to accessing reproductive health care. When those with low incomes receive the care they need, their future socioeconomic and health conditions improve.[iii] Yet, when they are denied care, the harm to their overall well-being and that of their children can last for decades.

What does this decision mean for New Jersey’s abortion laws?


Do New Jersey's laws go far enough to guarantee access to abortion care?

The short answer: No, not everyone can access abortion care in New Jersey because rights alone do not equal access to services. Barriers like cost or a lack of nearby providers can delay care and, in some cases, push it completely out of reach.[xi] Here is how these barriers play out in New Jersey.

Insurance Coverage and Affordability

Cost remains one of the biggest barriers for people seeking health care in New Jersey. Nearly 700,000 New Jersey residents do not have insurance coverage and must rely on non-profit funding sources or state-run programs to cover the cost of any care they need.[xii] This includes over 480,000 people of reproductive age (19-54 years old).[xiii] Nearly 100,000 of New Jersey’s uninsured residents identify as Black and over 325,000 identify as Hispanic/Latinx.[xiv] This disparity in insurance coverage means health care cost barriers disproportionately harm Black and Hispanic/Latinx communities and worsen already inequitable maternal health outcomes.[xv]

Even those who have insurance coverage may not be able to afford the procedure due to high out-of-pocket costs, such as copays. Health insurance plans can include high deductibles — the amount a person must pay out of pocket before services are covered — and high copays (flat rates for covered services) or coinsurance (a set percentage that a person pays for a covered service). Plans can also differ by employer or provider and can change year to year, creating confusion amongst residents about what their plan may cover.

Finally, the cost of an abortion depends on the pregnancy.[xvi] An abortion in the first trimester may cost a few hundred dollars or a few thousand dollars if the patient requires a hospital procedure due to pre-existing conditions. An abortion in the second trimester costs significantly more, as some procedures can cost more than $5,000.[xvii] This means that if someone is unable to access care early in their pregnancy due to cost barriers, geographic and time constraints, or because they didn’t know they were pregnant, they may face a higher bill than someone who learned about the pregnancy early and secured an appointment without delay.

Geographic Proximity

The location of available abortion providers can also impede access to care. Roughly one third of New Jersey counties — home to more than a quarter of all New Jersey women — do not have an abortion provider, meaning that more than one in four women do not have access to an abortion provider close to home.[xviii] And this is likely an undercount since available data does not represent an accurate count of people who can become pregnant, including transgender and nonbinary individuals.

At a time when the availability of maternal services in counties is in danger — exemplified by the recent closing of Cape May County’s only maternity ward — the limited availability of abortion providers puts many New Jersey residents and their families at an unfair disadvantage with lifelong consequences.[xix] Like other types of health care, and particularly care that can be urgent, the lack of nearby providers remains a key barrier to timely, quality care. 

Immigration Status

Abortion access, like other aspects of health care, is severely limited by restrictions on health insurance coverage due to immigration status. Rules that restrict which immigrants can access health insurance plans through health care marketplaces like GetCoveredNJ and state- and federally-run programs like Medicaid mean that many immigrant families do not qualify to enroll in coverage and struggle to find affordable insurance through private plans. Legal Permanent Residents are barred from enrolling in Medicaid for five years.[xx] Undocumented immigrants are barred from all programs except where the state has set up its own funding.[xxi] This lack of options forces individuals and families to pay for care with their own savings—which are often limited due to low-paying jobs. Without an expansion of affordable options, immigrant families will continue to be left behind.

How can state lawmakers improve abortion access in New Jersey?

Improving abortion access requires policies to ensure that everyone, regardless of immigration status, insurance status, gender, income, age, or location has access to reproductive health care when needed. Here are three top policy changes that would improve abortion access in New Jersey right now, many of which are included in a bill (S2918/A4350) introduced in June 2022 to improve equitable access to abortion care.[xxii]

Guarantee insurance coverage of abortion with no copays

New Jersey's Medicaid program, NJ FamilyCare, covers abortion without any out-of-pocket costs. But for private insurance plans, coverage of abortion care is not mandated.[xxiii] This means that access to this essential care not only relies on having insurance but on whether an employer or program has chosen to include abortion care in their health plan.

New Jersey can step up its role as a national leader in reproductive rights by mandating coverage in all state-regulated private plans and prohibiting cost-sharing for abortions. This is not a new concept: Seven states mandate coverage of abortion in all private insurance plans, including plans on their state health insurance marketplaces.[xxiv] As of January 1, 2023, all seven states outside of New Jersey that mandate abortion coverage (California, Illinois, Maine, Maryland, New York, Oregon, and Washington) will also all prohibit cost-sharing (deductibles, copays, or coinsurance), to make sure that, even when covered, the service remains affordable to the patient.[xxv] Following these states’ examples will help to ensure equitable access to coverage.

Secure funding for those who are uninsured or underinsured

The ability to access affordable reproductive care, including abortion, should not rely on a health care system that allows gaps persistent in coverage. Thousands of New Jerseyans, including undocumented immigrants and part-time workers who do not qualify for benefits, struggle to find quality, affordable coverage. And we know that without coverage, paying out of pocket is often untenable, putting health care, including time-sensitive abortion care, out of reach.

Mutual aid groups and non-profit entities, like the New Jersey Abortion Access Fund, can help, but these resouces can’t be expected to fill the access gaps alone. The state must take on a more defined role. Financial assistance for prenatal care and contraception is currently available for those who are uninsured, including undocumented immigrants, through the New Jersey Supplemental Prenatal and Contraceptive Program (NJSPCP).[xxvi] However, this program does not cover abortion care, nor is it codified in state law, leaving it vulnerable to cuts under a different administration in the future.

New Jesey can do three things to guarantee greater equity in abortion access: Expand services of NJSPCP to include abortion care, expand eligibility of NJSPCP to allow underinsured residents to access the program, and enshrine into statute the expanded program to codify these protections.

Expand services across the state so geographic proximity does not limit access to services

The state can do more to help support the availability of reproductive health services and providers across the state.[xxvii] The New Jersey Board of Medical Examiners rule change expanding which medical professionals can now perform abortion services will certainly help to grow the provider pool. However, the policy change must be codified into state law to protect this new class of providers from a future administration that could potentially be hostile to reproductive rights. The state should also commit to sustained support of family planning services (such as birth control, cancer screenings, and testing and treatment for sexually transmitted infections and HIV) and grants to help close remaining access gaps in counties without a single abortion care provider.

End Notes

[i] Many thanks to the teams at ACLU of New Jersey, Cherry Hill Women’s Center, and Planned Parenthood of Northern, Central and Southern New Jersey, Inc. for their helpful feedback in the preparation of this explainer!

[ii] Supreme Court of the United States, Jackson Women’s Health Organization, 2022, Docket No. 19-1392. Documents available at: https://www.supremecourt.gov/search.aspx?filename=/docket/docketfiles/html/public/19-1392.html

[iii] Guttmacher Institute, Induced Abortion in the United States, 2019. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states; Advancing New Standards in Reproductive Health (ANSIRH) at University of California - San Francisco, The Turnaway Study, 2020. https://www.ansirh.org/research/ongoing/turnaway-study

[iv] New Jersey Supreme Court, Right to Choose v. Byrne, 91 N.J. 287, 1982, Justia. https://law.justia.com/cases/new-jersey/supreme-court/1982/91-n-j-287-0.html

[v] UCLA Obstetrics and Gynecology, Medical versus Surgical Abortion, 2022. https://www.uclahealth.org/obgyn/medical-versus-surgical-abortion; New Jersey Monitor, Murphy signs law solidifying abortion rights in New Jersey, 2022. https://newjerseymonitor.com/2022/01/13/murphy-signs-law-solidifying-abortion-rights-in-new-jersey/;

[vi] Office of Governor Phil Murphy, New Jersey Expands Access to Reproductive Health Care, Adopts New Rules from Unanimous Vote by State Board of Medical Examiners, 2021. https://www.nj.gov/governor/news/news/562021/20211206a.shtml

[vii] New Jersey Monitor, State board expands access to abortion in N.J. through regulation changes, 2021. https://newjerseymonitor.com/briefs/state-board-expands-access-to-abortion-in-n-j-through-regulation-changes/

[viii] Office of Governor Phil Murphy, Governor Murphy Signs Legislation to Protect Reproductive Health Care Providers and Out-of-State Residents Seeking Reproductive Services in New Jersey, 2022. https://www.nj.gov/governor/news/news/562022/20220701a.shtml

[ix] New Jersey Office of the Attorney General, Acting AG Platkin Establishes Reproductive Rights Strike Force” to Protect Access to Abortion Care for New Jerseyans and Residents of Other States, 2022. https://www.njoag.gov/acting-ag-platkin-establishes-reproductive-rights-strike-force-to-protect-access-to-abortion-care-for-new-jerseyans-and-residents-of-other-states/

[x] New Jersey Policy Perspective, Affordable for Some: What’s Included and Missing in New Jersey’s FY 2023 Budget, 2022. https://www.njpp.org/publications/blog-category/affordable-for-some-whats-included-and-missing-in-new-jerseys-fy-2023-budget/

[xi] Guttmacher Institute, Induced Abortion in the United States, 2019. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states; Kaiser Family Foundation, Abortions Later in Pregnancy, 2019. https://www.kff.org/womens-health-policy/fact-sheet/abortions-later-in-pregnancy/

[xii] NJPP Analysis of American Community Survey Data, 2020 5-Year Estimates. https://data.census.gov/cedsci/table?q=health%20insurance&g=0400000US34&tid=ACSST5Y2020.S2701

[xiii] Generally, medical definitions of reproductive age range from 12 or 15 years old to 49 or 51 years old for women. Because the Census does not provide further breakdown, the above estimate provided the closest groupings available.

[xiv] NJPP Analysis of American Community Survey Data, 2020 5-Year Estimates. https://data.census.gov/cedsci/table?q=health%20insurance&g=0400000US34&tid=ACSST5Y2020.S2701

[xv] NJ Spotlight News, Access to abortion is an uphill battle for some in New Jersey, 2022. https://www.njspotlightnews.org/2022/07/nj-abortion-access-obstacles-state-law-supreme-court-roe-overturned/; NJ Spotlight News, Advocates fear Roe v. Wade ruling will impact Black women most, 2022. https://www.njspotlightnews.org/2022/06/us-supreme-court-roe-v-wade-nj-fear-racial-inequities-black-women-people-of-color/

[xvi] Health Affairs, Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017–20, 2022. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01528

[xvii] Range of costs determined through discussions with abortion providers in New Jersey.

[xviii] Guttmacher Institute, Abortion Incidence and Service Availability in the United States, 2017, 2019. https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017

[xix] The Press of Atlantic City, Come September, maternity services will no longer be offered at Cape Regional Medical Center, 2022. https://pressofatlanticcity.com/news/local/come-september-maternity-services-will-no-longer-be-offered-at-cape-regional-medical-center/article_9abcc3f8-09f8-11ed-8493-57a5151d95a7.html; Additionally, across the country, there have been concerns about the impact of the growth and consolidation of Catholic health care systems which may limit access to care: https://apnews.com/article/abortion-health-religion-new-york-oregon-8994d9b5fd0040d40d19fd1e44c313d8

[xx] New Jersey Department of Human Services, NJ FamilyCare - Immigrant Information, 2022. http://www.njfamilycare.org/imm_info.aspx

[xxi] One example of a state-funded program in New Jersey is the Cover All Kids program, which will open up NJ FamilyCare to all kids under the age of 19, regardless of immigration status, starting in January 2023.

[xxii] New Jersey Legislature, S2918/A4350: Strengthens access to reproductive health care; appropriates $20 million, 2022. https://www.njleg.state.nj.us/bill-search/2022/S2918; Thrive New Jersey, Abortion Access, 2022.  https://www.thrive-nj.com/rfa

[xxiii] Rutgers Today, What Does Overturning Roe v. Wade Mean for New Jersey?, 2022. https://www.rutgers.edu/news/how-far-does-new-freedom-reproductive-choice-act-go-keep-abortion-legal-new-jersey

[xxiv] Guttmacher Institute, Regulating Insurance Coverage of Abortion, 2022. https://www.guttmacher.org/state-policy/explore/regulating-insurance-coverage-abortion

[xxv] Guttmacher Institute, Regulating Insurance Coverage of Abortion, 2022. https://www.guttmacher.org/state-policy/explore/regulating-insurance-coverage-abortion; Office of Governor Gavin Newsom, Governor Newsom Signs Legislation to Eliminate Out-of-Pocket Costs for Abortion Services, 2022. https://www.gov.ca.gov/2022/03/22/governor-newsom-signs-legislation-to-eliminate-out-of-pocket-costs-for-abortion-services/; New York, Protecting & Strengthening Abortion Rights, 2022. https://www.ny.gov/abortion-new-york-state-know-your-rights/protecting-strengthening-abortion-rights

[xxvi] New Jersey Abortion Access Fund, About Us, 2022. http://njaaf.weebly.com/; New Jersey Department of Human Services - NJ FamilyCare, New Jersey Supplemental Prenatal and Contraceptive Program (NJSPCP), 2022. http://www.njfamilycare.org/njspcp.aspx

[xxvii] Recent reporting has discussed the need for OB/GYNs in New Jersey, particularly in certain areas. See: NJ.com, A Shortage of OB-GYNs Looms. Why are They Fleeing N.J.?, 2022. https://www.nj.com/healthfit/2022/11/why-are-ob-gyns-fleeing-nj-a-shortage-looms-on-the-near-horizon.html. It’s important to note that, as a state, New Jersey has a higher number of OB/GYNs than many other states (see Bureau of Labor Statistics, Occupational Employment and Wages, 29-1218 Obstetricians and Gynecologists, 2021. https://www.bls.gov/oes/current/oes291218.htm). Yet, finding ways to improve access to care should always be prioritized. OB/GYNs are one type of reproductive health care provider who can play a key role in access to abortion. As noted above, the Board of Medical Examiners rule change expands the types of providers able to provide their full scope of care, including abortion. This rule change helps to address one path to access. Ensuring all types of providers and their services are available across the state will be important for building more equitable access to care.

People Pay, Hospitals Profit: Rising Prices Drive High Health Care Costs

Posted on by Brittany Holom-Trundy

Editor’s note: This report was updated on March 15, 2023 to include new hospital data from RAND and clarify that the cost of hospitals overcharging was $1.2 billion from 2016 to 2018. 

Everyone in New Jersey deserves access to affordable health care, yet rising health care prices put high-quality coverage out of reach for far too many. The cost of medical care has outpaced both income growth and inflation for decades, driven in part by increasing hospital prices.[1] When hospitals charge beyond what’s needed to cover their daily operating costs, working families pay more for the same level of care. Recent spikes in premiums for New Jersey state employees highlight how rising health care costs are also passed on to public employees and state and local governments, stretching their budgets thin and costing the state more than $1.2 billion between 2016 and 2018.[2] By reining in high hospital prices, state lawmakers can make health care more affordable for patients, public employees, and state and local governments alike.

Excessive Prices Cost State and Local Governments Billions

Escalating prices for health insurance coverage are often attributed to increased utilization, costs to cover services, and inflation; however, these changes do not fully account for the significant climbs. This leaves rising prices and profits as not-so-hidden factors that could be costing state and local governments hundreds of millions of dollars each year.[3]

In New Jersey, increases in spending have outpaced utilization increases for years.[4] The state health benefits programs for public employees — the State Health Benefits Program (SHBP) and the School Employees’ Health Benefit Program (SEHBP) — are estimated to cover nearly 54,000 fewer people in Fiscal Year 2023 than in Fiscal Year 2015.[5] At the same time, medical benefit costs have increased by approximately $417 million (2022 Dollars).[6] Because of rising health care costs, the state must dedicate more funds toward this coverage each year despite having fewer people covered.

Hospital prices make up a significant portion of rising insurance costs, as the more that hospitals charge, the higher the price of coverage. There is little standardization of hospital prices paid by insurance plans, which are privately negotiated between insurance companies and hospitals.[7] As a result, the “Allowed Amount,” as these prices are known on insurance claims, often exceeds what experts estimate is needed for efficient, quality care.[8] In New Jersey, hospital prices far outpace Medicare rates, which the Centers for Medicare and Medicaid Services sets at amounts that “reasonably efficient providers would incur in furnishing high-quality care.”[9] They also outpace the higher commercial breakeven rate, an estimated “rate a hospital needs to receive from commercial payers to cover all of its expenses for hospital inpatient and outpatient services, without profit.”[10] This includes coverage for uncompensated care, bad debt, and expenses that Medicaid and Medicare do not cover. In New Jersey, the breakeven rate for hospitals is estimated to be approximately 150 percent of Medicare rates.

Claims data shows just how significantly the Allowed Amount for hospital prices in the state health benefits plans outweigh the costs for those same services and procedures at Medicare and commercial breakeven rates. From 2016 to 2018, state health benefits programs paid, on average, prices equal to 230 percent of Medicare rates for inpatient and outpatient care, and 1.5 times the commercial breakeven rate.[11]

With prices like these, programs like the SHBP and the SEHBP could be paying at least $400 million more per year than what we would expect to cover medical costs if prices were set to cover costs at the commercial breakeven level.

State Lawmakers Need to Rein in Rising Health Care Costs

With the potential loss of at least $400 million every year, New Jersey policymakers should look to better regulate and reduce high hospital prices. Cracking down on rising prices would provide savings to public employees and state and local governments alike, protecting the health care of the public workforce, reducing health care costs, and freeing up funds for other public investments.

While the state’s Office of Health Care Affordability and Transparency has spearheaded a new benchmark program to rein in the growth of health care costs with data-driven analysis, state lawmakers should explore other ways to contain costs driven by hospital pricing, such as price caps and reference-based pricing.[12] To put New Jersey on a path toward a more equitable future, the state cannot simply stick to one-time fixes as bandaids and continue to raise the cost of premiums on public employees and state and local governments. Instead, leaders must do more to rein in hospital costs to control premium costs.

End Notes

[1] New Jersey Office of Health Care Affordability and Transparency, New Jersey Health Care Affordability, Responsibility, and Transparency (HART) Program Blueprint, 2022, pg. 6. http://www.cshp.rutgers.edu/Downloads/Benchmark_Blueprint_March_31_2022.pdf

[2] New Jersey Monitor, Double-digit hike in insurance premiums approved for government workers, 2022. https://newjerseymonitor.com/2022/09/14/double-digit-hike-in-insurance-premiums-approved-for-government-workers/

[3] Health Affairs, It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt, 2019. https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144

[4] Health Care Cost Institute, 2018 Health Care Cost and Utilization Report: State Spending Trends, 2019. https://healthcostinstitute.org/interactive/2018-health-care-cost-and-utilization-report

[5] NJPP Analysis of FY 2017 – FY 2023 Budget Detail. New Jersey Office of Management and Budget, Budget Detail FY 2017 – FY 2023. https://www.nj.gov/treasury/omb/

[6] Ibid.

[7] For a study of the variability of prices charged by hospitals, see RAND Corporation, Prices Paid to Hospitals by Private Health Plans, 2022. https://www.rand.org/pubs/research_reports/RRA1144-1.html

[8] HealthCare.Gov, Allowed Amount, 2022. https://www.healthcare.gov/glossary/allowed-amount/

[9] RAND Corporation, Nationwide Evaluation of Health Care Prices Paid by Private Health Plans, 2020. https://www.rand.org/pubs/research_reports/RR4394.html; Centers for Medicare and Medicaid Services, Medicare Inpatient Prospective Payment System (IPPS) & New Technology Add-on Payment Provision, 2020, pg. 2. https://www.hhs.gov/sites/default/files/1.3-treitel-cms-508.pdf; Medicare Payment Advisory Commission, March 2022 Report to the Congress: Medicare Payment Policy, 2022. https://www.medpac.gov/wp-content/uploads/2022/03/Mar22_MedPAC_ReportToCongress_v3_SEC.pdf

[10] The commercial breakeven rate is calculated from annual hospital filings with the Centers for Medicare and Medicaid Services, and takes into account a variety of factors, including patient hospital costs, shortfalls or profit from public coverage programs, administrative costs, revenue from all sources, and much more. The details on how this is calculated can be found at: National Academy for State Health Policy, Understanding NASHP’s Hospital Cost Tool: Commercial Breakeven, 2022. https://www.nashp.org/policy/health-system-costs/understanding-hospital-costs/commercial-breakeven/

[11] RAND Corporation, Nationwide Evaluation of Health Care Prices Paid by Private Health Plans, 2020. https://www.rand.org/pubs/research_reports/RR4394.html; National Academy for State Health Policy, Hospital Cost Tool, 2022. https://d3g6lgu1zfs2l4.cloudfront.net/

[12] New Jersey Office of Health Care Affordability and Transparency, Home Page, 2022. https://nj.gov/governor/admin/affordablehealthcare/index.shtml; New Jersey Office of Health Care Affordability and Transparency, New Jersey Health Care Affordability, Responsibility, and Transparency (HART) Program Blueprint, 2022. https://nj.gov/governor/news/news/562022/docs/20220331a_Benchmark-Blueprint.pdf; National Academy for State Health Policy, Disrupting Hospital Price Increases: Using Growth Caps in Insurance Rate Review, 2021. https://www.nashp.org/disrupting-hospital-price-increases-using-growth-caps-in-insurance-rate-review/; National Academy for State Health Policy, Overview of States’ Hospital Reference-Based Pricing to Medicare Initiatives, 2021. https://www.nashp.org/overview-of-states-hospital-reference-based-pricing-to-medicare-initiatives/

Lessons Learned from New Census Data on Health Insurance

Posted on by Brittany Holom-Trundy

The Census Bureau released new data this month that gave us more insight on the health and wellbeing of our residents. Below, Senior Policy Analyst Brittany Holom-Trundy, Ph.D. breaks down the new data and what it means for New Jersey.

NJPP Senior Policy Analyst Brittany Holom-Trundy, Ph.D. (@bholom):

 

 

The New “Easy Enrollment” Program will Lower Barriers to Affordable Health Care

Posted on by Brittany Holom-Trundy

New Jersey took an important step towards improving access to health care when Governor Murphy signed legislation (A674/S1646) creating the Easy Enrollment program last month. This new program takes tax filing forms and unemployment claim applications and turns them into opportunities for uninsured residents to enroll in affordable health care coverage — all by checking a box.

With the Easy Enrollment program set to start at the end of 2022, uninsured residents who are filing taxes or an application for unemployment benefits can expect to:

  • Check a box on their tax form or unemployment benefits application indicating they would like information about how to enroll in affordable coverage.
  • Receive information from the Department of Human Services or Department of Banking and Insurance on their eligibility for NJ FamilyCare or GetCoveredNJ coverage.
  • Enroll in a coverage plan within the special enrollment period.
  • Avoid future fees for not having insurance by remaining enrolled for the rest of the calendar year.

 

Streamlining Enrollment Helps Those Facing Daily Barriers

Streamlining the enrollment process will make it much easier for uninsured residents to sign up for comprehensive health coverage, especially those who face information and time barriers to enrolling. Many of the nearly 700,000 residents who remain uninsured face language barriers or technical barriers in the enrollment process. Others have difficulty finding the time to enroll or gathering information about which plans are best for them, as they may work long or unpredictable hours, have long commutes, or have an unpredictable income and are unsure which coverage they can afford. Additionally, residents may be facing an abrupt end to existing coverage. In the case of young adults, they may be newly uninsured after being on their parents’ plan; for others who have been employed, they may face sudden loss of existing coverage after losing their job.

Maryland’s Easy Enrollment program, which began in 2020 and inspired many aspects of New Jersey’s program, has already succeeded in lowering these types of barriers for uninsured residents. The success of Maryland’s Easy Enrollment program is a good sign that the new program in New Jersey will result in more residents gaining health coverage, especially those who are often young, have low and perhaps seasonal income, and who may speak English as a second language or face other application barriers.

Simply Check the Box: Getting Info About Enrollment Will Be Easier Than Ever

Like Maryland’s program, New Jersey’s Easy Enrollment is designed to be as simple as possible: By adding a checkbox on tax forms and unemployment benefit applications, the state will provide residents with opportunities to enroll in affordable insurance they qualify for.

Each resident who checks this box will have their eligibility for different coverage options and subsidies confirmed based on their tax filing or unemployment application. Those participating in the program will then receive information about which coverage applies to them — whether it’s NJ FamilyCare (Medicaid and CHIP) coverage or coverage through GetCoveredNJ (the state health insurance marketplace) — and a special enrollment period of at least 30 days will begin. During that period, the resident can enroll in the coverage they choose and, in the case of marketplace plans, receive subsidies to lower the cost.

Additionally, if a resident enrolls in coverage through this program and remains enrolled for the rest of that calendar year, they will no longer have to pay the Shared Responsibility Payment, a fee paid by those who do not have health insurance coverage, as required by New Jersey’s individual mandate law.

Once the Easy Enrollment program is in full effect, enrolling in health coverage will be easier than ever for uninsured residents in New Jersey.

Roe v. Wade Decision Will Deny Millions of People the Freedom to Control Their Own Bodies

Posted on by Nicole Rodriguez

The Supreme Court has voted to strike down Roe v. Wade, ending the constitutional right to abortion and allowing states to ban access to this time-sensitive care. In response to the decision, New Jersey Policy Perspective (NJPP) releases the following statement calling on lawmakers to set an example for other states to follow by removing barriers to abortion care.

Nicole Rodriguez, President, NJPP:

“Striking down Roe v. Wade will deny millions of people the freedom to control their own bodies and lives. At its core, abortion care is a health service that has profound consequences for both the health and economic stability of pregnant people and their families. When such a personal and monumental decision is taken away, it disproportionately harms those who have already been pushed behind by decades of exclusionary, racist, and discriminatory policies. Given our nation’s legacy of racism, abortion rights are not only a matter of reproductive health but of economic and racial justice.

“New Jersey may have secured the right to abortion care, but decades of indifference to breaking down barriers to access means that abortion care remains out of reach for young adults, people in low-paying jobs, Black and brown families, and immigrants without a path to health insurance. State legislators have an opportunity to meet the moment and take immediate action to make abortion care accessible for all, yet deeply entrenched stigma and misinformation are holding them back. With a radicalized Supreme Court that has no problem taking away our rights, New Jersey lawmakers need to step up to protect their constituents and set an example for other states to follow.”

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