Topic Category: Health

Defending Reproductive Rights in New Jersey by Improving Access to Health Care for All

Posted on by Jazmyne McNeese

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

Access to safe, accessible, and medically competent reproductive health care in the United States is under concentrated and powerful attack. A more radical Supreme Court now puts in jeopardy key reproductive health services like Title X federal funding for family planning and the constitutional right to abortion. The current political climate provides progressive-leaning states like New Jersey an urgently important opportunity to develop and enact forward-thinking reproductive health care policy.

This report highlights some of those opportunities by examining a wide cross section of gaps and disparities in New Jersey’s reproductive health care landscape. The selected issues include:

  • Expanding access to contraception and abortion
  • Addressing maternal and infant mortality disparities
  • Providing dignity for people who are incarcerated
  • Expanding health care for undocumented immigrants

This sampling was chosen due to its urgency, invisibility, and vulnerability to political attacks. By highlighting a cross-section of issues, the report aims to foster renewed interest among policymakers and advocacy organizations in pursuing state-level policy that guarantees every individual—regardless of circumstances or identity—equal access to reproductive health care services.

The reproductive health care gaps identified in this report are based on a series of one-on-one interviews conducted with community leaders and advocates from several organizations representing communities that chronically face barriers to reproductive health care (see the list at end of the report). Those facing these challenges due to their circumstance, income, or identity include, but are not limited to, women of color, people who are undocumented, LGBTQI communities, incarcerated people, people with disabilities, indigenous high-poverty communities, young people, and residents of rural areas. As experts of their own lives, community members and leaders from these groups are best equipped to inform policy changes that can improve those lives.

By focusing on those who have been historically underserved, this report follows the example of the groundbreaking work of Reproductive Justice, the movement created by women of color as an alternative to the mainstream reproductive rights framework. To be clear, this report was developed by individuals who are not associated with Reproductive Justice organizations. Rather, the intention is to inspire New Jersey stakeholders to invest in the principles developed by leaders of the Reproductive Justice movement and champion legislation that embodies the Reproductive Justice framework. For more information about the history of the Reproductive Justice movement and framework, see Appendix I.

Reproductive Health Care Policy in the Garden State

New Jersey has a strong record for advancing reproductive health care policy, but programs that serve low-income people, especially women of color, have chronically been vulnerable to funding cuts.[1] For example, $7.5 million in annual state grants for family planning services, prevention and treatment of sexually transmitted infections, and cancer screenings for low-income residents were cut from the state budget for eight consecutive years.[2] Those cuts forced six of the 58 family planning clinics in the Garden State to close. Of the 136,000 mostly low-income patients served by New Jersey’s family planning clinics each year, many were left to find care elsewhere or skip care altogether.[3]

With a new governor in office, New Jersey has taken steps to correct course. Through advocacy efforts led by Planned Parenthood Action Fund of New Jersey, that funding has finally been restored. In addition, more people now have access to reproductive health services through the state’s Medicaid program which covers comprehensive contraceptives, abortion care, and prenatal care. More recently a pilot home visitation program providing parenting support to at-risk families has been established and $4.3 million in grants has been committed to address New Jersey’s dismal black infant mortality and maternal health rates.[4][5]

Still, there are many outstanding issues that demand policymakers’ attention. These issues persist because the advancement of reproductive health policy in the Garden State has failed to actively dismantle the ongoing, systemic oppression of women of color and other historically marginalized groups. When marginalized communities are absent at the forefront of a movement, chronic health care gaps and disparities can persist and worsen, harming the very communities most vulnerable to institutional injustice. Though presumably unintentional, the effect is ubiquitous. To improve reproductive health care access for everyone in New Jersey, policymakers must work to eliminate unnecessary barriers and focus resources on communities that historically have been the most disadvantaged. See Appendix II for examples of recent and pending legislation that represent the kind of forward-thinking policy agenda being advocated for in this report.

Improving Access to Contraception and Abortion

 The scope of reproductive health care is not limited to contraception and abortion care, but these specific services have long been targeted for political reasons. Given the intensified political climate on the national level around reproductive health care access, it is vital that New Jersey defend these services from ideological attacks by expanding access through multiple avenues. In the following discussion of contraception and abortion, when we refer to people who can become pregnant, we emphasize the inclusion of women, transgender men, and gender non-conforming people.

Contraception

 A person’s ability to plan, prevent, and space pregnancy is directly linked to their ability to access contraception. New Jersey has a responsibility to ensure that all people who can become pregnant, regardless of their circumstance, have control over their reproductive health decisions—and by extension their economic status—by removing unnecessary or outdated barriers to contraceptive services. New Jersey could begin by removing payment and logistical barriers that most impact communities vulnerable to patterns of institutional bias and discrimination.[6] Improving the lives and well-being of all families through better access to family planning services helps New Jersey conserve health care resources by reducing the number of unintended pregnancies, which cost the state over $185 million in 2010 alone.[7]

One immediate opportunity to remove harmful barriers is to require health insurance companies to provide a 12-month supply of birth control instead of 6 months—a measure that has been shown to cut down on both costly doctors’ visits and unintended pregnancies. According to a University of California, San Francisco study, dispensing a one-year supply of birth control at a time is associated with a 30 percent reduction in the likelihood of unplanned pregnancy.[8] Twelve states have mandated that health insurers cover an “extended supply” of birth control; several other states have pending legislation.[9]

 Should federal efforts to defund Title X be successful, New Jersey must step in and ensure that low-income communities continue to receive family planning care in a seamless manner. The state Medicaid program should also address several lingering logistical barriers. For example, offering long-acting reversible contraceptives, like IUDs, to patients immediately after giving birth, would dramatically expand contraceptive options for low-income parents. But billing logistics have stymied widespread implementation. Just before the release of this report, a first step toward improving this important access gap has been addressed. Another technical fix to make the process seamless for both the health care provider and the patient is under review.[10] New Jersey should also allow Medicaid recipients access to emergency contraception (EC) without the unnecessary extra step of having to obtain a prescription first—a logistical barrier left over from the George W. Bush era.[11] Requiring all retail pharmacies in the state to stock and dispense EC would greatly improve people’s ability to obtain this time-sensitive medication as well as improve another avenue toward reducing the rate of unintended pregnancy.

Abortion Care 

New Jersey has upheld the right to abortion care since the procedure was legalized under Roe v. Wade. Just as importantly, the state has largely remained outside the national trend of state-level abortion restrictions like waiting periods and gestational limits. Across the country, over 1,000 anti-abortion laws have been enacted with a notable increase in the last several years.[12] In fact, the state Constitution has been interpreted to provide more expansive protections for the right to privacy and the right to end a pregnancy than the federal Constitution does, even with the protections of Roe v. Wade.[13] Yet, barriers to abortion care remain in the Garden State, primarily due to inadequate insurance coverage and efforts by anti-abortion organizations to diminish access through harassment, intimidation, and deception. For uninsured or under-insured individuals who wish to end a pregnancy, the cost of care can be out of reach. According to a 2014 Guttmacher Institute national survey, 75 percent of abortion patients are low income and a majority paid for their abortion care out of pocket, even though most had health insurance coverage. Due to the large number of patients paying out of pocket for services, abortion providers have strived to maintain affordable cash fees. Still, the financial expense of accessing abortion care extends beyond the medical cost with a substantial number of patients reporting additional expenses such as transportation, childcare, and lost wages.[14] When faced with these unexpected expenses, some patients may be forced to delay paying bills, borrow money, or seek assistance from a privately-run abortion fund like the New Jersey Abortion Access Fund—options that can create unnecessary delays.

Before Roe v. Wadelegalized abortion nationwide, the class divide in access to the procedure was clear cut. Those in need of abortion care but without financial resources had no access to safe medical services. Those with means travelled to states like New York where the procedure was legalized in 1970. In the first two years, 60 percent of abortion patients were from outside the state.[15] AfterRoe, the Hyde Amendment was swiftly enacted, blocking all federal funds from paying for abortion information, referrals, or care. Recognizing this clear violation of state control over reproduction and decision-making, New Jersey opted in to use state funds to support Medicaid access to abortion services thereby mitigating the impact of the Hyde Amendment. New Jersey remains one of only twelve states to do so.

Despite this decades-long commitment, many abortion providers in New Jersey struggle to cover costs due to low reimbursement rates from both Medicaid and the private insurance sector. Even when private insurers have appropriately negotiated reimbursement rates, many people are still unable to utilize their policies to access abortion care. For example, some private policies do not cover abortion services for policy holders or dependents, or policies may have increasingly high deductibles, which forces many patients to pay for services out-of-pocket.[16] The overall effect of underfunding leaves health centers trying to provide high-quality care to everyone regardless of ability to pay while keeping the doors open in a safe environment for patients and staff. Independent abortion providers, committed to maintaining meaningful access to abortion care throughout pregnancy while enduring the bulk of harassment by anti-abortion extremists, feel this financial strain most acutely. As reproductive rights continue to erode across the county, now is the time for New Jersey to invest in expanding and preserving abortion access.

 Increasing Medicaid Reimbursement Rates for Abortion Providers: A Case Study

 Cherry Hill Women’s Center (CHWC), a premier independent abortion provider in Camden County, New Jersey, is a prime example of this struggle. CHWC specializes in providing first and second trimester abortion care and other reproductive health services, inspired by their belief in the autonomy of the individual and their commitment to strengthening communities. Yet, because abortion care is a highly politicized and stigmatized health service, it carries its own set of unique challenges and obstacles that increase operating costs.

For decades, abortion providers have faced the risk of violence at the hands of anti-choice extremists, creating unusual security needs that other health care facilities do not have. This includes security guards, secure entry, 24-hour closed-circuit video cameras, bullet-proof glass, high-level security trainings, and coordination of clinic volunteers to escort patients through protestors. Screening of patients, staff, and vendors is needed to eliminate the opportunity for anti-abortion extremists to breach security, violate privacy, and/or commit violence. All these safety measures require resources that may need to be diverted from health care services and clinic sustainability. Given the alarming increase of anti-abortion rhetoric at the federal level, there has been a notable increase in violence meant to disrupt care and intimidate patients and staff members.[17]

The threat of violence also has a ripple effect on other aspects of operating an independent abortion clinic like CHWC. It makes it more difficult to contract necessary services, such as facility maintenance, medical waste disposal, and the purchasing of medical supplies. Targeting by anti-abortion extremists also makes it difficult to recruit and retain medical professionals to perform abortion procedures due to their own safety and privacy concerns. Abortion providers are already hard to recruit due to limited access to training, low-reimbursements, and increasingly high insurance costs.

Medicaid reimbursement rates fail to consider not only the true cost of health care, but the unique costs associated with providing abortion care in a safe and secure setting. Simply put, Medicaid reimbursement rates for abortion care have not kept pace with medical care costs and certainly do not account for the complex challenges faced by abortion providers.[18]

Taken as a whole, abortion providers remain at an economic disadvantage due to the burden of these unavoidable extra costs. As it stands, the United States has a limited number of facilities qualified to provide abortion throughout all stages of pregnancy, particularly the third trimester. Policymakers looking to improve and expand abortion access in New Jersey can start by increasing Medicaid reimbursement rates for a medical service that has been politicized and stigmatized for far too long.

Fake Women’s Health Centers

 Everyone deserves unbiased, evidence-based health information, regardless of their zip code or financial situation. In New Jersey, this value is exemplified by mandated comprehensive sex education curriculum. Thorough and accurate sexual health education provides young people with the tools they need to make decisions about their health and well-being. Unfortunately, there are organizations operating in New Jersey with the sole intention of derailing access to legitimate reproductive health care services.

Fake women’s health centers, or crisis pregnancy centers, have become a well-established tactic used by anti-abortion extremist organizations with the intention of misleading women seeking pregnancy options, counseling, or abortion care.[19] They use false and deceptive advertising to lure unsuspecting pregnant women to a facility staged to look like a legitimate health care clinic, where staff attempt to coerce them to continue their pregnancies using false medical information, shame, and religious rhetoric.[20] Some of these unlicensed, unregulated “clinics” even provide cursory health services like ultrasound imaging to manipulate women.[21]

Fake women’s health centers have also infiltrated the public school system, offering supplemental abstinence-only sex education based in misinformation and stigma.[22] This puts students at a dangerous disadvantage, making them vulnerable to deception when accessing reproductive health care in the future. This kind of lapse speaks to the need for a comprehensive inventory of New Jersey’s existing sex education curriculum and funding sources, which includes federal “abstinence-only” dollars.[23] Fortunately, a review of New Jersey’s existing sex education curriculum for grades one through 12 is scheduled for 2019. Plans to re-evaluate federal contracts, update the standards, develop sample lesson plans, provide more sex education training for teachers, and incorporate an evaluation tool to ensure accountability are important steps toward getting New Jersey back on track as a strong supporter for comprehensive sex education.

But more commonly, fake women’s health centers target vulnerable women by burgeoning in underserved communities and offering their services free of charge, potentially increasing systemic inequalities.[24][25] Similar to the sex education example above, the proliferation of these health centers in New Jersey is an indicator of ongoing gaps in health care access. Most New Jersey counties have only one family planning clinic, and nearly one in four women live in a county with no abortion provider at all.[26] These gaps put those with limited finances and access to transportation at risk of being duped by fake women’s health centers. Addressing these gaps by increasing the availability and access to qualified health care providers, as well as clearly indicating where people can access these services, will have the biggest impact on the lives of New Jersey women seeking legitimate reproductive health care.

Addressing Maternal and Infant Mortality Disparities

When maternal health care needs go unmet—whether incidentally or systematically—the health and well-being of parents and children are put at serious risk. For decades, New Jersey’s Black families have been at a greater risk than anyone else.

While the overall maternal death rate in New Jersey has improved over time and is below the national rate, enormous racial disparities have persisted. Black women in New Jersey are more than four times more likely to die from pregnancy-related complications as white women.[27] Similarly, the likelihood of a New Jersey infant dying before their first birthday has recently dropped and is slightly lower than the national rate. Yet, the disparity between white and Black infant mortality in New Jersey is the worst in the country. A Black infant born in the Garden State is three times more likely to die than a white infant, regardless of their mothers’ income level or educational attainment.[28]

Research suggests that Black women are susceptible to dangerous pregnancies and birth outcomes due to “weathering,” the cumulative effects of racism on one’s health and well-being.[29] The chronic stress of discrimination in all aspects of society—from housing to employment to picking up groceries—may negatively affect the body causing it to age prematurely. These effects may “weather” African American women more acutely than other women resulting in high-risk reproductive health issues.[30]

New Jersey’s dismal Black maternal mortality rate is not breaking news to the state’s Health Department. Since 1931, it has reviewed maternal health outcomes with detailed research about the root causes of its high maternal mortality rate and possible causes of the stark racial and ethnic disparities. But, like other states, New Jersey has failed to find long-lasting solutions to close the racial gap in maternal health. With a new governor in office, interest in the issue has been renewed. Another maternal mortality review commission has been established, a proposed infant mortality review board is moving through the legislature and grants have been awarded to community-based organizations in high-risk areas to help coordinate maternal care including doula pilot programs in Newark and Trenton.

These targeted efforts are based on similar work taking place North Carolina, one of the few states that have successfully closed the racial gap in maternal health.[31] Doctors there are incentivized through Medicaid reimbursements to screen pregnant women for issues that may trigger a high-risk pregnancy. Patients that have either physical or psychological risks are connected to a “pregnancy care manager” who helps expectant mothers follow their care plan by addressing a wide range of barriers. The North Carolina Pregnancy Medical Home program provides support for everything from access to insulin to housing issues to helping offset both the physical stress of pregnancy and the physical stress in one’s life that has real consequences on one’s health.

In addition to the state-supported medical home model, over 60 North Carolina birthing hospitals have conducted several statewide quality improvement efforts including cutting down on inducing birth before a baby’s due date and improving rapid response treatment of mothers with gestational hypertension and preeclampsia—two of the most severe and dangerous health issues among African American mothers.

Studies also show that in countries with a generous parental leave policy there are tremendous effects on morbidity and mortality rates of infants and young children.[32] New Jersey is one of only four states that have implemented a paid leave policy providing workers and their families the opportunity to take time off work to bond with a new baby or adopted child or care for an elderly or very sick family member. However, very few New Jersey workers utilize the program because they are either not aware of it, or they fear negative repercussions at work, including job loss. In addition, workers struggling to balance work and family caregiving simply can’t afford the low wage replacement rate that is offered by the program.

Meanwhile, there are stark disparities among New Jersey mothers who take paid leave. Between 2012 and 2015, white women in New Jersey were 3 times more likely to take leave than Black women.[33] National research has shown that workers of color are more likely to work for firms that don’t offer family leave insurance.[34] New Jersey is poised to make major improvements to its existing Family Leave Insurance program including promotional efforts so that more workers take advantage of the program. However, the current bill may leave 750,000 workers without job protection putting their household economic security at risk.

The next step for New Jersey is to strengthen its Family Leave law and move beyond demonstration projects and pilot programs. One key component to addressing racial disparities in maternal health care is found in making the leap toward sustainable funding for medical home models in at-risk communities, higher Medicaid reimbursement rates for obstetric services in the hospital setting, and Medicaid coverage for related services including doula care and home visitation.

In fact, state legislators have recently introduced a bill to provide state Medicaid coverage for doula services. Doula care, non-clinical emotional, physical, and informational support before, during and after birth, is associated with lower caesarian section rates, fewer obstetric interventions, fewer complications, shorter labor hours, and healthier newborns. These improvements are critical for Black mothers who are disproportionately at risk for pregnancy-related complications and are routinely subjected to the inherent biases of medical staff that can have life or death consequences.[35] Doula care has been proven to reduce health disparities, improve health outcomes, and improve quality of care, especially in low-income communities.[36] Studies have shown potential cost savings, even if doula care services are partially covered.[37]

Dignity for Those Incarcerated

 Regardless of circumstance, everyone deserves to be treated with dignity. In the prison setting that includes having the right to serve a sentence free of abuse, to access appropriate health care, and to maintain parenting obligations. Key criminal justice policy reform like the expansion of drug courts and the overhaul of the bail system has helped New Jersey reduce its prison population by almost a third (28 percent) since 2000.[38] That trend has fared better for New Jersey women as the men’s prison population has declined by a smaller proportion.

Still, stark disparities persist. According to a 2016 report, New Jersey has the nation’s highest rate of Black/white disparity with African Americans being incarcerated in state prisons 12 times the rate of imprisonment of whites.[39] As a comparison, the national disparity rate is five to one.

To the state’s credit, a newly mandated racial and ethnic impact statement provides an overdue opportunity for lawmakers to address this glaring disparity by reviewing a statistical analysis of the impact of proposed criminal justice policy changes. It is a vital first step toward making informed decisions about improving public safety without exasperating existing racial disparities. Now it is time for policymakers to do the same for gender disparities in the criminal justice system.

Multiple studies show that there is a direct link between women with a history of trauma, substance use disorders, poverty, and mental health problems and their eventual contact with the criminal justice system, where these problems are often exacerbated. New Jersey’s only women’s prison serves as a sobering example.

The Edna Mahan Correctional Facility for Women, which houses about 650 inmates, is currently the subject of at least 11 lawsuits related to sex abuse allegations including a class-action suit that details a history of abuse at the prison since the early 1990s.[40] An independent review has been commissioned by the State Attorney General’s Office and a federal civil rights investigation is underway. Four staff members have been convicted, and three other correctional officers face trial.

Despite laws and procedures in place to ensure the safety of inmates, the Department of Corrections has systematically failed to protect these women. Policymakers’ response to this horrific pattern of abuse and inaction has been to propose ways of improving existing procedures. This is a missed opportunity to look beyond the deficiencies of the correctional system and instead shine a spotlight on the unmet needs of Edna Mahan’s prison population.

According to the Vera Institute for Justice, many jailed women experience mental illness and extremely high rates of victimization—including childhood sexual abuse, sexual assault, and intimate partner violence.[41] New Jersey’s correctional system has not only failed to properly treat women inmates, it has re-traumatized women through unchecked abuse of power. Even standard practices such as strip searches have the potential to retraumatize victims of sexual assault. A former inmate involved with the class action lawsuit said she came forward to help women like herself who “had to live with monsters just to come to a different place and have to live with a new set of monsters.”[42]

To improve conditions at Edna Mahan, state legislators have introduced bills that are primarily focused on codifying existing policy, including the prohibition of shackling pregnant women, limitations on the use of strip searches, and the expansion of the correctional ombudsman’s role to include sexual assault.[43] While these responses are notable, more must be done.

New Jersey’s criminal justice system is one that is primarily designed for the incarceration of men. To improve conditions in a meaningful way, reform must begin with identifying the unique needs of a prison population comprised entirely of women. An inclusive overview of Edna Mahan’s population would provide an opportunity to improve and expand access to health care that meets the needs of its inmates, including reproductive health care for individuals across the gender spectrum. This path toward meaningful reform should begin with policymakers sitting down with formerly incarcerated women and advocates who represent the interests of incarcerated women.

Expanding Health Care for Undocumented Immigrants

 Health care access is a fundamental right for everyone regardless of where they come from or how they arrived in the country. Yet, this right is routinely denied to undocumented families living in New Jersey due to financial and travel barriers to health care services.

Federal restrictions to programs that provide health care coverage, job-training, nutrition, and cash assistance vary depending on the immigration status of noncitizens. The Personal Responsibility and Work Opportunity Act/Illegal Immigration Reform and Immigrant Responsibility Act of 1996 created two categories of immigrant community members: “qualified” or “not qualified.”[44] In addition, the federal law banned legal immigrants who are permanent residents or green card holders from accessing a variety of welfare services or health care programs for a period of 5 years beginning on the date of entry into the United States.[45]

However, states do have the power to implement their own health care policies. For example, state health plans in six states and Washington D.C. cover all children, regardless of immigration status and health plans in 17 states cover all pregnant women, regardless of immigration status. New Jersey is not among these states, but there is movement to change that.[46][47]

While the Garden State has made great strides in reducing the overall uninsurance rate for children to 3.5 percent, there are still 70,000 kids who remain uninsured. Half of these children are undocumented immigrants not eligible for coverage through NJ FamilyCare, the state Medicaid program. Making the well-being of all children a priority would provide long-range health and social savings to the state. Children who are covered by Medicaid are more likely to do better in school, finish high school, attend college and graduate from college, have fewer emergency-room visits and hospitalizations, and earn more as adults.[48]

New Jersey would also benefit in the long run if undocumented immigrant adults also became eligible for health care coverage, starting with those who can become pregnant. Currently, undocumented women—including DACA recipients and women who have held lawful permanent resident status for less than five years—have no access to health care coverage including coverage for preventative reproductive health services. New Jersey should extend health coverage for all undocumented women by offering a full range of reproductive health services. Modeled after Oregon’s Reproductive Health Equity Act, this comprehensive measure would provide undocumented individuals with health care coverage for contraceptives and related services including counseling, voluntary sterilization, screenings for pregnancy, pregnancy care, birth services, sexually-transmitted infections and cancers, and abortion care.[49]

In addition to expanding Medicaid coverage, policymakers should address additional barriers to health care that undocumented families face every day. For example, immigrant rights advocates are pushing to join the 12 states and DC that already allow all residents to obtain a driver’s license, regardless of immigration status.[50] Though seemingly unrelated, expanding eligibility to a driver’s license to all qualified individuals in the state would profoundly improve the ability to access to health care. Transportation barriers created by the inability to access a driver’s license and fear of being detained at a routine traffic stop equate to real obstacles for undocumented people, missed doctor’s appointments and delays in picking up prescriptions. The outcomes have negative health implication and are especially detrimental for time-sensitive, pregnancy related care.[51] Transportation barriers are particularly harmful for those with lower incomes or those who are underinsured or uninsured.

 Special Thanks To:

 Cherry Hill Women’s Center

Planned Parenthood Action Fund of New Jersey

New Jersey Institute for Social Justice

National Immigration Law Center

Garden State Equality

Rutgers Criminal and Youth Justice Clinic

Women Who Never Give Up

National Council of Jewish Women – Essex County

American Friends Service Committee Prison Watch

New Jersey Family Planning League

Family Planning Association of New Jersey

American Civil Liberties Union of New Jersey

New Jersey Abortion Access Fund

Unitarian Universalist Faith Action New Jersey

National Institute for Reproductive Health

State Innovation Exchange

Appendix I: Reproductive Justice Definition and Resources

Reproductive Justice is both a theoretical framework and a social movement created by women of color in the Southern United States as an alternative to the mainstream reproductive rights movement. Sister Song describes Reproductive Justice as the complete physical, mental, spiritual, political, social, and economic well-being of individuals, based on the full achievement and protection of human rights.[52] The issues central to Reproductive Justice impact one’s right “to not have children using safe birth control, abortion, or abstinence; the right to have children under the conditions we choose; and the right to parent the children we have in safe and healthy environments.”[53] By centering the unique, interconnected identities that shape the lives of women within the movement, organizations using the Reproductive Justice framework present a holistic vision with which to challenge policy decisions entrenched in reproductive oppression.

By placing bodily autonomy and the right to access abortion care within the larger human rights framework, Reproductive Justice illuminates the intersections of seemingly unrelated issues like police violence, inhumane immigration policies and environmental racism.

The concept, in part, grew out of the acknowledgment that communities of color and other marginalized groups were often left out of reproductive rights advocacy work, which traditionally centers on abortion rights. This limited scope fails to account for the historical reproductive oppression of people of color engrained in the United States, including forced sterilization, medical experimentation, and family separation. By framing reproductive rights around the issues of “choice” and “privacy,” the mainstream movement for reproductive freedoms have effectively silenced the voices, experiences, and circumstances of women who historically have had to contend with racial and economic injustice. For example, shortly after Roe v. Wadewas decided in 1973, Congress quickly passed the Hyde Amendment, banning federal dollars from being used to provide abortion care. The failure of reproductive rights advocates to immediately mobilize against this policy has had a devastating and long-lasting effect on access to abortion care for poor women. Despite a 1993 modification that extended coverage in cases of rape, incest, or danger to the mother’s life, the Hyde Amendment remains a major barrier to abortion care, especially for women of color and immigrants.

For more information, we encourage you to look to the Reproductive Justice organizations led by people of color advancing policy campaigns that reflect the unique needs of their communities and the historical work of Reproductive Justice leaders.

Appendix II: Recent and Pending Legislation in New Jersey That Reflect a Reproductive Justice Framework

Endnotes

[1] In this report, low-income generally refers to those with incomes at 200 percent or less of the federal poverty guidelines which in 2018 is just over $50,000 per year for a family of four.

[2] NJ.com, Eliminated by Christie 8 Years Ago, $7.5M for Women’s Clinics is Making a Comeback, January 2017. http://www.nj.com/politics/index.ssf/2018/01/eliminated_by_christie_8_years_ago_75m_for_womens.html

[3] Last year 94 percent of those seeking care at family planning clinics had incomes at 200% or less of the federal poverty guidelines (Interview with New Jersey Family Planning League).

[4] P.L.2017, Chapter 50, An Act Establishing a Home Visitation Pilot Program in Medicaid, Approved May 1, 2017. https://www.njleg.state.nj.us/2016/Bills/AL17/50_.PDF

[5] New Jersey Department of Health, DOH Announces $4.3 million to Reduce Disparities in Birth Outcomes and Black Infant Mortality, April 2018. https://nj.gov/governor/news/news/562018/approved/20180430a_birthoutcomes.shtml

[6] AMA Journal of Ethics, “Vulnerable” Populations: Medicine, Race, and Presumptions of Identity, July 2011. https://journalofethics.ama-assn.org/article/vulnerable-populations-medicine-race-and-presumptions-identity/2011-07

[7] Guttmacher Institute, State Facts About Unintended Pregnancy: New Jersey, August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-new-jersey

[8] Obstetrics & Gynecology, Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies, March 2011. https://journals.lww.com/greenjournal/Fulltext/2011/03000/Number_of_Oral_Contraceptive_Pill_Packages.8.aspx

[9] California, Hawaii, Illinois, Maryland, Massachusetts, Nevada, New York, and Vermont. Colorado, Maine, Oregon and Washington State laws go into effect January 2019. Guttmacher Institute, Insurance Coverage of Contraceptives, August 2018. https://www.guttmacher.org/state-policy/explore/insurance-coverage-contraceptives

[10] New Jersey Department of Human Services, Division of Medical Assistance & Health Services, NJ FamilyCare Coverage of Long-Acting Reversible Contraceptive Devices, Newsletter Volume 28 No. 18, October 2018. https://www.njmmis.com/documentDownload.aspx?fileType=RecentNewsLetters

[11] Emergency contraception is not a medical abortion. Emergency contraception works primarily by delaying or inhibiting ovulation. Emergency contraception will not work if a woman is already pregnant. For more information about the difference between these two medications, see this fact sheet from the American Society for Emergency Contraception http://www.cecinfo.org/custom-content/uploads/2013/03/MedAbort_FactSheet_2013_ASEC.pdf

[12] Guttmacher Institute, Last Five Years Account for More Than One-quarter of All Abortion Restrictions Enacted Since Roe, January 2016. https://www.guttmacher.org/article/2016/01/last-five-years-account-more-one-quarter-all-abortion-restrictions-enacted-roe

[13] See Planned Parenthood of Cent. New Jersey v. Farmer, 165 N.J. 609, 629, 762 A.2d 620, 631 (2000) (“The language of that paragraph is ‘more expansive … than that of the United States Constitution….,’ it incorporates within its terms the right of privacy and its concomitant rights, including a woman’s right to make certain fundamental choices. Thus, in New Jersey, we have a long-standing history that begins even prior to Roe v. Wade, demonstrating a commitment to the protection of individual rights under the State Constitution.”) (citations omitted); id. at 632-33 (“Our inquiry begins with an examination of the nature of the affected right. We have earlier discussed the importance of a woman’s right to control her body and her future, a right we as a society consider fundamental to individual liberty. Although we will not repeat that discussion here, we are keenly aware of the principle of individual autonomy that lies at the heart of a woman’s right to make reproductive decisions and of the strength of that principle as embodied in our own Constitution. We have not hesitated, in an appropriate case, to read the broad language of Article I, paragraph 1, to provide greater rights than its federal counterpart. Our precedents make clear that the classification created by the statute is deserving of the most exacting scrutiny.”) (citations omitted).

[14] Women’s Health Issues, At What Cost? Payment for Abortion Care by U.S. Women, May-June 2013. https://www.whijournal.com/article/S1049-3867(13)00022-4/fulltext

[15] New York Times, ’70 Abortion Law: New York Said Yes, Stunning the Nation,April 2000. https://www.nytimes.com/2000/04/09/nyregion/70-abortion-law-new-york-said-yes-stunning-the-nation.html

[16] Guttmacher Institute, Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008, 2016. https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014

[17] National Abortion Federation, 2017 Violence and Disruption Statistics, 2017. https://5aa1b2xfmfh2e2mk03kk8rsx-wpengine.netdna-ssl.com/wp-content/uploads/2017-NAF-Violence-and-Disruption-Statistics.pdf

[18] Guttmacher Institute, Assessing the Gap Between the Cost of Care for Title X Family Planning Providers and Reimbursement from Medicaid and Private Insurance, January 2016. https://www.guttmacher.org/sites/default/files/pubs/Title-X-reimbursement-gaps.pdf

[19] NARAL Pro-Choice America, The Truth about Crisis Pregnancy Centers, January 2017. https://www.prochoiceamerica.org/wp-content/uploads/2016/12/6.-The-Truth-About-Crisis-Pregnancy-Centers.pdf

[20] Ibid 19

[21] Ibid 19

[22] Blue Jersey, Crisis Pregnancy Centers Are in Our Schools, Teaching Our Children, April 2018. http://www.bluejersey.com/2018/04/crisis-pregnancy-centers-are-in-our-schools-teaching-our-children/

[23] Sexuality Information and Education Council of the United States, State Profiles Fiscal Year 2017: New Jersey, July 2018. https://siecus.org/wp-content/uploads/2018/07/NEW-JERSEY-FY17-FINAL-New.pdf

[24] Although this paper seeks to include all those who can become pregnant, including women, transgender men, and gender non-conforming people, fake women’s health centers only target those they perceive to experience pregnancy, namely cisgender women.

[25] AMA Journal of Ethics, Why Crisis Pregnancy Centers Are Legal but Unethical, March 2018. https://journalofethics.ama-assn.org/article/why-crisis-pregnancy-centers-are-legal-unethical/2018-03

[26] Guttmacher Institute, State Facts About Abortion: New Jersey, May 2018. https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-new-jersey#7

[27] NJ Spotlight, Black Mamas Highlight Racial Maternal Health Disparities, April 2018. http://www.njspotlight.com/stories/18/04/24/black-mamas-highlight-racial-maternal-health-disparities/

[28] NJ Spotlight, Racial Disparity in Infant Mortality Remains Persistent Public Health Challenge, June 2017. http://www.njspotlight.com/stories/17/06/05/racial-disparity-in-infant-mortality-remains-persistent-public-health-challenge/

[29] Human Nature, Do US Black Women Experience Stress-Related Accelerated Biological Aging? A Novel Theory and First Population-Based Test of Black-White Differences in Telomere Length, March 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861506/

[30] Journal of Women’s Health, The Impact of Racism on the Sexual and Reproductive Health of African American Women, July 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939479/

[31] Vox.com, Black Moms Die in Childbirth 3 Times as Often as White Moms. Except in North Carolina, July 2017. https://www.vox.com/health-care/2017/7/3/15886892/black-white-moms-die-childbirth-north-carolina-less

[32] Texas A&M University, Why American Infant Mortality Rates are So High, October 2016. https://www.sciencedaily.com/releases/2016/10/161013103132.htm

[33] NJ Department of Health and The Center for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System (NJ PRAMS), Employment, Workplace Leave and Return to Work Among New Jersey Mothers, March 2018. https://www.nj.gov/health/fhs/maternalchild/documents/workforce_mar2018.pdf

[34] Ibid 33

[35] Choices in Childbirth, Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health, January 2016.https://choicesinchildbirth.org/wp-content/uploads/2015/12/DoulaBrief_FINAL_1.4.16.pdf

[36] Ibid 35

[37] Ibid 35

[38] Bureau of Justice Statistics, 2000, 2015 in The Sentencing Project, Color of Justice: Racial and Ethnic Disparity in State Prisons, 2016. http://www.sentencingproject.org/publications/color-of-justice-racial-and-ethnic-disparity-in-state-prisons/

[39] The Sentencing Project, Color of Justice: Racial and Ethnic Disparity in State Prisons, 2016. http://www.sentencingproject.org/publications/color-of-justice-racial-and-ethnic-disparity-in-state-prisons/

[40] NJ.com, Sex Abuse Scandal at N.J. Women’s Prison Keeps Getting Worse, July 2018. https://www.nj.com/politics/index.ssf/2018/07/sex_abuse_scandal_at_nj_womens_has_sparked_at_leas.html

[40] Vera Institute of Justice, Overlooked: Women and Jails in an Era of Reform, August 2016. https://www.vera.org/publications/overlooked-women-and-jails-report

[41] NJ.com, Locked Up, Fighting Back: More Than a Dozen Female Inmates Accused an Officer of Abuse, January 2017. https://www.nj.com/news/index.ssf/page/locked_up.html

[42] NJ.com, New Crackdown on N.J.’s Women’s Prison Pushed Amid Sex Abuse Claims, May 2018. https://www.nj.com/politics/index.ssf/2018/05/lawmakers_push_crackdown_on_nj_womens_prison_amid.html

[43] National Immigration Law Center, Overview of Immigrant Eligibility for Federal Programs,December 2015. https://www.nilc.org/issues/economic-support/overview-immeligfedprograms/

[44] U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation, Summary of Immigrant Eligibility Restrictions Under Current Law, February 2009. https://aspe.hhs.gov/basic-report/summary-immigrant-eligibility-restrictions-under-current-law#sec

[45] States with health plan that cover all children include Washington, Oregon, California, Illinois, New York and Massachusetts.

[46] National Immigration Law Center, Health Coverage Maps, January 2018. https://www.nilc.org/issues/health-care/healthcoveragemaps/

[47] The Center on Budget and Policy Priorities, Medicaid Helps Schools Help Children, April 2017. https://www.cbpp.org/research/health/medicaid-helps-schools-help-children

[48] Reproductive Health Equity Act (OR HB 3391), 2017. https://olis.leg.state.or.us/liz/2017R1/Downloads/MeasureDocument/HB3391

[49] New Jersey Policy Perspective, Let’s Drive New Jersey: Expanding Access to Driver’s Licenses is a Common-Sense Step in the Right Direction, January 2018. https://www.njpp.org/reports/lets-drive-new-jersey-expanding-access-to-drivers-licenses-is-a-common-sense-step-in-the-right-direction

[50] The Journal of Rural Health, Access to Transportation and Health Care Utilization in a Rural Region, Winter 2005. https://www.ncbi.nlm.nih.gov/pubmed/15667007

[51] SisterSong Women of Color Reproductive Justice Collective and the Pro-Choice Public Education Project, Reproductive Justice Briefing Book: A Primer on Reproductive Justice & Social Change, 2007. https://www.law.berkeley.edu/php-programs/courses/fileDL.php?fID=4051

[52] Ross, Roberts, Derkas, Peoples, Bridgewater Toure, Radical Reproductive Justice: Foundations, Theory, Practice, Critique, November 2017.

New Jersey’s Individual Market Premiums to be Among the Lowest in the Nation

Posted on by Raymond Castro

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

New Jersey’s ongoing efforts to protect the Affordable Care Act (ACA) are starting to pay off: all middle class New Jerseyans who purchase their insurance in the individual market will pay far less than they otherwise would have next year and for the foreseeable future. These major savings will be available to New Jerseyans who exceed the income cut-off for federal subsidies, which is $48,560 a year for an individual and $100,400 for a family of four. Time is of the essence as consumers can maximize saving by selecting a plan before the open enrollment period ends on December 15.

This relief could not occur at a better time since these same New Jerseyans were hit with a whopping 19 percent increase in their premiums this year as the Republican-led Congress and Trump administration worked tirelessly to undermine the individual market.[1] That made insurance unaffordable for many New Jerseyans and was one of the major reasons why the number of residents in the individual market decreased by about 40,000 in 2018.[2]

Thanks to the following actions taken by the state to reverse the federal ACA sabotage, consumers will be able to achieve major savings starting next year:

  • Establishing a reinsurance program that will reimburse insurers for individuals with unusually high medical costs, which will be mainly supported with federal funds.
  • Maintaining the federal individual mandate for New Jerseyans who can afford insurance.
  • Encouraging insurers to offer lower-cost Silver (mid-level) plans.
  • Launching a state outreach campaign, Get Covered New Jersey, that will result in healthier New Jerseyans obtaining insurance, and therefore a further reduction in premiums and the state’s uninsurance rate.

Middle-Class New Jerseyans Will Pay $3.3 Billion Less in Premiums Over Ten Years 

The New Jersey Department of Banking and Insurance (DOBI) estimates that the new reinsurance program will guarantee that premiums will be 15.1 percent less than they would have been otherwise. Maintaining the federal individual mandate will further reduce premiums by 6.8 percent, for a total reduction of 21.9 percent.[3] In 2019, the average consumer will pay a premium of $5,700 instead of $7,300,[4] a savings of $1,600 which will total at least $23,000 over 10 years (adjusting for inflation).[5]

All 140,000 middle class New Jerseyans in the current market will save a total of $3.2 billion over 10 years compared to what they would have paid.[6] This estimate is conservative as it does not consider an increase in the number of additional individuals who will obtain insurance because of the lower cost nor the savings that will be achieved from the other initiatives outlined in this report.

New Jersey Premiums Will Rank Fourth Lowest in the Nation

Remarkably, premiums for the Silver plan[7] (which is the most popular) will drop from 9th highest in 2014 to 47thin the nation in 2019. The main reason is the growth in premiums in New Jersey is the second lowest in the nation. New Jersey’s increase (9 percent) was eight times lower than the average for all states in the Marketplace (75 percent). Adjusting for inflation, there was essentially no increase in New Jersey. This is in stark contrast to premiums for employer-based insurance in New Jersey, which was fifth highest nationally in 2013 and increased to fourth highest in 2017.[8]

Whereas in 2014 premiums in New Jersey were 18 percent higher than the national average, next year they will be 26 percent lower. New Jersey’s average premium next year will be far less than its neighboring states: Delaware (94 percent less), Pennsylvania (38 percent less) and New York (61 percent less).

New Reduced Silver Plans Could Mean Even More Major Savings 

For the 2019 plan year, DOBI encouraged carriers to offer less expensive Silver plans which could prove to be a game changer for consumers. This year, Silver plans were kept artificially high because insurers had to factor in President Trump’s decision not to fund cost sharing reduction payments even though insurers were still required to maintain the reduction for policyholders. This did not affect consumers who received federal premium subsidies because those subsidies were increased to compensate for the higher premiums. However, consumers who were not eligible for premium subsidies had to pay for the full increase this year. That will not be the case for next year, which will result in several lower cost options. Seven new Silver plans have been added, two of which have the lowest Silver premiums.[9] Overall, the total number of plans off the Marketplace increased to 32 in 2019 from 28 in 2018 mainly due to the increase in Silver plans.

This will mean that the base rate for the lowest premium Silver plan will be reduced to $240 in 2019 from $312 in 2018, a 23 percent reduction.[10] For households that currently have the lowest Silver plans and want to switch plans to continue to have the lowest plans, the savings could be major. A family[11], 27-year-old single adult and 60-year-old single adult could see annual savings of $3,264, $792, and $1,944 respectively.[12] In addition, consumers who have higher cost Silver plans, or have Gold plans, may want to reconsider these new less expensive Silver plans next year even though the cost-sharing likely would be higher.

However, the two lowest cost plans, and three other higher cost Silver plans, will only be available to individuals who purchase insurance off the Marketplace.These plans will not even be listed in the Marketplace. These off the Marketplace options may be found at GetCovered.NJ.gov and purchased directly through carriers.

Premiums Reduced by 14 Percent or More in Half of Plans in Individual Market

DOBI estimates a 9.3 percent[13] average weighted reduction next year for all plans compared to this year. Of course, there will be some plans that exceed this average and those that fall below it. The table below shows the premium reduction in all current plans, which ranges between six and 22 percent, and that half of the plans exceed 14% or more.[14] Bronze plans had the least reduction (10 percent) and the Gold and Silver were similar (12 and 13 percent respectively). The good news is that premiums in the individual market for all middle class New Jerseyans should decrease this year unless their household situation changed. However, as is always the case, consumers should shop around for the best deal possible including new plans that are not listed below.

Endnotes

[1] KFF, Marketplace Average Benchmark Premiums, 2014-2019, https://www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[2] NJ DOBI, Total Lives Comparison, 2018 and 2019, https://www.state.nj.us/dobi/division_insurance/ihcseh/enroll/2018_1q_ihc_coveredcomparison.pdf

[3] Gov. Murphy’s Office, Governor Murphy Announces Impact of New Jersey’s Actions to Stabilize the Health Insurance Market, 2018. https://www.nj.gov/governor/news/news/562018/approved/20180907a.shtml

[4] The 21.9 percent premium reduction was applied to the projected baseline premium for 2019 in New Jersey Section 1332 State Innovation Waiver-Individual Reinsurance Program, Oliver Wyman, June 27, 2018

[5] Estimate is conservative because as individuals age their premiums go up which was not considered in the analysis.

[6] Same Section 1332 source as above but premium reduction was applied to each of the ten years.

[7] Based on second lowest benchmark Silver plan for a 40-year-old person, https://www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[8] KFF, Average AnnualSingle Premium per Enrolled Employee For Employer-Based Health Insurance, 2017https://www.kff.org/other/state-indicator/single-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Employee%20Contribution%22,%22sort%22:%22desc%22%7D

[9] NJ DOBI, 2019 and 2018 New Jersey Individual Health Benefits Plans and Rates, https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates_2018.pdfand https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates_2019.pdf

[10] Ibid.

[11] Assumes both parents are age 35, one child at 3 and one at 15.

[12] NJ DOBI,  IHC Premium Calculator, https://www.state.nj.us/dobi/division_insurance/ihcseh/IHC_Calculator_2018/IHC.HTM

[13] Gov. Murphy’s Office, Ibid 

[14] Not weighted.

Congressional Threats to Health Programs Could Harm Millions of New Jerseyans

Posted on by Raymond Castro

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

For impact data by congressional district, click here. 

Heading into the midterm elections, polls have shown that the number one concern of Americans – both Democrats and Republicans – is health care. This concern is understandable, especially in a state like New Jersey, given the millions of people who would be affected by threatened changes in federal health policy, a renewed effort to repeal the Affordable Care Act (ACA), or a scaling back of entitlement programs that are the bedrock of the nation’s safety net. Because New Jersey made the right decision to expand Medicaid under the ACA, repeal of that provision alone would result in the loss of health coverage for 800,000 New Jerseyans. In addition, there are other major threats to Medicare and the entire Medicaid program, as well as to residents who have pre-existing conditions or are uninsured.

The purpose of this report is to provide the facts that show how many New Jersey residents participate in the programs that could potentially be affected by these proposed changes statewide and by congressional districts (attached) using the most recent US census data released last month.Many New Jerseyans in all congressional districts could be affected by all the proposed changes, but the number varies based in the program and the congressional district.

Up to 1.7 million New Jerseyans on Medicaid could lose part or all of their coverage  

Medicaid has already been on the chopping block for the last two years. In legislation to repeal the ACA that almost passed Congress, Medicaid expansion would have been phased out completely, resulting in a half million New Jerseyans losing health coverage. Even worse in the long term, overall funding for Medicaid would have been permanently capped, resulting in the loss of billions of dollars in New Jersey and threatening health coverage for everyone on Medicaid. Because about two-thirds of Medicaid funding is for seniors and people with disabilities, they would most likely have been affected the most by such a major cutback. Also, one out of four children in New Jersey are covered by Medicaid.

Health coverage is threatened for up to 330,000 New Jerseyans who purchased their insurance directly

About 330,000 New Jersey residents rely on the individual market to obtain health care coverage. About 240,000 of them purchased their insurance through the federal Marketplace. It is in this category where most of the federal cutbacks have been made, such as eliminating funding for cost-sharing subsidies, eliminating the individual mandate and a reduction in outreach funds. Repeal of the ACA would result in the loss of coverage for most of these individuals. About 80 percent of all New Jersey residents obtaining health coverage in the federal Marketplace receive federal subsidies which protect them from high premiums. However, about 140,000 New Jerseyans do not receive these subsidies and had to pay for the full twenty percent increase in premiums this year.  Not surprisingly, as a result of these cutbacks, the enrollment in all these plans decreased by about 40,000 over the past year.

Up to 3.8 million New Jerseyans are threatened by proposals to effectively eliminate current protections for preexisting conditions

Protections in the ACA for Americans who have preexisting conditions remains one of the most contentious health issues in Congress. Because polls have shown that this is the most popular provision in the ACA, some Republican members of Congress have been quick to point out that they support continuing this protection. However, most of these same Republicans have supported allowing insurers to exclude essential benefits that these individuals need or to charge any premium they want, which would have the same effect as repealing the protection since virtually no one but the wealthy could afford necessary coverage.  In addition, the Trump administration has recommended in a Texas federal district court case that it invalidate the ACA’s core protections for people with preexisting conditions and allow non-compliant plans that would eliminate the availability of affordable comprehensive coverage. If the Texas court made such an adverse decision, and the Supreme Court upheld it, only an act of Congress signed by President Trump could remedy this problem.

Proposed federal cutbacks in Medicare threaten health coverage for up to 1.5 million New Jerseyans

Medicare is at major risk for cutbacks to offset the massive federal tax cuts that were enacted last year. The tax overhaul, which mainly benefits the wealthy, will deplete the federal revenues required to meet the escalating costs of Medicare, as well as other programs, in the future. Funding for Medicare represents 15 percent of the federal budget; the only other category that is slightly larger is Medicaid. Right after passage of these tax cuts, Republican leaders in Congress began to insist that “entitlement reform” was necessary to make up for these lost revenues. House Speaker Paul Ryan specifically mentioned Medicare as the “the biggest entitlement we’ve got to reform.” Some Republicans have also proposed privatizing Medicare by converting it to a voucher program for new beneficiaries that would limit how much an individual could spend on health care. Democrats, on the other hand, have been very protective of Medicare as it is, and some of them are urging different versions of a “Medicare for All” policy that would greatly expand Medicare for current beneficiaries and make many more Americans eligible.

Many of the 688,000 New Jerseyans who are uninsured could lose any opportunity to obtain health coverage

Remarkably, the ACA reduced the number of New Jersey’s uninsured by about a third. However, that still leaves too many New Jerseyans who are uninsured. About half of the uninsured (338,000 New Jerseyans) are eligible for Medicaid or tax credits under the ACA but would not be if the ACA were repealed or became more restrictive. Many of these eligible New Jerseyans do not seek insurance under the ACA because they do not know they are eligible for subsidies. Under the Trump administration, the open enrollment period was shortened by half and funding for navigators who help the uninsured apply for assistance was cut by about two-thirds. Repeal of the ACA would mean that all of these New Jersey residents would lose any hope of obtaining health coverage and the number of uninsured in New Jersey would jump to about 1.2 million.

Trump's ACA Sabotage: Bad Medicine for New Jersey

Posted on by Raymond Castro

To read a PDF version of this report, click here.
For a “By the Numbers” breakdown, click here.

President Trump and the Republican leadership in Congress have caused great harm to New Jersey with their efforts to undermine the Affordable Care Act (ACA). Their systematic sabotage of the health care marketplace has not only affected thousands of New Jerseyans but the economy as well. For the first time since ACA was implemented, there are decreases in both the individual market and Medicaid, which this year amounted to 62,000 fewer New Jerseyans obtaining this coverage.[1] There is also concern that the uninsurance rate in New Jersey may be increasing again. The most recent preliminary national survey found an uninsurance rate of 10.6 percent in 2016 and 11.8 percent in 2017 for ages 18-65 in New Jersey.[2]

The decrease in enrollment this year in the Marketplace and Medicaid has resulted in up to $150 million in lost federal funds in New Jersey which will affect the economy.[3] In addition­­­, 137,000 middle class New Jerseyans who are not eligible for federal premium subsidies in the individual market paid approximately $125 million more for their insurance this year.[4] It is also estimated that there was a decrease of 22 percent in the number of Hispanics who are obtaining plans in the Marketplace due to Trump’s anti-immigrant policies.[5]

ACA Undermined in Almost Every Way Possible by Trump Administration

Congress may have been unsuccessful in their attempts to repeal and replace the ACA, but that hasn’t stopped the Trump administration from taking steps to undermine the landmark health care legislation. While it is difficult to keep track of all the attempts to undermine the ACA, the Trump administration has taken at least eighteen actions to deny health care to New Jerseyans. This includes slashing funding for navigators and advertising even though 35 percent of uninsured adults did not know about the Marketplace last year.[6] The President successfully persuaded Congress to repeal the individual mandate and eliminated cost sharing reduction payments to insurers which contributed to a spike in premiums for middle class New Jerseyans. His administration is also allowing states to sell association and junk insurance plans that do not include essential benefits that are especially needed for people with preexisting conditions. Through the Attorney General’s office, the administration is also urging a Texas court to allow states to charge higher premiums for Americans with pre-existing conditions, and the President wants to nominate a judge to the Supreme Court who would uphold such a decision.

Unprecedented Drop in Individual Market Enrollment

Enrollment in the individual market (which consists of New Jerseyans purchasing their insurance through the federal Marketplace website and those who purchase their plans directly)decreased to 329,000 from 369,000 in 2017, a drop of 39,858 New Jerseyans. This is the first decrease in enrollment since the Marketplace was established, wiping out the last two years of gains. This is especially disturbing as there are an estimated 149,000 New Jerseyans who are currently uninsured and eligible for premium subsidies.[7]

Insurance Has Become Unaffordable for Many Struggling New Jerseyans 

There was a greater decrease in the enrollment rate (14 percent) this year in the off-Marketplace than there was in the Marketplace (9.6 percent) because those New Jerseyans in the off-Marketplace must pay the full cost for their premiums, whereas 80 percent of New Jerseyans in the Marketplace receive federal subsidies.[8] The income limits for subsidies – $48,240 for an individual and $98,400 for a family of four – are modest given New Jersey’s high cost of living, especially with the recent increases in premiums. The full cost of average premiums for the standard plan in the Marketplace increased 19 percent in 2018, which is seven times the average rate of the previous three years of 2.5 percent. Much of that increase was caused by the expected elimination of the individual mandate and cost sharing reduction payments.

The 137,000 New Jerseyans who did not receive subsidies paid, on average, $900 more this year in premiums for a single individual and $3,600 for a family of four compared to the average premium over the last three years.[9] Given that premiums for a family of that size were typically over $20,000 per year before the Trump administration’s sabotage of the ACA, this year’s premium increase simply made insurance unaffordable for many New Jersey families.[10]

Family Enrollment in Medicaid Decreases for the First Time

For the first time since the start of its expansion in 2014, Medicaid enrollment decreased in fiscal year 2018 for parents and children. The sabotage of the Marketplace appears to be at least one of the causes for this decrease. About one quarter of everyone who enrolls in Medicaid does so through the Marketplace even though they can apply directly.[11] Up to 140,000 of these consumers are children and parents who were already eligible for Medicaid before the ACA but were unaware until they applied for assistance in the Marketplace. This exemplifies how cutbacks in outreach and advertisement for the Marketplace also affect Medicaid enrollment.

Before the Trump administration’s efforts to sabotage the ACA, New Jersey had projected an increase in Medicaid enrollment for 2018. Instead, 14,814 fewer residents enrolled between 2018. and 2017. Taking the state’s projections into account, there were 22,290 fewer parents and kids enrolled in 2018 than was expected. As the number of unemployed New Jerseyans has remained largely flat during this period, this decrease cannot be explained by economic factors.[12]

Trumps Anti-Immigrant Policies Suppress Enrollment in Medicaid and the Marketplace  

President Trump’s anti-immigrant rhetoric, federal policies, and proposals have done serious harm to Medicaid enrollment, especially in New Jersey, which has the fourth highest share of unauthorized immigrants in the nation.[13] The Trump administration’s overly aggressive actions to deport millions of unauthorized immigrants and its proposal to deny citizenship to legal immigrants if they or their child are on Medicaid discourages all legal immigrants from applying for Medicaid. This is especially true for undocumented parents who are afraid to enroll their citizen child because they fear the information will be shared with ICE and the parent will be deported. In New Jersey, one in six children have an unauthorized parent.[14] This problem is also leading to anecdotal reports that unauthorized parents are disenrolling their children in Medicaid. In 2016 there were an estimated 150,000 children covered by Medicaid/CHIP who had unauthorized parents.[15]

New Jerseyin Better Position than Most States, but Much More to Do to Achieve Universal Health Coverage

 Looking into the future, New Jersey is ahead of most states in working toward universal, affordable health coverage. New Jersey already has policies in place that prohibit the sale of junk plans, and the state recently enacted legislation that restores the individual mandate and establishes a reinsurance plan that will largely offset the hike in premiums caused by the Trump administration. Governor Murphy is also formulating an outreach plan that will maximize existing state resources, although it is unclear if funding will be restored for community-based organizations to perform the same functions as navigators.

While New Jersey has taken admirable steps to defend against attacks on the ACA, the state and its congressional representatives should not lose sight of the ultimate goal to provide universal health coverage. New Jersey’s uninsured decreased by about a third due to the ACA, but there are still approximately 700,000 New Jerseyans who are uninsured, and this number may be increasing again. It will be critical that the New Jersey’s congressional delegation reverse the Trump administration’s anti-ACA actions and improve the ACA to assist more people with more affordable coverage at all income levels.

New Jersey is limited in its ability to meet this challenge by itself, but there are realistic steps it can take to reduce the uninsured in New Jersey and reversethe Trump sabotage. It can start by passing legislation to fulfill the governor’s promise to cover all the remaining uninsured kids in New Jersey. This is achievable as approximately 95 percent of all children already have health insurance. The state should also consider a state takeover of the Marketplace, so it can extend the open enrollment period and make other improvements as other state Marketplaces have done. In addition, the state will need to vigorously advertise that New Jersey has replaced the federal individual mandate with a state mandate. New Jersey will also need to tackle the biggest challenge of all: how to reduce health costs while maintaining quality and access. Recent state enactment of surprise billing legislation that also eliminates inappropriate out-of-network costs and pending bills to limit prescription drugs are good first steps Over the last six months, New Jersey has been a model for stabilizing the health insurance market, but further bold action will be necessary to combat the Trump administration’s attempts to unravel the ACA.

 

Endnotes

[1] Decrease in enrollment in the individual market is from New Jersey Department of Banking and Insurance website and Medicaid enrollment is calculated from the SFY 2018 governor’s budget.

[2] Robin A. Cohen, Ph.D., Emily P. Zammitti, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A, National Health Interview Survey Early Release Program, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017, https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf

[3] The calculations for the lost Medicaid funding are explained in the table in the report. The lost funding in the Marketplace was calculated by multiplying the average premium subsidy in 2018 by the difference in the marketplace enrolment with subsidies in 2018 and 2017.  See average premiums at Kaiser Family Foundation website at https://www.kff.org/health-reform/state-indicator/marketplace-average-premiums-and-average-advanced-premium-tax-credit-aptc/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[4] Calculated by inflating the premium in 2017 in the marketplace by the average increase over the previous three years and comparing that to what was the actual increase in 2018 multiplied by everyone who did not receive a subsidy.

[5] Karina Wagnerman, New Study Finds Evidence of a “Chilling Effect” in 2016 Marketplace Enrollment,July 19, 2018, https://ccf.georgetown.edu/2018/07/19/new-study-finds-evidence-of-a-chilling-effect-in-2016-marketplace-enrollment/

[6] Halley Cloud, In Latest Sabotage Administration Nearly Eliminates Marketplace Enrollment Assistance Funds, July 13, 2018, https://www.cbpp.org/blog/in-latest-aca-sabotage-administration-nearly-eliminates-marketplace-enrollment-assistance-funds

[7] Kaiser Family Foundation, Distribution of Non-Elderly Uninsured Individuals,https://www.kff.org/health-reform/state-indicator/distribution-of-nonelderly-uninsured-individuals-who-are-ineligible-for-financial-assistance-due-to-income-offer-of-employer-coverage-or-citizenship-status/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[8] Kaiser Family Foundation, Effectuated Marketplace Enrollment and Financial Assistance, https://www.kff.org/other/state-indicator/effectuated-marketplace-enrollment-and-financial-assistance/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[9] See note 5. Divided total increase in premiums by everyone who did not receive a subsidy.

[10] NJPP analysis of plans in Healthcare.gov for 2018.

[11] DMAHS email responding to OPRA request by NJPP, December 12, 2017. The period is December 2006 to November 2017. Through marketplace: 134,761; Direct: 277,679.

[12] NJ Department of Labor, Major Indicators of Labor Market Activity for New Jersey Seasonally Adjusted 2017 Benchmark, https://www.nj.gov/labor/forms_pdfs/lwdhome/press/2018/20180719UITABLES.pdf

[13] Pew Research Center, U.S. Unauthorized Immigration Population Estimates, November 3, 2016, http://www.pewhispanic.org/interactives/unauthorized-immigrants/ https://www.njpp.org/wp-content/uploads/2018/02/NJPPCoverAllKidsJan2018.pdf

[14] Samantha Artiga, Kaiser Family Foundation, Potential Effects of Public Charge Changes On Health Coverage For Citizen Children, March 2018, https://www.kff.org/disparities-policy/issue-brief/potential-effects-of-public-charge-changes-on-health-coverage-for-citizen-children/

[15] Ibid.

 

Trump’s ACA Sabotage: Bad Medicine for New Jersey

Posted on by Raymond Castro

To read a PDF version of this report, click here.
For a “By the Numbers” breakdown, click here.

President Trump and the Republican leadership in Congress have caused great harm to New Jersey with their efforts to undermine the Affordable Care Act (ACA). Their systematic sabotage of the health care marketplace has not only affected thousands of New Jerseyans but the economy as well. For the first time since ACA was implemented, there are decreases in both the individual market and Medicaid, which this year amounted to 62,000 fewer New Jerseyans obtaining this coverage.[1] There is also concern that the uninsurance rate in New Jersey may be increasing again. The most recent preliminary national survey found an uninsurance rate of 10.6 percent in 2016 and 11.8 percent in 2017 for ages 18-65 in New Jersey.[2]

The decrease in enrollment this year in the Marketplace and Medicaid has resulted in up to $150 million in lost federal funds in New Jersey which will affect the economy.[3] In addition­­­, 137,000 middle class New Jerseyans who are not eligible for federal premium subsidies in the individual market paid approximately $125 million more for their insurance this year.[4] It is also estimated that there was a decrease of 22 percent in the number of Hispanics who are obtaining plans in the Marketplace due to Trump’s anti-immigrant policies.[5]

ACA Undermined in Almost Every Way Possible by Trump Administration

Congress may have been unsuccessful in their attempts to repeal and replace the ACA, but that hasn’t stopped the Trump administration from taking steps to undermine the landmark health care legislation. While it is difficult to keep track of all the attempts to undermine the ACA, the Trump administration has taken at least eighteen actions to deny health care to New Jerseyans. This includes slashing funding for navigators and advertising even though 35 percent of uninsured adults did not know about the Marketplace last year.[6] The President successfully persuaded Congress to repeal the individual mandate and eliminated cost sharing reduction payments to insurers which contributed to a spike in premiums for middle class New Jerseyans. His administration is also allowing states to sell association and junk insurance plans that do not include essential benefits that are especially needed for people with preexisting conditions. Through the Attorney General’s office, the administration is also urging a Texas court to allow states to charge higher premiums for Americans with pre-existing conditions, and the President wants to nominate a judge to the Supreme Court who would uphold such a decision.

Unprecedented Drop in Individual Market Enrollment

Enrollment in the individual market (which consists of New Jerseyans purchasing their insurance through the federal Marketplace website and those who purchase their plans directly)decreased to 329,000 from 369,000 in 2017, a drop of 39,858 New Jerseyans. This is the first decrease in enrollment since the Marketplace was established, wiping out the last two years of gains. This is especially disturbing as there are an estimated 149,000 New Jerseyans who are currently uninsured and eligible for premium subsidies.[7]

Insurance Has Become Unaffordable for Many Struggling New Jerseyans 

There was a greater decrease in the enrollment rate (14 percent) this year in the off-Marketplace than there was in the Marketplace (9.6 percent) because those New Jerseyans in the off-Marketplace must pay the full cost for their premiums, whereas 80 percent of New Jerseyans in the Marketplace receive federal subsidies.[8] The income limits for subsidies – $48,240 for an individual and $98,400 for a family of four – are modest given New Jersey’s high cost of living, especially with the recent increases in premiums. The full cost of average premiums for the standard plan in the Marketplace increased 19 percent in 2018, which is seven times the average rate of the previous three years of 2.5 percent. Much of that increase was caused by the expected elimination of the individual mandate and cost sharing reduction payments.

The 137,000 New Jerseyans who did not receive subsidies paid, on average, $900 more this year in premiums for a single individual and $3,600 for a family of four compared to the average premium over the last three years.[9] Given that premiums for a family of that size were typically over $20,000 per year before the Trump administration’s sabotage of the ACA, this year’s premium increase simply made insurance unaffordable for many New Jersey families.[10]

Family Enrollment in Medicaid Decreases for the First Time

For the first time since the start of its expansion in 2014, Medicaid enrollment decreased in fiscal year 2018 for parents and children. The sabotage of the Marketplace appears to be at least one of the causes for this decrease. About one quarter of everyone who enrolls in Medicaid does so through the Marketplace even though they can apply directly.[11] Up to 140,000 of these consumers are children and parents who were already eligible for Medicaid before the ACA but were unaware until they applied for assistance in the Marketplace. This exemplifies how cutbacks in outreach and advertisement for the Marketplace also affect Medicaid enrollment.

Before the Trump administration’s efforts to sabotage the ACA, New Jersey had projected an increase in Medicaid enrollment for 2018. Instead, 14,814 fewer residents enrolled between 2018. and 2017. Taking the state’s projections into account, there were 22,290 fewer parents and kids enrolled in 2018 than was expected. As the number of unemployed New Jerseyans has remained largely flat during this period, this decrease cannot be explained by economic factors.[12]

Trumps Anti-Immigrant Policies Suppress Enrollment in Medicaid and the Marketplace  

President Trump’s anti-immigrant rhetoric, federal policies, and proposals have done serious harm to Medicaid enrollment, especially in New Jersey, which has the fourth highest share of unauthorized immigrants in the nation.[13] The Trump administration’s overly aggressive actions to deport millions of unauthorized immigrants and its proposal to deny citizenship to legal immigrants if they or their child are on Medicaid discourages all legal immigrants from applying for Medicaid. This is especially true for undocumented parents who are afraid to enroll their citizen child because they fear the information will be shared with ICE and the parent will be deported. In New Jersey, one in six children have an unauthorized parent.[14] This problem is also leading to anecdotal reports that unauthorized parents are disenrolling their children in Medicaid. In 2016 there were an estimated 150,000 children covered by Medicaid/CHIP who had unauthorized parents.[15]

New Jerseyin Better Position than Most States, but Much More to Do to Achieve Universal Health Coverage

 Looking into the future, New Jersey is ahead of most states in working toward universal, affordable health coverage. New Jersey already has policies in place that prohibit the sale of junk plans, and the state recently enacted legislation that restores the individual mandate and establishes a reinsurance plan that will largely offset the hike in premiums caused by the Trump administration. Governor Murphy is also formulating an outreach plan that will maximize existing state resources, although it is unclear if funding will be restored for community-based organizations to perform the same functions as navigators.

While New Jersey has taken admirable steps to defend against attacks on the ACA, the state and its congressional representatives should not lose sight of the ultimate goal to provide universal health coverage. New Jersey’s uninsured decreased by about a third due to the ACA, but there are still approximately 700,000 New Jerseyans who are uninsured, and this number may be increasing again. It will be critical that the New Jersey’s congressional delegation reverse the Trump administration’s anti-ACA actions and improve the ACA to assist more people with more affordable coverage at all income levels.

New Jersey is limited in its ability to meet this challenge by itself, but there are realistic steps it can take to reduce the uninsured in New Jersey and reversethe Trump sabotage. It can start by passing legislation to fulfill the governor’s promise to cover all the remaining uninsured kids in New Jersey. This is achievable as approximately 95 percent of all children already have health insurance. The state should also consider a state takeover of the Marketplace, so it can extend the open enrollment period and make other improvements as other state Marketplaces have done. In addition, the state will need to vigorously advertise that New Jersey has replaced the federal individual mandate with a state mandate. New Jersey will also need to tackle the biggest challenge of all: how to reduce health costs while maintaining quality and access. Recent state enactment of surprise billing legislation that also eliminates inappropriate out-of-network costs and pending bills to limit prescription drugs are good first steps Over the last six months, New Jersey has been a model for stabilizing the health insurance market, but further bold action will be necessary to combat the Trump administration’s attempts to unravel the ACA.

 

Endnotes

[1] Decrease in enrollment in the individual market is from New Jersey Department of Banking and Insurance website and Medicaid enrollment is calculated from the SFY 2018 governor’s budget.

[2] Robin A. Cohen, Ph.D., Emily P. Zammitti, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A, National Health Interview Survey Early Release Program, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017, https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf

[3] The calculations for the lost Medicaid funding are explained in the table in the report. The lost funding in the Marketplace was calculated by multiplying the average premium subsidy in 2018 by the difference in the marketplace enrolment with subsidies in 2018 and 2017.  See average premiums at Kaiser Family Foundation website at https://www.kff.org/health-reform/state-indicator/marketplace-average-premiums-and-average-advanced-premium-tax-credit-aptc/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[4] Calculated by inflating the premium in 2017 in the marketplace by the average increase over the previous three years and comparing that to what was the actual increase in 2018 multiplied by everyone who did not receive a subsidy.

[5] Karina Wagnerman, New Study Finds Evidence of a “Chilling Effect” in 2016 Marketplace Enrollment,July 19, 2018, https://ccf.georgetown.edu/2018/07/19/new-study-finds-evidence-of-a-chilling-effect-in-2016-marketplace-enrollment/

[6] Halley Cloud, In Latest Sabotage Administration Nearly Eliminates Marketplace Enrollment Assistance Funds, July 13, 2018, https://www.cbpp.org/blog/in-latest-aca-sabotage-administration-nearly-eliminates-marketplace-enrollment-assistance-funds

[7] Kaiser Family Foundation, Distribution of Non-Elderly Uninsured Individuals,https://www.kff.org/health-reform/state-indicator/distribution-of-nonelderly-uninsured-individuals-who-are-ineligible-for-financial-assistance-due-to-income-offer-of-employer-coverage-or-citizenship-status/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[8] Kaiser Family Foundation, Effectuated Marketplace Enrollment and Financial Assistance, https://www.kff.org/other/state-indicator/effectuated-marketplace-enrollment-and-financial-assistance/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[9] See note 5. Divided total increase in premiums by everyone who did not receive a subsidy.

[10] NJPP analysis of plans in Healthcare.gov for 2018.

[11] DMAHS email responding to OPRA request by NJPP, December 12, 2017. The period is December 2006 to November 2017. Through marketplace: 134,761; Direct: 277,679.

[12] NJ Department of Labor, Major Indicators of Labor Market Activity for New Jersey Seasonally Adjusted 2017 Benchmark, https://www.nj.gov/labor/forms_pdfs/lwdhome/press/2018/20180719UITABLES.pdf

[13] Pew Research Center, U.S. Unauthorized Immigration Population Estimates, November 3, 2016, http://www.pewhispanic.org/interactives/unauthorized-immigrants/ http://www.njpp.org/wp-content/uploads/2018/02/NJPPCoverAllKidsJan2018.pdf

[14] Samantha Artiga, Kaiser Family Foundation, Potential Effects of Public Charge Changes On Health Coverage For Citizen Children, March 2018, https://www.kff.org/disparities-policy/issue-brief/potential-effects-of-public-charge-changes-on-health-coverage-for-citizen-children/

[15] Ibid.

 

Newest Trump Sabotage of Obamacare Could Make Health Insurance Unaffordable for Many New Jerseyans

Posted on by Raymond Castro

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

Despite recent progress made by New Jersey to keep health care coverage more affordable, the Trump administration continues to come up with new and harmful ways to do just the opposite. In New Jersey, premiums have already increased by about 20 percent in 2018 and enrollment in the individual market dropped by an unprecedented 40,000 residents. These newest actions would further undermine the health care marketplace, make insurance unaffordable for many more New Jerseyans, and could even increase the uninsured rate, which has dropped by about a third due to the Affordable Care Act (ACA).

There is a long list of actions the Trump administration has already taken to sabotage the ACA, but the most recent include the following:

1. Payments for New Jerseyans with the most serious health conditions in the individual and small employer market are halted

The Trump administration indefinitely suspended $64 million in payments to insurers in New Jersey to defray the cost of covering consumers with high health costs in 2017 in the individual and small (employer) group markets. The decision by the Centers of Medicare and Medicaid Services (CMS) not to redistribute funds to insurers for high need consumers, who often have preexisting conditions, is based on their refusal to challenge or remedy a court decision in New Mexico that invalidated their methodology for distributing “risk adjustment” payments. Those payments were to be made to insurers to compensate them for consumers who are, on average, unhealthier and therefore have higher medical costs. The federal government does not save any money for halting these payments because they are paid by other insurers that have healthier consumers.

Risk adjustment payments are necessary as the ACA requires that insurers accept anyone with pre-existing conditions. Because some insurers end up assisting more of these and other, sicker consumers than other insurers, they need additional compensation for those higher costs. These payments are crucial as they are the only remaining mechanism to compensate insurers for higher than usual consumer costs. Reinsurance ended in 2016 and Republicans in Congress defunded the risk corridor program in 2013.

While a system without risk adjustment payments creates winners and losers in the short term, all insurers lose in the long run because those insurers that have relatively healthy consumers in one year may have more unhealthy consumers in subsequent years. Because of the uncertainly of these payments, there will be pressure on all insurers to increase premiums next year. Ironically, in the CMS announcement about halting the payments, it praised the effectiveness of risk adjustment which has been in operation for three years. By suspending the payments indefinitely, CMS has caused more uncertainty in the individual and small group (employer) market which will lead to higher premiums unless this matter is resolved.

2. Federal funds for outreach slashed to near nothing

A few days after announcing the suspension of the risk adjustment payments, CMS announced that they were also slashing funding for navigators who help New Jerseyans with signing up for insurance and outreach. New Jersey’s funding was already cut 61 percent last year, decreasing the state’s allotment from $1.9 million to $720,000, one of the steepest declines in the nation. CMS’s decision to lower national funding next year by another 70 percent would result in New Jersey only receiving about $400,000. In effect, this would result in no meaningful outreach and assistance statewide.

3. Trump’s Nominee for the Supreme Court could end protections for pre-existing conditions for most New Jerseyans

Because of the ACA, there are 3.8 million New Jerseyans with pre-existing conditions who cannot be charged more if they lose their employer-based coverage and need to purchase insurance in the individual or small group market. However, the Trump administration has argued in a case filed in Texas that because Congress eliminated the individual mandate, the court should allow insurers to charge consumers based on their pre-existing conditions as they did in the past. This would price many consumers out of the market. This threat has become even more serious given that President Trump will appoint a conservative justice to the Supreme Court where this case could ultimately be decided if it is upheld in lower courts. Should the administration get its way on eliminating protections for pre-existing conditions, it could finally unravel the ACA.

New Jersey has taken major actions to protect consumers, but more help will be needed

Thanks to Gov. Murphy and the Legislature, New Jersey was the first state to restore the individual mandate after Republicans in Congress repealed it. This was needed to avoid individuals gaming the system by waiting until they were very ill before purchasing insurance, which would drive up the premiums for everyone else to defray their additional cost. It also discourages individuals from not obtaining insurance and instead going to an emergency room, which would be paid for by taxpayers in the form of charity care payments to hospitals. Most low-income individuals who seek insurance in the marketplace find that their premiums are greatly reduced by federal subsidies and, if they are eligible for Medicaid, there is no cost at all.

New Jersey is also the only state to use the revenues from the individual mandate to help fund a reinsurance program to reduce premiums for middle class families who receive no federal premium subsidies. It has also submitted a waiver to the federal government that would secure $244 million in federal savings starting in the first year and increase thereafter over five years. The combination of these two initiatives would reduce premiums by an impressive 15 percent from what they would be otherwise.

In addition, one of the first acts of Governor Murphy was to sign an executive order requiring all state entities that interact with the public “to provide information to the public regarding the Affordable Care Act and ways to enroll,” subject to budgetary constraints and law. Such a plan to achieve this objective is being prepared by the governor’s office.

These laudatory pursuits will significantly reduce the impact of Republican efforts to undermine the marketplace, but they will not totally eliminate all the harm that will occur. This sabotage would still result in an increase in premiums from what they would otherwise be and possibly more uninsured people. The most effective strategy is for the state and New Jersey’s Congressional delegation to continue to strongly oppose these federal efforts to disrupt the marketplace. However, if that opposition is not successful, the state will need to come up with even more new and creative ways to protect New Jerseyans.

 

“American Health Care Act” Would Have Been a Disaster for New Jersey

Posted on by Raymond Castro

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

May 4th marks a day of infamy in New Jersey and nationally, for it was on that day that Congress passed the American Health Care Act of 2017 in an attempt to “repeal and replace” the Affordable Care Act.

The stakes were particularly high for New Jersey because about 800,000 New Jerseyans – nearly 10 percent of the state’s population – obtained their health coverage through the ACA, either in the private individual marketplace or though the Medicaid expansion. Enactment of this bill would have caused irreparable harm to the state’s health, budget and economy.

To the credit of the New Jersey Congressional Delegation, 10 of the 12 members voted against it, including three of the five Republican members. While that was not enough to prevent passage in the House, the bill fortunately failed in the Senate. Here is what would have happened in New Jersey if this regressive bill had become law:1

Over Half a Million New Jerseyans Would Have Lost Health Coverage

  • 540,000 New Jersey residents would have become uninsured.
  • The uninsurance rate would have spiked by 50 percent (from 9.8% in 2016 to 14.7% by 2026).
  • The newly uninsured would have consisted of an equal number of New Jerseyans who had insurance in Medicaid or the Marketplace.

The Uninsured Would Have Spiked in All Congressional Districts

  • Tens of thousands of residents would have lost health coverage in all Congressional districts (see table).
  • Districts represented by Republicans would have seen a larger average percentage increase in the number of uninsured than districts represented by Democrats.

One in 10 New Jersey Adults Would Have Lost Coverage Due to the Effective End of the Medicaid Expansion

  • Enrollment would have likely fallen from 562,000 adults to 6,000 by 2027.
  • Eliminating the federal matching rate of 90 percent would have meant that New Jersey could not afford to maintain the Medicaid expansion.
  • New Jersey would have lost about $21 billion in federal funds for the Medicaid expansion over 7 years.
  • State costs for charity care would have increased by the hundreds of millions.

A Permanent Cap on Federal Medicaid Funds Would Have Threatened the Health of 1.6 Million Vulnerable New Jerseyans

  • The cap would have harmed everyone on Medicaid but especially seniors and people with disabilities because they represent about three quarters of Medicaid funding.
  • The already very low reimbursement rates to providers would have been reduced even lower which would have sharply limited access to critical medical care.

Premiums for New Jerseyans With Preexisting Conditions Could Have BecomeUnaffordable

  • Premium tax credits would be reduced by $7 billion in New Jersey over 10 years.
  • Instead of a share of a person’s income, premium credits would have been based on age.
  • Older New Jerseyans would have been hit with up to an 800% increase in the cost for their insurance, making it unaffordable for most of them.
  • Due to New Jersey’s own Congressman Tom MacArthur’s amendment, states would have been allowed to greatly increase premiums based on pre-existing conditions and eliminate essential benefits like hospitalization, maternity care and mental health or substance abuse treatment.

New Jersey’s Economy Would Have Been Disrupted and Thousands of Jobs Lost

  • New Jersey would have lost about $4.8 billion annually in federal funds which would have led to a $6.6 billion loss in economic activity and 54,000 jobs.

 

Endnotes

[1] For sources to all data, see Raymond Castro, House-Passed Health Bill Would End Coverage for More Than Half a Million New Jerseyans, New Jersey Policy Perspective, June 2017, https://www.njpp.org/healthcare/house-passed-health-bill-would-end-coverage-for-more-than-half-a-million-new-jerseyans

New Jersey Takes A Step Toward Restoring Health Care Mandate

Posted on by Raymond Castro

Today’s passage of legislation restoring the individual mandate is essential to keep insurance affordable and sends a powerful message to Washington that New Jersey will not allow the Affordable Care Act to be sabotaged. Despite New Jersey’s progress in reducing the number of uninsured residents, this measure is needed because there are still about 700,000 New Jerseyans without coverage.

This bill is critically important to stabilizing the health insurance market and will help make sure that insurance coverage remains affordable for as many New Jerseyans as possible. The state still has hundreds of thousands of uninsured residents and it is vital that we do all we can to make sure everyone can secure affordable health insurance and improve public health.

If New Jersey does not act the consequences will be dire. NJPP estimates that the number of uninsured in New Jersey will increase by about 300,000 over the next decade; premiums will rise about 10 percent; the state will lose billions in federal Medicaid funds and premium subsidies; and taxpayers will be hit with a much bigger bill for charity care payments to hospitals.

Importantly, the revenues collected from the penalties can be used for a reinsurance plan that will decrease the cost of providing health coverage for very sick individuals, thereby further reducing premiums for these families as well as generating federal funds( if a waiver is approved). This bill (S-1878) also passed today.

The penalty should encourage younger, healthier people to obtain insurance, spreading the risk in the health insurance pool. Without robust participation of these individuals, insurance premiums will climb and the market could destabilize.

This bill will mainly help 150,000 middle-class New Jerseyans who purchase their insurance directly since they are not eligible for federal subsidies under the Affordable Care Act and therefore must pay for the full cost themselves. Since premiums already increased this year in anticipation of the repeal of the mandate, these families would save up to $76 million next year by its restoration.

Currently a four-person family must pay about $23,000 a year; when the maximum out of-pocket costs are added, the total cost increases to $37,700, which guarantees that insurance is unaffordable.

Lower-income families will also benefit because the proposed legislation will encourage many uninsured to seek out more-affordable insurance. National research shows most of these individuals are eligible for federal subsidies and that about half are eligible for a plan that costs less than the penalty they may otherwise have to pay. Due to the mandate, over 100,000 New Jerseyans found out they were eligible for Medicaid – which has no cost sharing – when they searched the Marketplace for insurance.

The bill also applies the penalty to anyone who purchased a plan that does not meet the essential benefits requirements in the ACA or New Jersey law. This measure was added to prevent short term and association plans – sometimes called “junk plans” which are being pushed by the Trump administration to circumvent the ACA – from being sold in New Jersey.

Passage of 'Out-of-Network' Bill a Historic Step Forward

Posted on by Raymond Castro

The legislature made history today by finally passing legislation (S-485) that will help to address surprise billing and the high cost of health insurance. This is critical as polls show that a primary concern of New Jerseyans is the high cost of health care. While this legislation is extremely important and welcomed, more legislation will be needed in the future to bring down these costs.

Simply put, insurance is becoming unaffordable in New Jersey, especially for middle class families who are not eligible for public coverage or subsidies. While it took many years to finalize this bill, it demonstrates that the legislature can take on powerful interest groups and establish policies that will benefit consumers.

The average cost for a family with employer-based coverage is about $18,000, the 13th highest amount in the nation. This affects the family, but also the employer which shares in the cost and is one of the main reasons why the number of New Jerseyans covered by small employers has dropped by half since 2010 (from 740,000 to 371,000). This problem is even worse for families who do not have employer- based coverage and must pay the entire cost for coverage in the individual market; a four-person family typically pays about $23,000 in premiums, plus cost sharing, which often represent between a quarter to a third of their gross income.

This bill addresses this problem in two major ways. First, it provides new protections and transparency for New Jerseyans to avoid surprise billing, including a prohibition on balanced billing. In a 2016 report on this issue, NJPP estimated that 168,000 New Jerseyans receive surprise bills from their health providers annually. These bills amount to $420 million and average about $2,500 per person. Under this legislation, many of these individuals would no longer receive a bill or, if they did, they would know about it before they agreed to medical treatment. New Jerseyans who obtain their insurance in the individual or small group market, Medicare or Medicaid, and the health system for public employees already have some – but not all – of these protections, however many of the 3.8 million New Jerseyans in self-insured employer-based plans do not.

The second way in which this bill will reduce costs is that it addresses the problem of health providers that submit claims to insurers for exorbitant, inappropriate costs by requiring a fair and expedited method to arbitrate bills when there is no agreement on what should be paid. In effect a small number of health providers can charge significantly higher bills by going out of network.  NJPP estimated that the total claims submitted to insurers for out of network costs amounted to about one billion dollars in New Jersey, much of which are passed along in higher premiums and cost sharing to five million New Jerseyans with commercial insurance. The new arbitration system also benefits many health providers because it provides a quick and fair method to resolve billing disputes.

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