The New York Times

New Jersey To Consider Health Plan To Cover All

The New York Times — Tuesday, March 18, 2008


TRENTON — Thrusting New Jersey again into the vanguard of social change, a bipartisan group of legislators unveiled a proposal on Monday that would require all residents to have health care coverage within three years.

If adopted, New Jersey would become the fourth state to require universal health coverage, following Massachusetts, Maine and Vermont. But at a time when New Jersey is reeling from financial problems, and the country appears headed toward a recession, the plan would avoid adding to the budget and would instead try to redistribute federal and state dollars in a more efficient way.

About 1.4 million of New Jersey's residents – or nearly 1 in 5 – do not have health insurance. To bridge that gap, State Senator Joseph F. Vitale, a Democrat from Middlesex County who is chairman of the health committee, recommended that the state focus first on enrolling more children in the existing NJ Family Care program for families who earn as much as 350 percent of the federal poverty level, or about $74,200 for a family of four.

Then, Mr. Vitale said, the state would focus on cutting costs while establishing a self-financed plan, run by the state, to provide individuals with health insurance at affordable rates on a sliding scale.

The insurance would be required, not an option: Residents would need to prove they have health insurance, similar to the way drivers must obtain auto insurance. It would be financed, Mr. Vitale said, by using small surpluses in NJ Family Care and Medicaid and revamping the costly and much-maligned system of Charity Care, under which the state reimburses hospitals for costs associated with caring for the poor, often in emergency rooms.

"Through these reforms, we will become better stewards of our limited health care dollars, by using those dollars to cover the uninsured, rather than by throwing those dollars away on inappropriate care in an inappropriate setting, like we do today," said David L. Knowlton, president of the New Jersey Health Care Quality Institute, a nonprofit foundation. Mr. Knowlton, a Republican, is a former deputy commissioner of health under former Gov. Thomas H. Kean.

The sponsors said that they hoped to introduce legislation formalizing the proposal in the next few days. They also said they would like to enact it before the July 1 budget deadline.

Gov. Jon S. Corzine, a Democrat, has said he favors universal health care. But given the state's fiscal difficulties, he offered a guarded assessment of the legislators' proposal.

"The public is well aware that there is nothing closer to my own agenda than providing universal health care," Mr. Corzine, who traveled to Albany on Monday to attend Gov. David A. Paterson's swearing-in ceremony, said in a statement. "But I'm a realist, and I understand that the current budget circumstances may inhibit our ability today to reach that common goal."

New Jersey has long had a reputation of being one of the more aggressive states in trying to expand health care, said Sonya Schwartz, program manager for the National Academy for State Health Policy in Washington. In December, for instance, the state reached an agreement with Horizon Blue Cross Blue Shield allowing middle-income families to obtain health insurance for children at lower rates – at a loss of up to $1 million in the first year for Horizon.

But now, New Jersey will be trying to learn from – though not necessarily copy – the example set by, most prominently, Massachusetts.

New Jersey's plan would be similar in that the responsibility for obtaining the insurance would rest with residents and would expand existing state and federal health insurance programs. But unlike Massachusetts, New Jersey would use a single plan administered by the state rather than requiring individuals to buy such a plan in the private market, which Mr. Knowlton said drove costs higher.

"The Massachusetts model is one we don't want to follow," said State Senator Robert W. Singer, a Republican from Ocean County. "We do not want a Band-Aid approach. We want a permanent solution."

Initially, key interest groups representing employers and health care providers applauded the proposal as laying a solid foundation for reducing costs and moving the state closer to universal coverage.

"While most of our members provide health insurance, those that don't have consistently said the cost is what is preventing them from purchasing insurance," said Jim Leonard, a vice president with the New Jersey Chamber of Commerce. "This initiative will make health insurance more affordable."

But some unions and consumer groups reacted tepidly, saying it could prompt employers to drop health insurance plans.

"Of grave concern is the proposal's underlying policy that seeks to shift the cost of coverage away from a shared responsibility between employers and employees," said Phyllis Salowe-Kaye, executive director of New Jersey Citizen Action. "Senator Vitale's proposal would have insurance costs borne solely by consumers and taxpayers."

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