Christie Urged To Expand Medicaid

The Record ( — Monday, February 25, 2013

The Record

A coalition of health care advocates and other groups is pressing Governor Christie to announce the expansion of the state's Medicaid program for poor people during his annual budget address Tuesday.

The federal government has told states it will pick up the entire cost of expanding Medicaid for three years beginning in 2014. Afterward its contribution would be gradually reduced by 10 percent.

New Jersey is one of only 11 states still undecided about the expansion, which is part of the federal health care overhaul.

According to estimates from the Rutgers Center for State Health Policy, the expansion would make more than 300,000 of the state's 1.3 million uninsured eligible for coverage, with about 230,000 people expected to enroll.

This is "one of the most important things we can do in New Jersey to fix our broken health care system," said Dena Mottola Jaborska of New Jersey Citizen Action at the press conference.

Others, however, said they fear expansion would end up causing the state to spend money it can't afford to cover more low-income residents.

The Supreme Court last year gave states the option of refusing to expand Medicaid when it upheld the main part of the Affordable Care Act — a requirement that most individuals buy health insurance or pay a tax. Twenty-two states, including seven led by Republican governors, have already announced they'll use federal subsidies to expand their Medicaid programs. Last week, Florida Gov. Rick Scott, a vocal opponent of the health care law, reversed himself on Medicaid expansion, and over the weekend a deal was struck to expand it in Virginia, also led by a Republican governor.

Expansion would be "a win-win for New Jerseyans," said Ray Castro of New Jersey Policy Perspective, a progressive think tank. Not only would it help those who can't afford insurance, it would save the state money and boost the economy, he said.

The governor has not indicated which way he is leaning. While he was not among the governors whose states sued to block the health-care law in 2010, he has refused to participate in a key initiative of health reform, heath insurance marketplaces where people can buy insurance. Last month, he decided that New Jersey would not run such an exchange or partner with the federal government to do so. He left the design and operation of the exchange to the federal government.

The governor's staff and commissioners are taking a careful look at the impact of the decision, rather than basing it on ideology, said Suzanne Ianni, president of the New Jersey Hospital Alliance, representing the state's urban safety net hospitals, which care for large numbers of poor and uninsured patients. Her organization favors expanding insurance coverage to more state citizens.

While there is no deadline for a decision, efforts to reach potential enrollees — almost all of whom currently lack insurance and are unaware of changes in the law — would need to start soon, advocates said. If the state chooses to expand, enrollment for childless adults with incomes up to 138 percent of poverty, or about $15,000, would begin on Oct. 1 for coverage starting Jan. 1, 2014.

The federal government is to pay the entire cost of the expansion for three years beginning in 2014. Afterward, states would be responsible for 10 percent. The federal government would also pick up New Jersey's current share of the cost for some adults who already are eligible for Medicaid and NJ FamilyCare.

Overall, the state would save about $2.5 billion over nine years, said Castro. "This is a very good deal for our state," he said at the news conference Monday. "New Jersey is actually going to do better than most states."

But the state's eventual commitment of 10 percent would total $1.5 billion over seven years, money the state can't afford, said Steve Lonegan, of Americans for Prosperity, a group affiliated with the Tea Party. "It's an explosion of government," he said, and a shift away from American traits of individual responsibility and charitable giving.

"The people of New Jersey will be left holding the bag on this," he said.

The Medical Society of New Jersey, which represents the state's doctors, said New Jersey should address underlying problems in its Medicaid program before expanding it. Few doctors accept new Medicaid patients because of the state's historically low reimbursement rates, said Lawrence Downs, the society's chief executive officer.

"We need to make sure it's paying a fair fee for the services provided" and that the provider networks in Medicaid's managed care plans are adequate, he said.

Advocates say federal subsidies of about $1.7 billion annually would not only enable people who currently lack insurance to get coverage, but would flow through the state's economy, sustaining hospitals and creating new jobs.

Hospitals last year spent about $1.3 billion to provide care to the uninsured, and received $675 million from the state to compensate for those costs, said Kerry McKean Kelly, a spokeswoman for the New Jersey Hospital Association.

"We support efforts to insure more New Jersey residents, including Medicaid expansion," she said. "But we do respect and understand the need for more independent analysis about the cost impact and potential benefits for our state."

The news conference at the State House included representatives of the AARP, a Latino group, a health care union, a public-interest law group, the Greater Newark Healthcare Coalition, the New Jersey Association of Mental Health and Addiction Agencies and the state chapter of the American Heart Association.

A poll last fall by the Eagleton Institute of Politics found that a majority of 57 percent of voters said Medicaid eligibility should be expanded so that more poor people could gain health coverage in New Jersey.

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