Philadelphia Inquirer

Christie Quietly Reaps Obamacare Budget Benefits

The Philadelphia Inquirer — Sunday, March 1, 2015

By Andrew Seidman, Inquirer Trenton Bureau

Gov. Christie's proposed budget for the fiscal year that begins July 1 assumes hundreds of millions of dollars in savings achieved through the expansion of Medicaid under President Obama's health-care law.

But in a budget address last week devoted almost entirely to the costs of public employees' pensions, Christie notably did not mention how much the Affordable Care Act has helped New Jersey residents and the state's tight finances.

Two days after his budget address in Trenton, the governor traveled to Maryland for a conference of conservative activists, where attendance was all but mandatory for 2016 GOP presidential hopefuls. The vociferous opposition to the health-care law there might explain why Christie isn't trumpeting his partial acceptance of Obamacare at home.

"Obamacare is a train wreck," Sen. Ted Cruz (R., Texas), a crowd favorite, said at the gathering, "and that's actually not fair to train wrecks."

"We must repeal every single word of Obamacare," Louisiana Gov. Bobby Jindal said to applause.

High court action

Such rhetoric is likely to ratchet up as the U.S. Supreme Court hears oral arguments Wednesday in a lawsuit that challenges federal subsidies for people in 37 states, including New Jersey and Pennsylvania, which did not establish their own insurance exchanges.

A ruling against the Obama administration could affect health insurance for more than 200,000 New Jersey residents who gained subsidies through the federal marketplace and raise the cost of premiums for others. A ruling is expected in June. The case doesn't involve Medicaid, the government-funded health-care program for the poor.

Patrick Murray, director of the Monmouth University Polling Institute, said Christie wouldn't suffer politically from such a ruling.

"He can blame it on the federal government for not setting this up properly," Murray said.

'Very appropriate'

In a briefing last week, state Treasurer Andrew Sidamon-Eristoff said 390,000 New Jersey residents had signed up for Medicaid since the state expanded the program Jan. 1, 2014. An additional 250,000 have gained health insurance through the federal marketplace on healthcare.gov, he said.

As a result, he said, the number of claims submitted to the state through hospital charity care — the program through which the state covers medical expenses for the uninsured — has declined substantially.

The shift has saved the state about $150 million, Sidamon-Eristoff said, some of which will be invested in graduate medical education and increased funding for Medicaid physician reimbursement rates.

"We feel this is a very appropriate opportunity to realize some savings for the state's taxpayers," Sidamon-Eristoff said.

Christie's total fiscal 2016 budget calls for $33.8 billion in spending.

The Department of Human Services projects that the state will save an additional $417 million because of Medicaid expansion in fiscal 2016 and about $2 billion more through fiscal 2020.

That's because some 175,000 individuals eligible for Medicaid or NJ FamilyCare before implementation of the new federal law were deemed "newly eligible" for Medicaid after the state expanded the program to adults earning up to 138 percent of the federal poverty line, or under $16,000 a year for a single adult.

Where the state used to share the cost of that population's medical expenses with the federal government, the feds are now covering 100 percent of the bills. Federal reimbursement will drop to 90 percent by 2020, and the state will pay 10 percent.

The Affordable Care Act will impose about $75 million in taxes and fees on the state's health-care system in fiscal 2016, according to Christie's budget.

The law also helped workers laid off amid casino closings last year in Atlantic City, said Maura Collinsgru, health-care program director for New Jersey Citizen Action, a nonprofit consumer group.

Although Christie vetoed legislation that would have established a state exchange through which individuals could sign up for federal health insurance, he did decide to expand Medicaid.

'The smart thing'

In his February 2013 budget address, Christie said he opposed the Affordable Care Act but described Medicaid expansion as "the smart thing to do for our fiscal and public health."

He added, "If that ever changes because of adverse actions by the Obama administration, I will end it as quickly as it started."

In addition to Christie, other high-profile Republican governors, such as Mike Pence of Indiana and John Kasich of Ohio, expanded Medicaid in their states.

Govs. Scott Walker of Wisconsin and Jindal in Louisiana did not expand, nor did former Gov. Rick Perry of Texas. Each appeared at the Conservative Political Action Conference last week and is considering running for president.

New Hampshire State Sen. Jeb Bradley, a Republican who voted to expand Medicaid in his state, said governors such as Christie and Kasich could "make a case that it's not just about expanding an entitlement," since emergency-room visits by the uninsured cost taxpayers anyway.

"I don't think it hurts [Christie] that much," said Bradley. "Maybe a little bit."

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