Burlington County Times

NJ Groups Sound Alarm About Possible Trump Rollback To Medicaid Expansion

Burlington County Times — November 28, 2016

By David Levinsky, staff writer

TRENTON — Nearly 20,000 Burlington County residents may be in danger of losing their tax-funded health insurance if President-elect Donald Trump and leaders of the Republican-controlled Congress follow through on their promises to repeal and replace the Obama administration's health care reform law, the Affordable Care Act.

They are among the half-million-plus New Jerseyans who obtained coverage under the law's expansion of Medicaid, the state-run insurance program for the poor.

What changes the Trump administration might make to the law, also known as "Obamacare," are still uncertain, but already New Jersey proponents of the law are sounding the alarm, particularly about the potential for the new administration to roll back the Medicaid expansion or make other changes, such as transforming the federal share of Medicaid funding into a federal block grant.

"I can't recall a proposal that would cause as much harm to New Jersey," said Ray Castro, a senior policy analyst with left-leaning think tank New Jersey Policy Perspective on Monday during a conference call with reporters. "It would have a major impact in all areas of the state."

Castro isn't alone in expressing concerns. Joining him on the press call were Rep. Frank Pallone, D-5th of Long Branch, as well as representatives from the New Jersey Hospital Association and advocacy group New Jersey Citizen Action.

All of the officials said repeal of the Affordable Care Act would be bad policy, but they singled out the potential rollback of the Medicaid expansion as particularly egregious.

The 2014 expansion was optional for states, but has been described as a crucial component of the law and its goal of extending coverage to millions of Americans who were previously uninsured.

The health care law allowed states to open Medicaid to all adults with incomes at or below 138 percent of the federal poverty level, with all costs paid by the federal government through 2016 and 90 percent paid through 2020.

New Jersey was one of 31 states and the District of Columbia that signed onto the expansion and with it the extra federal dollars.

Gov. Chris Christie, who was an outspoken critic of the Affordable Care Act before and during his failed presidential campaign, was one of only a handful of Republican governors who opted to go along with the expansion when it became available, saying at the time that he opposed the law but that the expansion was the right move for New Jersey.

Christie has since touted the impact the Medicaid expansion has had in the Garden State. In late August, he said 566,655 more residents had enrolled in the program since the expansion, including 336,141 newly eligible adults and 101,644 adults and children who were previously eligible but were not enrolled.

According to New Jersey Policy Perspective, about 19,500 Burlington County adults have enrolled since the expansion, including 6,300 parents with children and 13,200 adults without children.

A total of 1.7 million residents are now insured under the program.

During his presidential campaign, Trump repeatedly promised to put a stake through the Obama administration's signature health care law.

Since his surprise election, he has not provided many specifics about how soon the law could be repealed and what might replace it, other than to say that some of the more popular components might be saved, such as the prohibition on insurers denying coverage to individuals due to pre-existing health conditions and permitting young adults to remain covered under their parents' policies.

The billionaire businessman has said he supports Medicaid block grants, which would give more states more autonomy in running the program but may also limit the federal expense.

Block grants could also permit states to adopt requirements for participants such as mandating that enrollees work or participate in job training, or pay premiums or payments into health savings accounts.

Pallone, one of the chief architects of the reform law, warned that while the discussed changes could provide a way to reduce or limit federal funding, they could also raise states' costs and force them to cut benefits or eligibility.

"All these changes involve money because they don't want to pay for any of it," he said Monday during the press call.

Pallone warned that Republicans in Congress could succeed in repealing most of the reform law with a simple majority through budget reconciliation. He said gutting the law would backfire as millions would lose coverage, and with it the benefits of preventive medical care and other cost-saving services such as substance abuse and mental health treatment.

Christie has also cited those services in touting the benefits of the expansion.

There have also been financial benefits for New Jersey's government to the tune of about $1 billion a year since Medicaid expansion, Castro said. He said repealing the law would likely cost the state at least a half-billion going forward.

Hospitals would also suffer because uninsured patients would return to using emergency departments as their primary medical provider, officials said.

"Sending these individuals back to the emergency rooms is not only bad for patients, but would put additional strain on hospitals," said Neil Eicher, vice president of government relations and policy for the New Jersey Hospital Association.

The Affordable Care Act also cut Medicare reimbursement for hospitals with the promise that hospitals would be treating more insured patients because of the Medicaid expansion and more affordable coverage through federal subsidies.

Eicher claimed that rolling back the expansion would be "devastating" to New Jersey hospitals.

"Quite frankly, some hospitals would not survive it," he said.

Maura Collinsgru, health care program director for New Jersey Citizen Action, said her organization was focused on the law's impact on families and in outreach to boost enrollment numbers. She said it's her hope that some Republican lawmakers might reconsider supporting repeal if they understand the consequences in their home states and districts.

"All of this is based on the fundamentally flawed idea that the ACA was a failure," Collinsgru said. "Not only have individuals benefited, but the entire health system has benefited and the state has benefited."

Christie's press office did not respond to a request for comment. The governor, who is a longtime friend of Trump and an occasional adviser, previously said that if asked he would encourage Trump to give states "flexibility to do Medicaid expansion as they see fit."

"When they give us the flexibility to do it, not only have those states expanded Medicaid and provided more care, they've done it in a way that's more cost effective," Christie said during an August news conference. "I think we need to get away from the federal government that thinks it can do this better than the state."

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