NJ Spotlight

NJ Democrats – And A Few GOP Colleagues – Gear Up To Deal With ACA Repeal

'Repeal and replace' could cost state billions and would almost certainly affect quality of healthcare available to poor and middle-class residents

NJ Spotlight — January 17, 2017

By Lilo H. Stainton

Spurred by President-elect Donald Trump and Republican leadership, Congress has approved a legislative mechanism that will enable them to quickly "repeal and replace" the federal Affordable Care Act. But opposition is building quickly.

In New Jersey, Democrats have also begun to assemble a response, assessing how ending Obamacare would impact New Jersey's vulnerable patients, the healthcare industry, and the state budget, which may need to absorb hundreds of millions — if not billions — of dollars in expenses now borne by the federal government. And they have support from a growing group of healthcare advocates, labor unions, and even some physician and hospital alliances — some of whom had questioned benefits of the law early on.

Democratic leaders in the state Senate and Assembly underscored the importance of the ACA recently, including during reaction to the State of the State address delivered by Gov. Chris Christie last week, which focused largely on drug addiction but barely mentioned the landmark law.

The following day, Senate Budget Committee Chairman Paul Sarlo (D-Bergen) sounded the fiscal alarm. Sarlo said not only would repealing the law endanger residents' health, but also it would potentially cost state taxpayers billions to maintain existing health coverage and hundreds of millions in additional hospital costs. "The budget implications in New Jersey would be extremely serious," he wrote in a letter that ran in some publications as an op-ed.

Sen. Joseph Vitale, (D-Middlesex), the health committee chairman, has begun to put together a working group of experts to figure out how the state could continue to provide the benefits of the program, which has extended insurance coverage to some 700,000 Garden State residents and reformed coverage in one way or another for millions more.

"This group will contemplate any and all movement from Washington and our options," Vitale said. The architect of what is now NJ Family Care, Vitale has led efforts to extend Medicaid coverage to working poor families and their children for more than 15 years, a program long considered a national model.

Nationwide, the ACA has grown to cover nearly 30 million Americans since it took full effect in 2014. The law has also prompted a range of reforms to improve primary care for patients by providing free cancer screenings and preventative care and make insurance more accessible to those who had been excluded in the past by eliminating bans on pre-existing conditions, among other changes. Democrats in Congress have said eliminating the most controversial tax and fee elements would create a $350 billion hole in the federal budget over the coming decade.

But on Friday, Congress approved a budget resolution that, among other things, instructs staff to continue to craft a plan to dismantle the ACA and blocked the ability of Democrats in the minority to filibuster on the issue, greatly diminishing their procedural leverage in the pending fight. House Speaker Paul Ryan (R-Wisconsin) has continued to push for a reform based on his "Better Way" blueprint that would shift Medicaid to the states and provide a limited block of funding. (Ryan's plan also calls for an overhaul to Medicare.)

While Trump made overturning the ACA a campaign priority, any specifics on his own goals for changes remain largely unclear.

New Jersey Sen. Robert Menendez (D-Union), blasted the vote Friday and called protecting the ACA "a fight for our lives," while Sen. Cory Booker termed a repeal "reckless, dangerous and cruel." Nine Republicans broke ranks to join Democrats in opposing the resolution Friday, including the Garden State's Tom MacArthur, (R-Ocean) who represents an area along the Jersey Shore.

New Jersey Citizen Action, a leading patient-advocacy organization, praised MacArthur and the state's Democratic representatives in Washington, D.C., for "acting to preserve the coverage and protections for all New Jerseyans now guaranteed by the ACA," according to a statement from Maura Collinsgru, the healthcare policy director. "We urge the rest of the Republican members to join with them in resisting attempts to repeal the ACA without a replacement that would guarantee the same level of coverage and protection for all our residents."

As part of a national campaign, members of the Health Professional and Allied Employees union, the state's largest group of healthcare laborers, planned to spend Sunday handing out pamphlets with information about the impact of a repeal at healthcare facilities around New Jersey. HPAE leaders were also scheduled to speak at rallies in Camden and Newark calling on Congress to withstand any repeal efforts.

In addition to the healthcare concerns posed by a repeal, Sarlo noted an end to the law could have significant budget implications for a state like New Jersey. The federal government now provides the state some $3 billion to cover the nearly 500,000 residents who gained protection through the Medicaid expansion portion of the law, he said, and it's not clear how much of this could fall to state taxpayers in future years.

In November, New Jersey Policy Perspective, a liberal think tank, released a report that predicted a full repeal could leave the state on the hook for up to $3 billion in the first year alone, as well as endangering the jobs of some 24,000 healthcare workers and $4 billion in economic activity — and reducing the quality of care available to those who could still afford coverage.

A repeal would also impact state funding for hospitals, Sarlo noted. As the ACA's coverage enabled more patients to get preventative care, hospitals began to see a decline in the number of uninsured residents they treated, which reduced their Charity Care caseload and allowed the state to cut $350 million from the taxpayer-funded pool it uses to help hospitals cover these costs.

"A repeal of the ACA would create a situation that would force these patients to revert to obtaining routine healthcare services from hospital emergency rooms rather than primary-care offices and urgent-care centers. As a result, New Jersey would be forced to pour hundreds of millions back into Charity Care," Sarlo wrote.

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