All state-run plans would be required to cover basic services and not penalize patients with preexisting conditions
Gov. Phil Murphy said a passel of new laws he just approved will help protect New Jersey residents from federal actions to undermine the Affordable Care Act, building on his administration’s ongoing efforts to claim greater responsibility for the program’s operation and oversight.
Murphy signed nine bills into law Thursday that would essentially ensure certain health insurance benefits remain in place for Garden State residents, even if the federal program is further reformed or fully repealed. The Legislature approved the Democratic measures earlier this month.
“We’re too exposed if we’re relying on an unsettled, if not hostile, reality in Washington. We have to protect ourselves,” Murphy said at an event held at Hackensack Meridian Health (HMH)’s JFK Medical Center in Edison. New Jerseyans should not “wake up one day and find out their health care has been stripped away from them.”
Among other guidelines, the new laws — some of which took effect immediately — would require all health insurance plans regulated by the state to cover basic services, including emergency room visits, maternity care and mental health treatments, and not exclude or charge extra for patients with preexisting conditions. The insurers would also have to permit children to remain on their parent’s plan until age 26 and invest at least 85% of premium revenue in patient care.
Assemblywoman Joann Downey (D-Monmouth), a sponsor of the preexisting condition bill, said the ACA’s passage changed the lives of millions of residents with long-standing medical issues. “We cannot go back to a world where people had less access to critical medications or treatments because of poor insurance coverage,” she said. “With this law, we ensure that will never happen in New Jersey.”
Murphy said these reforms, which protect coverage for an estimated 1.7 million residents, will complement the state’s work to expand ACA enrollment outreach and take control of the health insurance exchange, or marketplace, from the federal government. The marketplace is an online platform for individuals and small businesses seeking to buy commercial coverage.
Earlier this month, state officials announced that two private companies would carry out much of this work. GetInsured was chosen to build the site, which is slated to become active later this year. (The technology company has built similar sites for four other states, including California.) MAXIMUS, a 40-year-old company that assists the federal government with multiple health programs, will provide customer assistance.
Achieving larger goals
All of this work aligns with larger goals of protecting and improving quality of care while better controlling health costs, Murphy explained during what was billed as a “fireside chat” with HMH CEO Robert C. Garrett, but was in fact more of a “flower-side” armchair conversation on a stage at the Edison hospital. In his State of the State speech on Tuesday, Murphy hinted at plans to create the Office of Affordability and Transformation within the Governor’s Office to help tackle this goal.
New Jersey has some of the best hospitals and medical research facilities in the U.S., Murphy said, but individuals, families and businesses still struggle to afford and access effective care. “Our job is, collectively, to still keep the quality high and to make sure New Jersey is still the place where people come to get treatment and do research,” he explained, “and to make sure we can make [health care] a right, and not a privilege, for everybody.”
The ACA, or Obamacare, has helped improve health care access significantly in New Jersey, Murphy said, calling it a “game changer, but not perfect.” The law enabled the state to add some 500,000 people to its Medicaid program, with the federal government shouldering much of the cost. (The Commonwealth Fund released a report Thursday that shows the law also helped increase health equity, in New Jersey and nationwide.)
In addition, the ACA enabled nearly 300,000 New Jerseyans who don’t have insurance through work to access quality commercial plans, and two-thirds qualified for federal subsidies to help offset the monthly cost. The federal law also provided new benefit protections (like coverage for those with preexisting conditions) for all kinds of commercial insurance customers. But more than 3 million of these residents have insurance plans regulated by the federal government — not the state Department of Banking and Insurance — and therefore would not be protected by the state laws Murphy signed Thursday.
Garrett agreed that while not flawless, the ACA has made a “big difference” for patients and health care providers in New Jersey. Patients who lacked coverage once flooded emergency rooms for routine care, he said, while today they are more likely to have a regular doctor they can see. “We’re in a much better state in health care with it than we were without it,” he said.
“I’m really in favor of building on the success of the Affordable Care Act,” Garrett continued, as opposed to repealing or totally reforming the law, like the Trump administration and some GOP leaders in Washington have urged. “Let’s not go back in time. That doesn’t serve our state; it doesn’t serve our country well,” Garrett said.
‘We need to take care of our own’
Given the federal instability related to the ACA, Garrett said he “applauded the governor” for the bills he signed earlier that day, which he noted will “make a profound difference” for New Jersey patients. “What’s going on in Washington, who knows what’s going to happen. So we need to take care of our own,” he added.
New Jersey has taken deliberate steps under Murphy to shore up the ACA protections, starting with implementation of the state-based individual mandate — a tax penalty for not having health insurance — which took effect last year, when the federal mandate ended. The governor also invested in significant public outreach during the fall enrollment period, filling a gap left when the Trump administration suspended most of the federal funding for these tasks.
Last July, Murphy signed a law to enable New Jersey to create its own health insurance exchange instead of relying on the federal ACA marketplace system and website, making it the 12th state to take on this role. Officials said the shift gives New Jersey greater control over the cost and quality of the plans sold, as well as the enrollment process.
Protecting the ACA is critical, as it’s helped New Jersey address its “mountain” of health care challenges, Murphy said. “We are more than halfway up the mountain. It’s made a huge difference for so many lives in our state. Let’s make sure we don’t slip back down that mountain.”
The nine bills Murphy signed into law:
A-5500 – Sponsored by Assembly members Louis Greenwald (D-Camden), Yvonne Lopez (D-Middlesex) and Pamela Lampitt (D-Camden), and Sens. Nellie Pou (D-Passaic) and Joe Lagana (D-Bergen). Expands the rate review process in the Department of Banking and Insurance for certain individual and small employer health benefit plans, giving the state power to review rate hikes over a certain threshold.
A-5501 – Sponsored by Assembly members John McKeon (D-Union), Valerie Vainieri Huttle (D-Bergen) and Shanique Speight (D-Essex), and Sens. Pou and Loretta Weinberg (D-Bergen). Requires continuation of health benefits for a parent’s dependent until child turns 26.
A-5503 – Sponsored by Assemblywomen Verlina Reynolds-Jackson (D-Mercer) and Lisa Swain (D-Bergen), and Sens. Joseph Vitale (D-Middlesex) and Joe Cryan (D-Union). Establishes open enrollment period under Individual Health Coverage Program to assure that those using the health insurance exchange have adequate time to sign up each year.
A-5504 – Sponsored by Assemblymen Daniel Benson (D-Mercer) and Gary Schaer (D-Bergen), and Sens. Cryan and Patrick Diegnan (D-Middlesex). Applies 85% loss ratio requirement to certain large group health benefits carriers, which requires insurers to invest this percentage in patient benefits.
A-5506 – Sponsored by Assemblymen P. Christopher Tully (D-Bergen) and Joe Danielsen (D-Somerset), and Sens. Troy Singleton (D-Camden) and Diegnan. Repeals statute authorizing offering of “basic and essential” health benefits plans under individual health benefits plans and other statutes concerning basic health plans; makes conforming amendments. These basic and essential plans do not conform to ACA requirements.
A-5507 – Sponsored by Assemblymen McKeon, Herb Conaway (D-Burlington) and Raj Mukherji (D-Hudson), and Sens. Pou and M. Teresa Ruiz (D-Essex). Requires health benefits coverage for certain preventive services, like cancer screenings.
A-5508 – Sponsored by Assembly members Andrew Zwicker (D-Monmouth), Carol Murphy (D-Burlington) and Shavonda Sumter (D-Passaic), and Sens. Ruiz and Pou. Revises law requiring health benefits coverage for certain contraceptives to expand access to birth control.
A-5248 – Sponsored by Assemblymen Conaway, Mukherji and McKeon, and Sens. Nia Gill (D-Essex) and Singleton. Preserves certain requirements that health insurance plans cover essential health benefits, like emergency room care, maternity care, addiction treatment and mental health services.
S-626 – Sponsored by Sens. Vitale and Diegnan, and Assembly members Vainieri Huttle, Nicholas Chiaravalloti (D-Hudson), Downey and Joe Danielsen (D-Somerset). Clarifies prohibition on preexisting condition exclusions in health insurance policies to ensure those with long-standing health issues can still access coverage.