NJ Advocates Warn That Affordable Care Act Remains Under Attack

The law remains in effect pending the lower court’s review and an appeal to the U.S. Supreme Court appears likely. But advocates claim the uncertainty surrounding the future of the law has already had a “chilling” effect on enrollment and that the threat to the law is both real and alarming.

TRENTON — New Jersey has created its own individual mandate that residents must obtain health insurance or potentially face a tax penalty, and it’s moving forward with its own state-based exchange where residents can shop for affordable coverage.

There’s even been state legislation proposed to enshrine many of the Affordable Care Act’s most cherished components into state law, including its protections for people with pre-existing conditions.

But make no mistake, there’s no replicating the entire Affordable Care Act, particularly the law’s expansion of Medicaid to give more poor adults access to government care.

New Jersey officials and health care advocates stressed that point during a Statehouse news conference Friday to sound the alarm about a federal appeals court ruling that could potentially threaten the landmark law and imperil health care for thousands of New Jersey residents.

Judges on the U.S. Fifth Circuit Court of Appeals in New Orleans ruled that the Affordable Care Act’s policy requiring insurance coverage is unconstitutional, but the panel held off on scrapping the entire law. Instead it returned the multistate lawsuit to a Texas district court, which had previously ruled that the entire law was invalid because of the loss of the now-meaningless requirement for people to have health insurance or face a tax penalty.

The law remains in effect pending the lower court’s review and an appeal to the U.S. Supreme Court appears likely. But advocates claim the uncertainty surrounding the future of the law has already had a “chilling” effect on enrollment and that the threat to the law is both real and alarming.

“Today feels a little bit like deja vu,” Maura Collinsgru, health care program director for New Jersey Citizen Action, said Friday, recounting a similar news conference close to seven years earlier when the progressive group pushed for the state to expand its Medicaid rolls with the federal support provided by the federal law.

“Now here we are all these years later, gathered to address another threat to our health care. They just seem to be never-ending,” she said.

The expansion of Medicaid is arguably one of the most impactful components of the Obama-era law. The state-run program provides insurance for the disabled, elderly and poor that the federal government helps fund. Under the Affordable Care Act, eligibility for the program was raised to 138% of the poverty level.

The change is credited with providing health care to more than 400,000 uninsured adults in New Jersey, with the federal government absorbing nearly all the additional cost. More than $3 billion in federal funding has flowed into New Jersey because to ACA from the Medicaid expansion.

Losing that level of federal support would be disastrous, said New Jersey Human Services Commissioner Carole Johnson.

“Those aren’t dollars we can replicate in the state, so we need the important work that is continuing to go on by the individuals in this room and across the state to continue to fight for and protect the Affordable Care Act,” Johnson said Friday. “Everyone who cares about fighting the opioid epidemic, everyone who cares about individuals who have chronic health conditions, everyone who cares about individuals who have mental health conditions. This is the way we are providing the care to so many individuals in our state who need that support and we need the federal government to be the partner they committed to being on this.”

Others at the news conference warned of other consequences if the federal law is invalidated by the courts, including the potential loss of protections for people with pre-existing conditions and other components, such as the law’s mandate that all insurance plans provide so-called “essential health benefits” like maternal and mental health services.

Legislation to codify essential benefits into New Jersey law along with other major components of the Affordable Care Act, including the requirement that insurers allow children to remain covered under their parents’ insurance until they turn 26, have been approved by the state Assembly but are still pending in the Senate.

Sen. Nia Gill, D-34 of Montclair, and Sen. Troy Singleton, D-7 of Delran, are the prime sponsors of the bill to enshrine the essential health benefits. Gill said the recent court ruling adds more urgency to the efforts to get her bill and others approved to Gov. Phil Murphy’s desk.

“Access to health care ought to be a right, not a privilege in the United States. Right now we have a federal government that is dead-set on limiting access to health care to millions of Americans. They’re fighting tooth and nail to make health care harder to find, more expensive and less comprehensive,” Gill said Friday. “While we cannot control the actions of the federal government or the decision of the court. We can and must protect the health care of New Jerseyans.”

New Jersey has already created its own individual mandate requiring most state residents to obtain health coverage or pay a penalty, as well as a state reinsurance program that reimburses insurers for a portion of the cost of expensive claims. Doing so reduces those companies’ costs and risk and allows them to charge less for premiums.

Those actions, and the state’s move to a state-based exchange where residents can shop for insurance coverage, provide the state with more flexibility and some insulation against the potential consequences if the full health care law is invalidated. However, officials said the mere threat of the law’s demise has created confusion among consumers that has likely impacted enrollment.

“We have seen tremendous fear, people thinking they can’t enroll in coverage. A lot of misinformation,” said Collinsgru. “It’s the messaging we’re hearing over and over and over again from Washington. It’s certainly dissuading people.”

Jonathan Chebra, senior director of federal affairs for the New Jersey Hospital Association, and Hetty Rosenstein, state director for the Communication Workers of America, also participated in the event and spoke about the importance of protecting the federal law.

“Coverage for 800,000 New Jerseyans and millions of Americans. Coverage for pre-existing conditions. Access to preventative health services. Elimination of lifetime and annual limits. Making Medicare Part D prescriptions more affordable. And provisions that have transformed how hospitals and health systems deliver care. ... These are all things worth fighting for,” Chebra said.

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