Players in the Life and Death Game Of The Affordable Care Act

There are about 1.3 million people in NJ without health insurance – people who forgo needed doctor visits, can not afford medicines, avoid surgery, receive short term help in emergency rooms, and die earlier than those insured. One would think that such a large group would have a significant voice in NJ’s approach to the Affordable Care Act (ACA). Alas!… no way.

There is the Republican approach which is to “repeal and replace Obamacare” and the Democratic approach which is to implement a NJ health exchange with consumer friendly rules and participate in Medicaid expansion. While political dogma will play a role and there are strong consumer advocacy groups, there is also a handful of high-powered industry lobbying organizations with money and access who will influence the outcome. Governor Christie, who boasts he is not shy about stating his position, has yet to enunciate with any clarity where he stands. Unfortunately, there is little time to meet the deadlines – the first of which is just two weeks after elections, to notify the federal government whether NJ plans to build its own healthcare insurance exchange.

Below are key players and oversimplified explanations of their positions, primarily on the type of health exchange needed for NJ. The players do not always publicize what they are seeking and may take different tacks as matters progress. The devil is always in the details.

NJ Association of Health Plans – NJAHP represents the six NJ health insurers. While members of this group like the idea of adding more patients to their rosters and they support a NJ health exchange, they want a “passive model” based on allowing all NJ insurers to participate under the minimum federal regulations, as opposed to facing additional state requirements which might be more consumer friendly – the “active model.” This disagreement was one of the reasons Governor Christie vetoed Senators Nia Gill’s (D-34) and Joseph Vitale’s (D-19) more progressive “active model” health exchange bill (S551).

Medical Society of New Jersey (doctors) – MSNJ did not support ACA legislation largely because “it did not address the sustainability of the Medicare and Medicaid programs and tort reform.” Doctors in NJ for Medicaid are reimbursed at a low rate of 37 percent of the federal Medicare rate, compared with a national average of 72 percent, and see little advantage in expanding Medicaid. More recently MSNJ has stated support for a NJ health exchange.

NJ Hospital Association – NJHA supports the goal of ACA to create health insurance exchanges. Hospitals receive monies from the State for charity care (this year $665 million) which they always consider insufficient. More patients with health insurance would decrease charity care and increase hospital revenue.

For other players, both pro and con, go beyond the fold.

New Jersey Business & Industry Association – NJBIA opposes the active model saying that it could increase bureaucracy and push costs higher.

Americans For Prosperity, NJ (Koch brothers) – AFP with no ambiguity opposes ACA. “Steve Lonegan calls on citizens to urge Gov. Christie to stop ObamaCare by vetoing the NJ Health Care Exchange Act!”

American Association for Retired People– AARP supports ACA and a health exchange more robust than that in S551 which would be further “strengthened to clearly allow [the exchange] to work on behalf of consumers and demand quality, responsiveness to consumer concerns, reasonable rates, efficient plan designs, robust provider networks, and comprehensive benefits.”

Other advocates for the active model include NJ Policy Perspective, New Jersey Citizen Action, the Main Street Alliance, and NJPIRG.

Stay tuned to what the key players say. The legislature will have an important role in policy and budget matters. However, the biggest player is our postponing, vetoing, hemming and hawing Governor Christie.

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