Healthcare in New Jersey heading toward a zombie apocalypse. Part VI: Some final thoughts and suggestions

As Better Choices Better Care NJ points out, “New Jerseyans continue to struggle every day with the cost of rising health care. Their premium and out-of-pocket costs go up, but they do not feel they are receiving better quality of care. How to decrease these costs while increasing quality outcomes might seem unsurmountable. However, most other developed countries have proven more successful than the United States.

Key obstacles in lowering costs of healthcare include the influence of corporate lobbyists and their contributions to politicians. Outdated and costly regulations in drug pricing for example is another problem. The amount of paperwork required of doctors results in less patient visits. Data reveal that Medicare pays far less than private firms in overhead and Medicare seeks no profit – an argument for “single payer.”

It depend on your income levels. The state of New Jersey has expanded its Medicaid coverage as part of the Affordable Care Act offering advantages for low income adults, families with children, and pregnant women at little or no cost. If you don’t qualify for Medicaid your best options will either be a Bronze or Silver plan through the New Jersey marketplace on Unfortunately some people earn too much to qualify for Medicaid, but cannot afford even a subsidized marketplace insurance plan.

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It’s is no secret that drug prices have been rising at an alarming rate, particularly new life-saving medications. AARP suggests these actions to lower drug costs: Let Medicare negotiate drug prices, allow more (much less expensive) drugs to be imported, create transparency in drug pricing, and provide for easier drug comparisons. The N..J. Prescription Drug Retail Price Registry helps consumers compare the retail prices charged by many pharmacies for the 150 most-frequently prescribed prescription drugs. Horizon and many other firms let you purchase drugs on-line, often at reduced prices. There is speculation that Amazon might get into the business of selling prescription drugs. The possible megamerger between pharmacy giant CVS Health and health insurer Aetna might also reduce drug prices. has been working on passing legislation that would help reduce the cost for seniors, working families, and veterans. During his campaign Trump said he wanted to lower drug prices, but since then has done nothing. Gov. Murphy’s efforts to broaden the medical marijuana eligibility could generate lower prices for pot as a substitute for more expensive, addictive drugs.

A small step: After a five year study of NJ hospitals, the results indicated that greatest healthcare cost savings were by reducing the rate of hospital readmissions by 30 percent; reducing the rate of pressure ulcers by 38 percent; and in savings through the decline in adverse drug events. More such studies would be helpful. Reducing the redundant availability of expensive medical hardware within a region lowers costs. With the highest expenses being staffing, more functions carried out by RN’s, like transporting patients through the hospital, should be performed by aides, and more functions performed by MD’s could be undertaken by Physician Assistants and Nurse Practitioners. Having more New Jerseyans covered by insurance would reduces the unnecessary high costs of frequent emergency room visits and other charitable care costs, which end up increasing overall hospital (and everyone’s) costs. Hospital executives spend too much time creating horrendous, exorbitant charges that they then foist upon those who lack insurance.

Hospital mergers and closures designed to reduce costs in NJ have been frequent in the past 20 years. In February four NJ hospital systems and two standalone hospitals partners joined in an effort to control health care costs. However, hospital mergers with the reduction of independent hospitals can be double-edged sword, reducing costs but also creating monopolies which can result in higher prices. Horizon’s new OMNIA program might be viewed in a similar way – advantageous for its limited members but not for others patients or hospitals left out of the program.

Beginning in 2019 the new tax law repeals the requirement under the Affordable Care Act that mandates that Americans carry health insurance or pay a penalty. That means 340,000 New Jerseyans stand to lose their health care by 2027, and with the loss of younger, healthier people in the marketplace pool, the costs for everyone else will rise considerably. Our legislature is considering creating a similar state mandate to solve the problem. There is another aggravating factor in the package passed into law. Medical expenses for 2017 and 2018 remain tax-deductible to the extent they exceed 7.5% of Adjusted Gross Income (AGI). However, after 2018 the threshold will increase to 10% of AGI, making it harder for many to use the deduction.

New Jerseyans last year spent much of their time resisting the repeal and replacement of the ACA, largely but not totally successful. Our efforts this year are best spent, and likely to be successful, in flipping up to four congressional districts (CD 2, 3, 7 and 11) from red to blue. Control of the House and/or the Senate by Democrats will dramatically reduce zombie efforts in Congress and the White House and likely result in better healthcare legislation.

To kill zombies one need to destroy their brains. The most surefire route is simply lopping off the cranium with a chainsaw, machete, or samurai sword. Short of following this surefire approach, we should use our own brain. Remember that as consumers we have every right to advocate for changes. NJ consumers have a litany of complaints such as “I broke my ankle in October and the bill that I got even with my insurance was outrageous,” and “Doctors move you along a lot quicker now.” After wrestling for close to a decade New Jersey lawmakers are ready to once again tackle the question of what to do about the “surprise” super expensive out-of- network medical bills. Encourage them to complete the task. Let your state legislators know what you want, particularly those on the Assembly and Senate health and budget committees and support federal legislators like Rep. Pallone in their efforts. To make your voice is heard by your legislators, go here.

You can read Part I which provides a broad view of the healthcare crisis and looks specifically at the ACA marketplace and Trump’s injurious “An American Budget” here.   Part II shows how our governor and legislators are fighting back here.   Part III: Our imperiled Medicaid under attack by Trump and a Republican congress here.   Part IV: Employer-sponsored healthcare here.   Part V: Elder healthcare here.

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