New Jersey: Well I'll be damned! They brought back the mandate after all (along w/reinsurance & more!)

I've noted before that now that the Republicans in Congress have repealed the ACA's much-hated (but vitally necessary) individual mandate penalty (effective 2019), the odds of it being reinstated at the federal level are virtually zilch. Even if there's a massive blue wave in November and the Democrats are able to retake both the House and Senate, they're extremely unlikely to be willing to face the same type of firestorm/backlash that they did back in 2009-2010 over it.

If you need proof of this, take a look at the "ACA 2.0" bills recently proposed by both the House and Senate Dems. Both versions check a whole bunch of items off of my "If I Ran the Zoo" wish list...but neither one includes restoring (much less increasing) the Individual Mandate penalty at the federal level.

HOWEVER, I've also noted that some of the blue states might be able to pull it off. Massachusetts, of course, has had an individual mandate penalty since long before the ACA was in place. It was never repealed, but was simply superseded (or "trumped"...) by the ACA's federal penalty instead. Vermont's state House actually passed a mandate penalty a few weeks ago, and it's supported by the (Republican!) governor, but the last I heard it still had to go through the state Senate...and even if it's signed into law, the details are kind of vague:

The revised legislationestablishes an individual mandate as of Jan. 1, 2019, but it does not immediately create a penalty for those who don’t comply.

Instead, a working group of state officials would look at administration and enforcement options and report back to the Legislature later this year. It would fall to lawmakers in the 2019 session to determine the best way to enforce the mandate.

Um...that's great, guys, but that also makes it sound like the mandate itself wouldn't go into effect until 2020?

Meanwhile, Connecticut had been considering tow radically different mandate bills. One was weaker than the ACA's was (a flat $500 penalty), while the other was a far more strict state-level mandate bill which would in theory charge up to $10,000 for not having coverage (based on a percent of income). However, that became moot when both bills died in committee a couple weeks back.

Anyway, that brings me to New Jersey. With a new, Democratic Governor, the New Jersey state legislature decided to take a crack at several common sense bills to shore up the individual market, protect the ACA from Trump/GOP sabotage and generally, you know, improve the situation state-wide. Unfortunately, a couple weeks back it wasn't looking so good for the mandate for obvious reasons:

New Jerseyans by more than a two-to-one margin want Obamacare to continue, but their support for the mandate that nearly everyone have insurance or pay a penalty is lukewarm at best, a Rutgers University poll released Thursday found.

Just 40 percent of New Jerseyans think the state should continue the individual mandate — a provision that President Donald Trump repealed beginning in 2019.

Classic case of "everyone wants to go to heaven but no one wants to die". The good news is:

"Nobody wants to see the government mandate something like that," said Joel Cantor, director of the Rutgers Center for State Health Policy and the poll’s lead author. "But once people have a sense of why it's there and what the consequences of it going away would be, support goes up."

...The Rutgers findings:

  • More than two-thirds of New Jerseyans favor the state continuing Obamacare if Congress repeals it. About 28 percent opposed it.
  • Two-thirds think the state should increase funding instead of reduce enrollment if Congress cuts spending on Medicaid.
  • Two-thirds think New Jersey should tax employers who don't offer insurance for their workers.
  • Nearly 55 percent don't think New Jersey should reinstate the individual mandate.

Well, apparently the New Jersey state legislators decided to grit their teeth and go for it anyway, because this story just broke:

Obamacare: NJ lawmakers approve health insurance mandate

...Lawmakers Thursday sent to Gov. Phil Murphy a bill that will require nearly all New Jerseyans to have health insurance or pay a penalty in a bid to stabilize premiums for consumers in the Obamacare marketplace.

But that's not all!

They approved another bill that would set up a reinsurance plan that would partly be paid for by the federal government and cover some of the most expensive health care claims.

Not only did both bills pass, they did so easily:

...The mandate bill passed 23-13 in the Senate and 50-23 in the Assembly. The reinsurance bill passed 22-14 in the Senate and 46-22 in the Assembly.

The bills would most directly affect consumers who don't get health insurance through Medicare or their employer. About 275,000 people in New Jersey were covered in the individual market, according to federal data released this month.

(sigh) No, 275,000 people are enrolled in exchange-based policies; there's another ~100,000 or so enrolled in off-exchange ACA plans, but whatever.

The reinsurance bill would create a program to pay for high-cost patients. It would be funded by both the federal government and insurance companies. And the money would be kept in a newly created fund at the Treasury Department.

In addition, according to Andrew Sprung, a third Good News® healthcare bill also passed today which tackles out-of-network balance billing:

The legislation would protect thousands of New Jerseyans covered by state-regulated health plans from "balance-billing," or paying what an insurance company won't.

Specialists like orthopedists and neurosurgeons predict the law, if enacted, could drive them out of business and deter young professionals from settling in N.J.

The least controversial elements of the bill -- and perhaps the most important from a consumer's point of view -- are the disclosure requirements. Too often, patients say they learned a doctor was not part of their insurance network after the bill arrived.

Hospitals must post on their website the names of medical professionals they employ, their contact information and the insurance coverage they accept, according to (S485) Hospitals also must provide the same information for specialists they do business with, such as anesthesiologists and pathologists.

If the network status of the facility changes as it relates to the covered person's health benefits plan, the hospital must notify the patient "promptly," according to the legislation.

Likewise, medical professionals must disclose which health insurance coverage, if any, they accept and the cost of out-of-network services.

The bill stalled for years because doctors, insurers and hospitals have fought over the new arbitration system it would create. If insurance carriers and doctors or physicians cannot agree on an acceptable reimbursement, a third party would choose between one of two offers, under what lawmakers have referred to as "baseball-style" arbitration.

UPDATE: I almost forgot! Sprung says that the individual mandate bill would also head off Trump's "association plan" scheme at the pass (New Jersey already prohibits "short term" plans). This part of the bill gets a bit into the weeds, but Sprung says:

If I understand right, if the federal government and courts ultimately assert unequivocally that a large-group MEWA can sell to employees of small business in any state, this provision would effectively tell those individuals in New Jersey: "True enough -- but you can't buy what they're offering unless you want to pay a penalty."

Another statute in the list above appears to declare that coverage obtained from an association formed purely for the purpose of offering insurance would not qualify as minimum essential coverage.

The only question now is whether new Governor Phil Murphy will sign one, two or all three bills. Obviously I'm hoping he'll do so for all of them.