New Jersey Dem assembly pushing a TON of state-level ACA bills through!

Holy Smokes! Right on top of my post earlier today about nearly twenty healthcare/ACA bills being pushed through the California legislature, here's a similar story about another batch of ACA improvement/protection bills being pushed through the New Jersey state assembly! via Lilo Stainton of NJ Spotlight:

Democratic lawmakers introduced a dozen bills late last week to create the infrastructure, funding, and regulatory structure for a state-based system that would enable New Jersey officials to create, market, and sell health insurance policies to low-income individuals and small businesses with fewer than 50 employees.

...Nearly 300,000 low-income residents — who earn too much to qualify for Medicaid but don’t get coverage through work — are now insured through the individual marketplace, which is regulated by the federal government and largely sold through the website. Another 330,000 have policies through New Jersey’s separate, small-employer market, according to state data.

This is an excellent and informative article overall, but for some reason it keeps describing the ACA exchange marketplace as being intended for "low-income individuals", when it's simply meant for anyone who doesn't receive coverage through their employer, Medicare or Medicaid. On the other hand, given the 400% FPL income eligibility cut-off for financial subsidies, I suppose that's pretty much what the ACA exchanges have effectively become, so I guess that's a matter of interpretation.

There's some important data points included as well:

...The ACA, or Obamacare, enabled New Jersey to expand health insurance coverage to nearly 850,000 low-income state residents; at least 500,000 gained access to Medicare under the new income limits; some 200,000 purchased plans through the subsidized federal marketplace; and nearly 100,000 more benefited from marketplace-type policies they purchased directly from insurance carriers. As a result, the state’s uninsured rate has declined to a record-low 9 percent.

255,246 New Jersians officially selected ACA exchange policies during the 2019 Open Enrollment Period, but due to drop-outs, non-payment and cancellations, it's likely down to perhaps 80% of that as of May...which happens to be around 204,000, or right around the 200K noted above.

The "nearly 100K off-exchange" figure is actually more important to me. IF that number is relatively current (i.e., as of at least the end of March 2019), that means that New Jersey saw a significant increase in their 2019 off-exchange ACA-compliant enrollment year over year...even as their on-exchange enrollment dropped by 7%. NJ had around 89,000 off-exchange ACA enrollees as of the end of March 2018. If they're up to 100K as of May 2019 (or even March), that'd be at least a 12% increase. The worst-case would be if the 100K was as of January, in which case it'd still mean the off-exchange market held even year over year (89K as of March last year would likely mean around 100K as of January).

It'll be another few weeks before the Q1 2019 enrollment report is available from the New Jersey Insurance Dept., however, so I'll have to keep an eye on this issue. It's important because New Jersey is the only state to reinstate the ACA mandate penalty since it was repealed at the federal level, so a lot of attention will be paid to how much their total ACA market changed this year.

...Murphy and Democrats in New Jersey’s Legislature have pushed back, instituting a number of policies designed to protect the federal program, regardless of what happens in Washington, D.C. Among other things, they committed some $800,000 to enhance public outreach and enrollment assistance during the sign-up period last fall.

In late March, Murphy announced plans to take control of the ACA marketplace, making New Jersey the first state to make this switch since Trump took office.

I'm afraid one item here is only partly true: Nevada actually announced they were breaking back off of the federal marketplace onto their own platform back in early 2018, and New Mexico made a similar announcement last October. On the other hand, both Nevada's and New Mexico's exchanges were already established as their own legal entities...they're both basically just "renting out" or piggybacking on top of HealthCare.Gov as a technical platform. New Jersey is, in fact, the first state which is fully administered via the federal exchange to break free, so the claim is partly accurate.

Here's the skinny on the fourteen bills being pushed by the Democratically-controlled state assembly. The first two

  • A-5499...would allow the state Department of Banking and Insurance to create a state-based exchange and charge a fee on each plan equal to the 3.5 percent assessed now under the federal system.
  • A-5500...would change how insurance companies price plans, outlawing gender as a factor and requiring the most expensive plan to be no more than three times the cost of the cheapest.
  • A-5501...would ensure children could remain on their parent’s plan through age 26.
  • A-5502...alters the definition of the small-employer plan, to allow for the changes.
  • A-5503...extends the enrollment period to 90 days, which it initially was.
  • A-5504...requires 85 percent of the profits made from these plans be reinvested in care.

Hmmm...that's somewhat misworded. The ACA's Medical Loss Ratio (MLR) provision requires 85% of premiums be utilized for actual medical claims for large group plans (which aren't sold via ACA exchanges anyway)...but only 80% for small group and individual market policies. There's a big difference between premiums and profits. According to the NJ legislative bill lookup website, A5504 actually "Applies 85 percent loss ratio requirement to large group health insurance plans." which is what I figured, except it only applies to large group plans, not small group or individual market plans. It's possible those are already required to hit 80% under state law, however.

  • A-5505...allows companies to use age and geography when determining price, but not gender.
  • A-5506...repeals existing language related to “basic and essential” policies, which are no longer permitted.
  • A-5507...outlines protections for free preventive services.
  • A-5508...requires these plans to cover contraception.
  • A-5509...ensures breastfeeding support services are covered.
  • A-5510...prohibits various discriminatory practices.
  • A-1733...would be amended to ensure providers selling these policies could not deny coverage based on pre-existing conditions; first introduced several years ago, this measure passed an Assembly committee last week.
  • A-5248...protects coverage for essential benefits as defined by the ACA, which include labor and delivery, mental health, and other services.