New Jersey's top state senator *almost* made meat pie out of the state ACA exchange (UPDATE: But not quite!)

via Susan Livio of (thanks to Andrew Sprung for the heads' up):

New Jersey’s most powerful state lawmaker said he will delay a vote to create the state’s own online shopping portal for health insurance, one of Gov. Phil Murphy’s priorities intended to guard against the possible repeal of the Affordable Care Act.

The delay means the state won’t meet an Aug. 1 deadline to submit an application to the federal government to create the exchange. The anticipated launch of a Fall 2020 open enrollment period would have to be postponed until 2021, a group of health policy experts warned.

State Senate President Stephen Sweeney, D-Gloucester issued a statement Tuesday affirming his support for creating New Jersey’s own health exchange. Sweeney said he just disagrees with the way fellow lawmakers want to go about it because it doesn’t include a means to automatically enroll low-income people into the Medicaid program. both Murphy and others note in the artcile, this excuse really doesn't pass the smell test. The state already can't auto-enroll people into Medicaid now while using the federal exchange (HealthCare.Gov); that feature could certainly be added in later on. The problem is that while they have until August, the end of the normal legislative session is...tomorrow:

Sweeney’s spokesman Richard McGrath confirmed the legislation would not be posted for a vote at the Statehouse in Trenton on Thursday, which is likely the last voting session for the summer.

...“Getting our state-bases health care exchange up and running is a race against the clock. Any unnecessary delay jeopardizes New Jersey’s ability to chart our own course in the best interest of our residents and could cost the state millions of dollars more to the federal government should we miss the rapidly approaching Aug. 1 deadline," Murphy said.

How much money are we talking about again?

The amendment is not worth delaying action for a year — not when New Jersey could recoup the $50 million it sends to Washington every year to run the exchange, he said. New Jersey could do a better job than the feds, by expanding the time people have to enroll — a window cut in half by Trump.

New Jersey has around 224,000 residents enrolled in ACA exchange policies via the federal exchange. charges 3.5% of premiums per enrollee. At an average of $511/month, that's around $215 per enrollee, or $48 million this year. The fee will drop to 3.0% next year, but that's still excessively high (around $41 million assuming premiums remain flat and enrollment is identical). Other state-based exchanges are able to run on 1.5 - 2.0% fees or their equivalent, which should save New Jersians a good $20 million or so each year.

Most folks seem to agree that the "auto-enroll Medicaid" excuse is silly, so what's really going on here?

Sweeney’s decision to redraft the bill is the latest in a long line of clashes between himself and the governor, a fellow Democrat.

On Tuesday, NJ Advance Media reported Sweeney won’t allow a bill up for a vote that would let more hospitals perform non-emergency angioplasties — a matter of debate for a decade. He wants assurances the governor will sign his bill making it more difficult for doctors to transfer patients to out-of-state hospitals.

Hmmm...that doesn't sound like too big of a deal...I've heard some folks say that this is actually more about Sweeney's opposition to a Murphy-supported millionaire's tax than anything. If so, that certainly says where his priorities lie.

However, I'm not a New Jersey native, nor am I familiar with the scene on the ground, so I'll just say this: I hope Senator Sweeney changes his mind and schedules the vote tomorrow after all.

UPDATE 6/27: Good news! They worked things out at literally the last minute after all:

The icy relationship between Gov. Phil Murphy and state Senate President Stephen Sweeney thawed briefly on Thursday to allow legislation to move forward that would permit New Jersey to run its own Obamacare insurance exchange in 2020.

The state Senate cast emergency votes Thursday afternoon on a bill creating the online insurance shopping site for people seeking commercial plans and Medicaid coverage, according to the sources, who requested anonymity to speak freely. The final vote was 24-12.

The Assembly’s approved the bill by a 49-24 vote.

...After the vote, Sweeney expressed satisfaction with the compromise, which made the bill “1000 percent better.”

“We’ve proven we can get things done and work together. The ACA is a perfect example,” he said.

The spokesman for the governor declined to comment.

So what actually changed? I'm not sure. This tweet from healthcare reporter Sam Sutton just says that it "includes Sweeney's Medicaid amendments", so I guess they, what, required the exchange to include automatic Medicaid enrollment by scribbling it into the margins of the bill or something?

Anyway...whatever. Good.