New Jersey

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

Me, three weeks ago:

A few weeks ago, I posted about New Jersey's preliminary 2019 ACA-compliant individual market rate filings. At the time, the official New Jersey Dept. of Banking & Insurance specifically stated that:

Note: Much of this entry is a repeat of yesterday's, but I felt it was worth a separate entry.

This metaphor will take a bit, but bear with me.

On March 16, 1981, CBS aired the 17th episode of Season 9 of M*A*S*H. For those of you too young to remember, M*A*S*H, set at a U.S. Army medical camp in Korea during the Korean War, was one of the most successful TV shows in history, running 11 seasons. I believe the series finale remains the most highly-viewed broadcast in history. While M*A*S*H started out primarily as a sitcom, it evolved over the years into more of a drama with comedic moments.

Anyway, in S9 Ep17, "Bless You, Hawkeye", the main character, Dr. Benjamin Franklin "Hawkeye" Pierce (played by Alan Alda) finds himself stricken with a sudden, unexplained and violent allergic reaction to something. He spends much of the episode trying standard medical solutions, but his fits of sneezing and coughing become so bad that eventually a recurring character, psychiatrist Dr. Sydney Freedman, is brought in to see if there might be a psychological cause.

A few weeks ago, I posted about New Jersey's preliminary 2019 ACA-compliant individual market rate filings. At the time, the official New Jersey Dept. of Banking & Insurance specifically stated that:

• Because Congressional Republicans repealed the ACA's Individual Mandate Penalty, carriers were planning on increasing 2019 premiums by 12.6% on average, in part to account for the adverse selection which was expected to happen next year.

• However, thanks to the Democratically-controlled New Jersey state legislature and Governor swiftly reinstating the ACA individual mandate, actual 2019 rate filings are only expected to increase rates an average of 5.8%, saving the average unsubsidized indy market enrollee around $470 apiece next year.

• Finally, the NJ legislature also passed, and Governor Murphy signed into law, a robust reinsurance bill which, if approved by CMS, is expected to lower unsubsidized 2019 premiums by an additional 15 percentage points, for a final 2019 average premium reduction of around 9.2%.

• It's also important to understand that New Jersey's portion of the funding for the proposed reinsurance program will be coming from the revenue generated by the reinstated mandate penalty itself.

New Jersey was one of a handful of states with a newly-full blue government which took swift and decisive action to cancel out some of the worst ACA sabotage efforts of the Trump Administration and Congressional Republicans this year. The following bills were passed by the state legislature and signed by new Governor Phil Murphy:

• Reinstate the ACA's individual mandate penalty,
• Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
• Protect people from out-of-network "balance billing", and
• Cancel out Trump's expansion of "Association Health Plans"
• In addition, New Jersey already outlawed "Short-Term Plans" (and "Surprise Billing") before the ACA was passed anyway.

Thanks to Maanasa Kona of the Center on Health Insurance Reforms at Georgetown for the heads up:

For the first time since 2014, the # enrolled in individual health plans in the first quarter of the calendar year in NJ went down from the previous year. Commissioner Caride blames the current administration's actions. https://t.co/xuuGLQV7BE pic.twitter.com/rGNpfx2IYS

— Maanasa Kona (@MaanasaKona) June 22, 2018

Here's the press release and table:

Health Insurance Enrollment in NJ Individual Market Down 10 Percent in First Quarter of 2018

Reduced Enrollment Demonstrates Importance of Policies Aimed at Stabilizing the Market, Increasing Access to Affordable and Quality Coverage

Last week I noted that the New Jersey state legislature, along with new Governor Phil Murphy, has moved quickly to pass and sign into law a number of critical ACA protection bills, to:

• Reinstate the ACA's individual mandate penalty,
• Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
• Protect people from out-of-network "balance billing", and
• Cancel out Trump's expansion of "Association Health Plans"

In addition, New Jersey already outlawed "Short-Term Plans" (and "Surprise Billing") before the ACA was passed anyway.

Well, until today, there was some lingering doubt about the first two bills (which are connected...the reinsurance program would be partly funded by the revenue from the state-level mandate penalty), as Gov. Murphy was reportedly kind of iffy about signing them. As I understand it, he's been supportive of both ideas but is concerned about the potential budget hit in case the mandate penalty revenue doesn't raise enough to cover its share of the reinsurance program.

Last month I noted that New Jersey is taking a leading role regarding protecting and improving the Affordable Care Act; the state legislature has passed bills which would:

• Reinstate the ACA's individual mandate penalty,
• Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
• Protect people from out-of-network "balance billing", and
• Cancel out Trump's expansion of "Association Health Plans"

(New Jersey actually already had several other "ACA protection" laws on the books in the first place, including protections against short-term plans and "surprise billing".)

In addition, new Governor Phil Murphy had alread proven that he understands and supports the ACA; within days of taking office he had already issued an executive order telling all state agencies to do everything they reasonably can to inform the public about how to enroll during Open Enrollment and so forth.

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.

This won't have too much effect until November (aside from more mentions of Special Enrollment Periods, I presume), but this is EXTREMELY welcome news for ACA supporters; 

EXECUTIVE ORDER NO. 4

WHEREAS, a primary goal of my administration is to ensure that every New Jerseyan has access to affordable health insurance and none of our residents are unable to see a doctor when they are sick; and

WHEREAS, the Affordable Care Act represented a huge step forward in ensuring that all Americans have access to affordable health insurance; and

WHEREAS, New Jersey turned down a substantial amount of federal funding when it declined to create a state-based exchange that would have been customized to the needs of New Jersey residents, and given the State greater flexibility in its enrollment period; and

WHEREAS, over 275,000 New Jerseyans currently receive health insurance coverage on the federal marketplace created under the Affordable Care Act; and