“People actually thought the ACA was gone, that they were able to dismantle it,” said Tara Rosenberg, a health care navigator with Hackensack Meridian Health.
Actually, the ACA, or Affordable Care Act, is still alive, though many suspect it could be on life support sooner than later. The Trump administration’s rollbacks, more specifically the repeal of the individual mandate, is having a significant effect here at home.
“We’ve had 20,000 fewer individuals in the open enrollment period at the end of 2017 signing up for this year for the individual market,” said Acting New Jersey Health Commissioner Shereef Elnahal.
Rep. Frank Pallone is pushing his federal bill that expands and protects the provisions in the Affordable Care Act. His legislation would get rid of the cap on eligibility for tax credits, meaning everyone enrolled gets something; increase the amount of those tax credits and cost-sharing subsidies; and restore funding for outreach and advertising.
It will also keep requirements in place for essential health care. In other words, no junk plans allowed.
“The Republicans say to me, ‘Oh, what are you worried about? We believe in personal responsibility, everybody has to take responsibility for their plan.’ How many of the people are actually buying these things know it doesn’t include hospitalization, or maternity care or pediatric care? They don’t know, that’s the problem,” said Pallone.
“If you lower those standards for certain plans, what’s going to happen is that healthier people will go into those plans, and sicker people will have to go into the plans we already have, which will get higher and higher, so it’s going to have a huge impact on individuals who are the sickest in our state,” said Ray Castro, director of health policy with New Jersey Policy Perspective.
“The risk pool is compromised when healthy people drop out, when it’s harder for insurance plans to stay in an individual market, and then of course, premiums rise for people, and then access to health care suffers,” said Elnahal.
Health care advocates shared stories of patients who are suffering from the initial changes to the law. New Jersey saw a 23 percent increase in premiums this year.
“If you’re making $60,000, and you’re an individual, you’re not eligible for any subsidies at all under the federal rules, and they’re bearing the full 20 percent increase and they just can’t afford that,” said Castro.
State Sen. Joe Vitale has a dual-bill package to support the marketplace that allows the state to impose an individual mandate, set up a special security fund to collect the money and redistribute it to stabilize the market.
“What we would do is have our individual mandate kick-in when that ends, so it’s a seamless transition to the new one. The reinsurance element of this package takes time to develop, so we would apply to CMS for that waiver like other states have done,” said Vitale.
“We’re trying to sell this on a bipartisan basis, we’re trying to get it even into the omnibus spending bill that we’re going to hopefully adopt this week. I can’t imagine that all of it will get in there, maybe some of it will,” said Pallone.
So with little help from the Republicans in Washington, Pallone and his Democratic colleagues are counting on state leaders to keep what’s left of this law intact.