What the ACA Ruling Means for New Jersey
The Supreme Court decision could mean fewer uninsured New Jerseyans, and a renewed drive to improve healthcare while driving down costs
By Beth Fitzgerald and Colleen O'Dea of NJ Spotlight
The Supreme Court's decision upholding the Affordable Care Act could clear the way for New Jersey to extend health coverage to nearly half of the state's more than one million uninsured. Then again, it is unclear whether state Republicans, including the governor, will try to block the law's implementation and join the legal argument that members of the national GOP have vowed to continue after learning that the court affirmed the ACA 5-4 on Thursday.
New Jersey healthcare executives, doctors, and Democratic legislators reacted positively — in some cases jubilantly — to the court's decision and said they would return with renewed vigor to implementing the law. First on the agenda is creating a health insurance exchange, which will allow individuals and small businesses to buy coverage online in a transparent manner.
An exchange had been designed and approved by the state legislature earlier this year but was vetoed by Gov. Chris Christie, who said he did not like some provisions of the bill and wanted to wait for the Supreme Court ruling before moving forward. Christie issued a brief statement Thursday calling the decision "disappointing" as well as the "wrong approach for the people of New Jersey who should be able to make their own judgments about healthcare."
In upholding the constitutionality of the ACA's individual mandate, the court said that what the Obama administration has called a "penalty" to be imposed on individuals who refused to get coverage is really a tax that's within the power of Congress to impose. Christie said in his statement that "the Supreme Court is confirming what we knew all along about this law — it is a tax on middle-class Americans."
Sen. Joseph F. Vitale (D-Middlesex), chairman of the Senate health committee, brushed off speculation that Christie will continue to fight the legislation and said he will start meeting next week with the administration to draft a new exchange bill that the governor can support. "With all due respect to the governor," said Vitale, "if he doesn't like the decision of the Supreme Court he has two choices: We can design an exchange that works for New Jersey or the federal government will come in and do it. And I don't think he [Christie] is keen on the Obama administration coming in here and designing a health exchange."
The states must demonstrate to the federal government by January 1, 2013 that they can run their own exchanges in 2014, or the federal government will step in and run the exchange, where billions of dollars in federal subsidies will help make coverage affordable for those who either can't afford to buy health insurance now, or who struggle to pay the premiums.
"We will sit down with the administration and talk about the differences that divide us and whether or not we can work together to operationalize this," Vitale said, adding that there is time enough for New Jersey to get an exchange up and running by the federal deadline.
Sen. Nia Gill (D-Essex), a sponsor of the vetoed exchange bill, said she will reintroduce it and called for quick action. "Now that we have validation the law is constitutional, we must forge ahead with our responsibilities as a state so that our residents are afforded the true benefits of health reform."
In the Assembly, Herb Conaway (D-Burlington), a doctor and the prime Assembly sponsor of the bill agreed. "Healthcare should not be a luxury. No one should have to choose between their health and paying their bills."
Still, there were those who vowed to continue the fight. Steve Lonegan, state director of the conservative Americans for Prosperity, called the repeal of the ACA his group's top priority. "While it appears that the Supreme Court has upheld most of this law, Congress must approve funding and that's one battleground. The other is within our state where AFP will continue the fight against creating a state-based Health Care Exchange and other implementations of this dangerous job-killing legislation."
Both health insurers and physicians spoke in favor of moving ahead quickly with an exchange. Ward Sanders, president of the New Jersey Association of Health Plans, the state's organization of health insurers, said it was "nose to the grindstone time" and noted his organization has been participating in preparations for the exchange so "we are better prepared as an industry to serve New Jersey consumers."
The Medical Society of New Jersey, the physicians' group, noted that an exchange "could increase competition and remove barriers in the healthcare insurance market, so that more uninsured New Jersey residents may purchase affordable healthcare insurance with transparent terms."
Hospitals, health insurance companies, physicians, and other healthcare providers have already invested considerable time and money to implement the ACA's basic philosophy: that the American healthcare system is broken, and needs to both improve the delivery of care and reduce waste. Indeed, many providers have argued they were already on the path toward improve quality, better patient outcomes, and less wasteful spending well before the ACA was passed, in the face of the resistance from employers to the relentless double-digit upward spiral in the nation's healthcare bills.