Health Reform in New Jersey CHIPRA Statewide Coalition Meeting April 5, 2012 Dorothy Gaboda, MSW, PhD Rutgers University
Sources Jose Nova contributed to the analysis of American Community Survey (ACS) data Kristen Lloyd, Jose Nova, Joel Cantor, and Susan Brownlee contributed to design and analysis of the New Jersey Family Health Survey (NJFHS) The NJFHS was funded by the Robert Wood Johnson Foundation 2
Questions How will the ACA affect coverage in New Jersey? Who is uninsured in New Jersey? Who will be hardest to reach? 3
Selected Early Impacts of ACA in New Jersey* 69,000 fewer uninsured young adults (as of 6/11) 926 enrolled in NJ Protect pre-existing condition plan (3/12) $31.4 million in grants to community health centers $20.6 million in grants for prevention and public health ~$16 million in other grants for workforce development, school-based health centers, infant/child home visiting, etc. Source: US Dept. of Health and Human Services at healthcare.gov except NJ Protect enrollment from the NJ Dept. of Banking and Insurance 4
Change in Coverage in New Jersey Under the ACA Non-Elderly, based on 2009 ACS 100% Other Private Health Insurance Exchange Medicaid/CHIP Uninsured 80% 60% 71.5% 74.3% Total Private 66.6% Non-Exchange 40% 13.8% 20% 0% 7.7% Exchange 17% Medicaid/CHIP 14.7% Without Reform 8.7% Uninsured With Reform Source: Cantor, Gaboda, Nova, Lloyd, August 2011 5
Change in Health Insurance Coverage after Implementation of the ACA, 0-64 Non-group health insurance will increase from 2.8% to 7.6% of the nonelderly Medicaid/NJ FamilyCare will increase from 13.6% to 16.7% of the nonelderly 65,000-75,000 would be eligible for a NJ Basic Health Plan (BHP) 6
Who is Likely to Remain Uninsured? Eligible for Medicaid but uninsured Unauthorized immigrants not eligible Affordability (premium over 9.5% of income) and other exemptions Pay penalty rather than buy coverage Source: Hall and Buettgens, RWJF/Wake Forrest University/Urban Institute, March 2011 7
New Jersey Uninsured by Age Group Non-Elderly, 2009 New Jersey Family Health Survey Uninsured Rate Composition of Uninsured 40% 31.1% 30% 17.8% 13.0% 20% 14.5% 10% 0% 11.6% 6.3% <19 19-30 31-49 Age Group 33.8% 35.4% Age Group <19 19-30 31-49 50-64 50-64 8
Uninsured Rate by Income and Race/Ethnicity Non-Elderly, 2009 New Jersey Family Health Survey 80% 60% 40% 37.2% 37.4% 20% 20.5% 4.6% 8.3% 17.5% 6.5% 0% % Federal Poverty Level Race/Ethnicity 9
Uninsured Rate by Nativity and Citizenship Non-Elderly, 2009 New Jersey Family Health Survey 80% 60% Children (<19) Adults (19-64) 70.7% 40% 33.8% 41.9% 20% 4.2% 5.9% 12.9% 16.1% 0% Nativity of Child/Parents Adult Nativity, Citizenship, Time in US 10
Coverage-Related Attitudes Non-Elderly Adults, 2009 New Jersey Family Health Survey 100% Weak insurance preferences 80% 60% 40% Strongly Disagree 20% Somewhat Disagree 0% Somewhat Agree If you are healthy, having health insurance is still a necessity Having my needs I am a lot more taken care of at a likely to take risks public or free clinic than the average is just fine with me person Strongly Agree *Asked of household respondent only, applied to all household members 11
Percent with Weak Preferences by Coverage and Income Non-Elderly, 2009 New Jersey Family Health Survey 100% Insurance Unnecessary Public/Free Clinic Fine Risk Taker 90.3% 80% 69.2% 69.7% 68.3% 60% 40% 20% 7.6% 25.9% 42.6% 18.7% 39.4% 42.7% 53.4% 20.4% 41.4% 25.8% 44.9% 0% Private Public Uninsured <139%FPL Uninsured 139%-400%FPL Uninsured >400%FPL Insurance Coverage and Federal Poverty Level of Uninsured 12
Percent with Weak Preferences by Coverage and Income Non-Elderly, 2009 New Jersey Family Health Survey 100% Weak Preferences on at Least Two Attitude Measures 80% 67.1% 60% 40% 38.5% 43.6% 45.6% 20% 15.6% 0% Private Public Uninsured <139%FPL Uninsured 139%-400%FPL Uninsured >400%FPL *p<0.01 Insurance Coverage and Federal Poverty Level of Uninsured* 13
Percent with Weak Preferences by Demographics Non-Elderly, 2009 New Jersey Family Health Survey 100% 80% 74.7% 60% 40% 39.8% 53.2% 58.4% 41.5% 55.1% 46.1% 34.0% 28.2% 40.1% 57.7% 41.0% 20% 0% Age Group* *p<0.10 ** p<0.05 ***p<0.01 Sex* Race/Ethnicity*** Education** (age 19-64) 14
Percent with Weak Preferences by Nativity/Citizenship 2009 New Jersey Family Health Survey 100% 80% Children (<19) Adults (19-64) 85.5% 81.5% 84.1% 60% 40% 37.4% 43.5% 20% 20.1% 19.1% 0% *p<0.01 Nativity of Child/Parents* Adult Nativity, Citizenship, Time in US* 15
Who will be most challenging to reach? Most likely to be uninsured Young adults in their 20s Low-income Hispanic New immigrants Weak preferences for coverage Low-income uninsured Young adults (<30) and early middle aged (30s & 40s) Hispanic! Low education Non-citizen adults, foreign born children 16
How does the ACA support public outreach? Health Insurance Exchanges Consumer-friendly web portal Toll-free assistance hotline Federally fundable through 2014 Exchange should conduct aggressive and multi-faceted outreach to inform the public of their services and coverage options (HHS guidance) Navigator programs must [C]onduct public education activities Provide fair and impartial information In a culturally and linguistically appropriate manner (ACA language) Not federally fundable 17
NJ Health Insurance Exchange issues to watch How will Governor respond to enabling legislation (S-1319/A- 2171) passed by legislature? Will Exchange be active versus passive purchaser? legislation gives Exchange power to reject plans Should the Basic Health Plan be included? What are the options for Essential Health Benefits? What will be the standards for selecting Navigators? 18
NJ Health Reform Resources New Jersey health reform web site http://www.state.nj.us/dobi/division_consumers/insurance/ppaca.html CSHP health reform resources, www.cshp.rutgers.edu Health Insurance Status in NJ After Reform Stakeholder views on Design of the NJ Exchange Governance of the NJ Health Insurance Exchange The Basic Health Plan Option Combining Individual and Small Group Risk Pools Defined Contribution Strategy for the SHOP Exchange Quality Measures for the Exchange More forthcoming 19