Nobody would blame you for mistaking a “skinny repeal” for the latest low fat latte or frozen dessert.
The phrase that’s entered the lexicon of health care refers to the most recent approach to replace the Affordable Care Act. The plan is less “all-out-repeal” than earlier versions, but still largely guts the ACA.
Under “skinny repeal,” Americans will not be required to carry health insurance and employers will not have to provide insurance to their workers.
The plan keeps Medicaid relatively intact. That’s good. The losers are people who work for themselves or whose employers don’t provide health insurance and, therefore, need to purchase insurance on the individual market.
The repeal proposals in Washington change not just daily, but hourly, and by the time you read this, a new plan may be in the works. Still, enough information has emerged to make it clear that all of us in New Jersey — especially our legislature and our next governor — need to be prepared and must:
Take steps to save our individual market.
The continuing uncertainty — and perhaps the end of subsidies to help people pay for premiums and out of pocket medical costs — could destroy New Jersey’s individual insurance market. The U.S. Department of Health and Human Services, meanwhile, is not expected to do much to promote enrollment for 2018. We have over 368,000 New Jersey residents in this market and more than 58 percent receive federal subsidies to help them pay the premiums.
Our market was stabilizing but premiums are bound to soar without the enforcement of the individual mandate. We must consider other options, such as a waiver from the federal government that would allow everyone in the individual market to purchase insurance through our Medicaid program — or through our State-run employee benefit program. The same amount of federal funds that is being used to help people buy insurance in the individual market could be redirected to keep people insured in a more stable market. Other states are looking at these types of solutions and we should, too.
Consider a State-based mandate or auto-enrollment of everyone into insurance.
Insurance only works if large numbers of people participate — both the healthy and the sick. If the federal mandates go away, we must do everything we can in New Jersey to show the value of having health insurance. State leaders, health care professionals and advocates, and the business community must get behind a plan that supports either an auto-enrollment program or State-based mandate that leads to insurance coverage for as many people as possible. We would have to demonstrate to small employers and to individuals that being healthy — and having a healthy workforce — is critical. More people in the insurance market means more stability and lower premiums for everyone.
Use the State’s power as a purchaser and regulator to reduce costs in our commercial and Medicaid markets.
We still pay enormously for avoidable costs. We pay for care that is unnecessary and unhelpful. We pay for care that is over-priced. Sometimes we pay for poor quality care that leads to increased costs — along with the administrative overhead of our overly complex system. We can add all those costs to those driven by our unhealthy American life-styles. At the Quality Institute, we’re working to address cost in a number of ways: Implementing the 24 recommendations in the Medicaid 2.0 Blueprint; passing the surprise billing ban; and moving the health care system away from fee-for-service payments, which encourage a greater volume of treatment and interventions, and toward paying for better patient outcomes. Reducing costs is our biggest challenge — one that neither party is focused on enough as the repeal debate rages on.
As we watch what happens in DC, I am eager for your thoughts and ideas for how New Jersey can respond. The tumult in health care is not a challenge for any one legislator or even one governor to solve alone. As Quality Institute members and health care leaders, we need to share our ideas and experiences — and our passion — to create a cost-effective and sustainable health care system that protects the people of New Jersey.