Like it or not, it’s here. Implementation of the Affordable Care Act—a.k.a. Obamacare—began October 1 amid the added confusion of a federal government shutdown. At deadline, the President and Congress were still attempting to sort out their differences on the budget. Despite that bump in the road, almost 1 million New Jersey residents now are eligible to sign up for health-insurance coverage through an online marketplace. This exchange is a one-stop shop where residents can compare insurance plans and apply for subsidies to help cover their premiums.
In New Jersey, Governor Chris Christie has opted to have the federal government—and not the state—manage the marketplace. (It can be accessed at healthcare.gov or 800-318-2596.) In all states, those with existing insurance need not seek coverage through the marketplace, but uninsured residents must sign up by March 31 or pay a penalty on their 2014 tax return, starting at $95 per adult.
Those are the basics, but there are still plenty of questions. For clarity, we turned to Joel C. Cantor, director of the Rutgers Center for State Health Policy and a distinguished professor of public policy.
What are the biggest challenges to implementation of the Affordable Care Act?
The nature of New Jersey’s media market is such that it is hard to get the information out to the public, given that so many New Jerseyans pay attention to the media emanating from New York and Philadelphia. Add to that the issue of budgeting, as states that choose to implement their own exchanges have a lot more resources to get the message out than those relying on the federal government.
Are there other implications of the governor’s decision to leave the Feds responsible for the insurance marketplace in New Jersey?
In terms of the mechanism and the way the subsidies will flow, we won’t notice any difference. In some ways, it is more efficient for the federal government to do this in every state. Unfortunately, this wasn’t the plan. Congress and the Obama Administration anticipated that more states would do this on their own, and the lawmakers booked the money that way. On the early-implementation and public-education side, that is the biggest negative of the state not doing this on its own.
Will the process be as confusing or complicated as critics claim?
The health care system was confusing and complicated before Obamacare. In some ways, Obamacare has simplified some of it. The basic structure of the health care system is unchanged; we are just grafting off some new parts. Anything new brings anxiety and more complexity.
What are the biggest benefits of the new system?
The most important piece is that affordable coverage will be available to over 900,000 New Jersey residents. We are anticipating that well below that number will actually sign up, but there will be an affordable option available for most people who are uninsured. The other potential benefits are long-term—and the jury is still out on how effective these pieces will be, such as a change to incentives that providers receive to deliver higher quality and lower cost.
Primary-care physicians already are in short supply in New Jersey. How will the new system impact the demand for their services?
There are training grants available to prepare primary-care providers and advanced-practice nurses [those with post-graduate degrees]. There are a number of vehicles to encourage the growth of primary care. Each of these policies on its own is a fine thing, but the medical-education and nursing-education pipeline is years long. These programs…will not address the short-term problem, so some areas will probably see a shortage in primary-care physicians.
What do you say to those people who would rather pay the penalty than sign up before March 1?
It is certainly an option. The penalty is not very severe. It is the greater of $95 or 1 percent of income. It goes up over three years, and gets more serious over time. I don’t think any of the close observers think it is the penalty that will get people to enroll. Instead, it is the opportunity to get an affordable premium that will be the incentive….what will drive this is the access to affordable health care.
