Health Insurance Exchange in New Jersey Ruth J. Schulze, MD 221 st President, Medical Society of New Jersey Presentation to OSMAP November 15, 2013 National Harbor, MD

Early Exchange Legislation NJ Legislation introduced in 2008 – The New Jersey Health Insurance Connector Act – A1939. The measure is based on legislation establishing an exchange in Massachusetts. The bill languishes in committee until the ACA passes in Congress. The bill passed the NJ General Assembly, but is never considered by the Senate.

Second Attempt Exchange Legislation is (A2171/S1319) is passed by the Democratically controlled Legislature in May of Shortly after the measure passes the SCOTUS begins arguments on the constitutionality of the ACA May 2012 Gov. Chris Christie absolutely vetoes the exchange legislation based on the uncertainty of the continued viability of the federal ACA.

Third & Final Attempt Next attempt at a state level health insurance exchange comes after the SCOTUS opinion upholding certain ACA provisions that included exchanges. A3186/S2135 passed the Legislature with mostly Democratic votes in October In December of 2012 Gov. Chris Christie again vetoes the exchange legislation. Gov. Christy sets out several factors underlying the veto.

Rationale The time for decision for states to establish exchanges (under federal regulations) [was] just a week away and the states were still awaiting implementation guidance at that time. (December 2012). As drafted Senate Bill No would create an expensive new bureaucracy and while the federal government had offered start up funds the total price for a health exchange has never been quantified. He noted that the federal government has provided states with future flexibility to amend their decision on exchanges in subsequent years. Based on these factors...I have determined that federal operation of the exchange is the responsible choice for our state.

MSNJ Positions General support for exchanges as a way to temper health insurer behavior and increase transparency in health insurance Supported Active Purchaser model as the method for the most control over MCOs - Supported MD/DO representation on the Board of the Exchange Alternatively supported clinical advisory panel to the Board.

Current status – How is the Federal Exchange Working? Problems with healthcare.gov have frustrated many navigators and groups funded to enroll NJ residents in health insurance programs. As of last week just a few hundred individuals in NJ have been enrolled. Many more individuals are reported being enrolled in the state Medicaid program because the states Family Care website is working well. The more affluent, healthy, young residents (above Medicaid) lacking health insurance are not being enrolled. After January 1,2014 Medicaid eligibility expansion should include more of this population.

Health Insurance Exchange in New Jersey Ruth J. Schulze, MD – 221 st President Medical Society of New Jersey Presentation to OSMAP November 15, 2013 National Harbor, MD