TRENTON, N.J. (AP) - The congressional Republican and White House-backed plan to overhaul the Affordable Care Act threatens to saddle Gov. Chris Christie’s successor with budget difficulties, but the administration isn’t saying exactly what those will look like.
Christie, a twice-elected, term-limited governor, leaves office in January after expanding Medicaid under President Barack Obama’s Affordable Care Act in 2014. The governor has touted the decision that led to health coverage for more than half a million residents and saw federal Medicaid matching funds grow while state costs for charity care dwindled. Christie recently said that the Republican bill is the “beginning of negotiations,” but his office didn’t respond to requests for reaction to a Congressional Budget Office estimate that the GOP plan would lead to 14 million Americans losing coverage.
Christie faces competing pressures because of the bill: New Jersey benefited from the expansion of Medicaid under Obama’s signature legislative achievement, but a major tenet of the Republican Party in recent years has been a promise to repeal and replace the legislation.
Democrats are sharply criticizing the plan and calling on the governor to defend it.
A closer look at the issue in New Jersey.
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COVERAGE AND SAVINGS
About 500,000 people gained insurance through expansion in New Jersey, according to the Christie administration, and the state has seen about $2 billion in cost savings thanks to the federal plan. Christie also attributes decreased state costs to expansion. For example, charity care - state aid to hospitals to cover residents who meet certain income criteria - has fallen dramatically since Medicaid was expanded.
In 2016, the state budgeted about $500 million for charity care, down to $300 million in the current fiscal year. For next fiscal year, Christie proposes about $250 million for charity care. The prospect for increased charity care costs has made Democrats who control the Legislature particularly skeptical.
“If people don’t have health insurance we’re gonna have to start funding it out of state dollars. That’s not a good thing. It’s a scary thing they’re contemplating cutting that many people off health insurance,” Senate President Steve Sweeney said.
New Jersey also began covering substance abuse under the Medicaid expansion. The state’s opioid crisis, which saw 1,500 people die in 2015, is a major focus for Christie in his final year in office.
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THE NEXT GOVERNOR
Phil Murphy, the leading candidate in the Democratic primary, has assailed the plan as “Trumpcare” and called on Christie to defend the Affordable Care Act. It’s unclear how Murphy and other candidates would manage any potential budget holes resulting in reduced federal matching. Democratic candidate Assemblyman John Wisniewski has called for a state-funded single-payer insurance program for New Jersey.
Republican candidate Lt. Gov. Kim Guadagno said through a spokesman that the GOP bill is just the beginning of debate and the result must be a “better plan.” Republican candidate Assemblyman Jack Ciattarelli called the ACA “failed and flawed” and called for a “new and improved” Medicaid. It’s unclear whether the congressional GOP plan meets that test.
Peter Woolley, a politics professor at Fairleigh Dickinson University, said if the GOP plan is enacted and leaves the next governor with a budget hole, he or she would be forced to act, likely taking an unpopular remedy such as raising taxes or cutting spending.
“When January comes, his successor will, as is always the case, lay any blame at the predecessor’s door,” he said. “But that will be only a temporary comfort.”
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THE GOP BILL
The House bill calls for repealing the Medicaid expansion, which covers about 11 million people nationally. Currently the federal government offers a generous matching payment to states that expand their programs. Starting in 2020, that payment would only be available for beneficiaries already enrolled under the expansion, not new ones.
The legislation would also end Medicaid’s open-ended entitlement status, moving to a system of limited federal financing. Washington would pay the states a fixed amount per beneficiary, based on Medicaid spending in each state, adjusted annually for medical inflation.
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WHAT’S NEXT?
The health care legislation is sure to come up as the Democrat-controlled Legislature takes a short break from lawmaking and instead focuses on Christie’s final, $35.5 billion budget. The Assembly budget committee is scheduled to meet Wednesday to kick off its review of the spending blueprint.
For now, though, it looks as if New Jersey lawmakers are focusing on lobbying Congress to halt the legislation.
“Gov. Christie and our Republican representatives in Congress should be using their access to lead the charge against it,” said Assembly Speaker Vincent Prieto.
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