NJ For Health Care was established in 2008 with the support of the Robert Wood Johnson Foundation and Community Catalyst as part of their Consumer Voices for Coverage initiative. Campaign Our coalition is made up of a broad-based alliance of health care, consumer, senior, student, disability, women's, labor, faith-based, civil rights and social justice organizations working to bring guaranteed, high quality, affordable health care to all New Jersey residents.
Since 2008 we have been a voice for New Jersey health care consumers. We've worked on a number of issues to advance our core mission of increasing access to quality, affordable health care for all New Jerseyans. We have and will continue to work to build strong alliances with patients, providers and payers across the State to achieve that goal.
Read the NJ For Health Care Core Principles.
Become an ally in the fight for guaranteed access to quality, affordable health care for all. Join more than 100 other organizations working with us to in support of our principles to improve access and delivery of health care for all New Jerseyans. Members receive regular updates on our activities, monthly meetings and policy priorities. Join us (click here)!
Read on for highlights from some of our past campaigns.
National Health Care Reform Bill Passes After Long-fought Fight!
On Sunday evening, March 21, 2010 the U.S. House of Representatives PASSED comprehensive national health care reform by a vote of 219 to 212. For the first time in history, a comprehensive health care bill has passed both Houses of Congress. The bill will give health care to 32 million Americans and save over 30,000 lives per year. And it will regulate the insurance companies so they can no longer deny care for pre-existing conditions, charge you more if you're sick, put limits on your benefits, or increase rates with impunity.
Immediate benefits will include the opportunity to keep adult children on family health insurance policies up to age 26 and relief for seniors who have fallen into the Medicare Prescription Drug "donut hole."
Not one Republican voted for the bill. In New Jersey — only one Democrat voted against the bill: Rep. John Adler (NJ-03).
CALL Toll Free: 1-877-264-4226 to THANK members of Congress who voted YES and express your disappointment to the ones who voted NO.
How NJ's Members Voted:
YES — Representatives Rothman, Pascrell, Sires, Payne, Pallone, Holt and Andrews
NO — Representatives Adler, Garrett, Frelinghuysen, Lance, Smith and LoBiondo
To find out how your Representative voted click here.
What Does the Patient Protection and Affordable Care Act Mean for New Jersey?
Read the recent analysis by New Jersey Policy Perspective!
- New Jersey has more uninsured people than most states and will receive more federal aid. By 2019 nearly one million New Jerseyans will receive insurance at a cost to the federal government of about $25 billion over ten years.
- Prescription drug coverage will be subsidized to a greater degree by the federal government for more elderly and disabled people in New Jersey. Reform will provide about $57 million in relief for 227,000 Medicare Part D beneficiaries in New Jersey. We will receive over $15 million for over 30,000 PAAD and Senior Gold beneficiaries. All 1.3 million Medicare beneficiaries in New Jersey will benefit from provisions of the new law like no cost sharing for prevention services and free, annual wellness visits.
- Small businesses will benefit. Health reform will provide tax credits this year to most of the 215,000 businesses with fewer than 25 employees to offset the cost of providing health coverage for their employees.
- More adults will be eligible for affordable health coverage. All adults in poverty will become eligible for either Medicaid or other affordable insurance in the Exchange starting in 2014. The federal government will pay all health costs (about $150 million annually) for adults who do not have children and are on General Assistance.
- New Jersey's pharmaceutical companies will benefit. New Jersey has one of the largest concentrations of pharmaceutical companies in the world. Health reform in effect provides them with up to 32 million new insured customers nationwide because health plans will be required to provide prescription drugs.
- The increase in federally funded Medicaid reimbursement rates to New Jersey primary care physicians will be the highest in the nation. Health reform will require Medicaid to pay the same rates as Medicare in 2013 and 2014 to primary care physicians to make this care more accessible. Because New Jersey has the lowest Medicaid payment rate in the nation (37 percent of the Medicare rate) this rate will almost triple and will be funded entirely with federal funds.
- More New Jersey hospitals will benefit. A reduction in the number of uninsured people should result in less demand for state-funded charity care beginning in 2014. Increasing the number of New Jerseyans with health insurance will help reverse hospital distress.
- The new law allows New Jersey to provide better health care and share its cost with the federal government. Given growing health care costs and the associated decline in the number of businesses offering health insurance to their employees, it was only a matter of time before health care reform would have come to New Jersey at a cost borne entirely by the state. National health reform has taken this pressure off the state and will provide a winning situation for all.
What is a Health Insurance Exchange?
The Affordable Care Act (ACA) makes great improvements to access and affordability in our health care system. One major way that the law does this is by establishing new state health insurance exchanges. A health insurance exchange is a virtual marketplace intended to make purchasing health insurance more transparent and affordable for consumers. An ideal health insurance exchange would create competition, transparency and accountability in the insurance market, therefore bringing down the cost of insurance premiums for consumers.
Under the ACA, states are required to establish these state level health insurance exchanges or allow the federal government to establish an exchange for their state. It is also the only provision in the law that requires states to include stakeholders in the planning process. On January 1st, 2013, all 50 states must submit a proposal for their own health insurance exchange to the federal government and by 2014 all exchanges must be implemented. So far New Jersey has received $1 million to begin planning for a New Jersey exchange. The NJ for Health Care Coalition believes that a good exchange must meet the following principles:
Principles for Establishing a Pro-Consumer NJ Health Insurance Exchange
The Patient Protection and Affordable Care Act (ACA) greatly improves access and affordability in our health care system. State health insurance exchanges are a cornerstone of this law, providing a way to promote competition, transparency and accountability in the insurance market and bring down the cost of insurance premiums for consumers.
The new exchange must meet the following principles:
- Public Interest Mission — The New Jersey Exchange should be established in the public interest, for the benefit of the people and businesses who obtain health insurance coverage for themselves, their families and their employees. It should empower consumers by giving them the information and tools they need to make sound insurance choices. The Exchange should work to reduce the number of uninsured, improve health care quality, eliminate health disparities, control costs, and ensure access to affordable, quality, accountable care across the state.
- Independent Public Exchange — The Exchange should be a distinct legal public entity that is independent of other units of state government. It should be able to perform inherently governmental functions like determining income eligibility, coordinating with other state agencies and programs, and adopt rules and policies governing health insurance plan participation. The Exchange must be transparent and subject to open meetings and public disclosure laws.
- Qualified, Pro-Consumer Governing Board — Consumer representatives should comprise a majority of the board. All board members must have expertise in one or more of the following areas: consumer advocacy, individual health care coverage, small employer health care coverage, health benefits plan administration and health care finance. The governing board may not include members who are affiliated with the health care industry.
- Negotiate on Behalf of Consumers — The exchange must be given the authority to act as an "active purchaser." This means the Exchange should use its large pool of consumers to negotiate, as large groups do, for the best premiums and plans. The Exchange must use this leverage to demand quality, responsiveness to consumer concerns, reasonable rates, efficient plan designs, robust provider networks, and comprehensive benefits.
- Full Integration with Medicaid and NJ FamilyCare — To promote seamlessness in the application process and continuity in coverage, the Exchange plans must be fully coordinated and integrated with Medicaid and NJ FamilyCare. Plans that are available in Medicaid and NJ FamilyCare must also be available in the Exchange.
- Consumer Friendly — The Exchange must be easily accessible to all consumers and small businesses, use plain, easy-to-understand language, meet established standards for language, literacy and cultural competency. The Exchange must adopt a "no wrong door" approach, meaning people can access insurance through the exchange no matter how they come to seek assistance. It must reduce paperwork for individuals and small businesses, and provide in-person, telephone and online assistance and access.
- Effective Outreach and Assistance — The Exchange should contract with independent organizations that will help consumers and small groups "navigate" the various health insurance plans and services offered through the Exchange. Contractors providing these navigator programs should be free of insurer conflicts of interest and have a history of working with diverse communities. The exchange must also provide customer service that understands diverse populations, such as people with disabilities, mental health needs or low-income.
- One Insurance Pool — Health insurance markets work best when risk is shared across large numbers of people. The Exchange should explore how best to transition toward a unified insurance pool that combines both the individual and small employer markets. Other opportunities to expand the pool of insured people should be explored.
- Improve Health Care Quality & Promote Prevention — The Exchange should only offer plans that provide a comprehensive and high-quality package of health care services. Every plan should prioritize prevention and work to reduce health disparities. Dental and mental health benefits should be included. Health care delivery networks should include essential community providers. Patients should have access to providers who speak their native language.
- Community Health — The Exchange itself should promote community health by fostering collaborations between the Exchange insurers and community organizations, such as local public health departments, mental health associations, maternal and child health consortia and disease-specific nonprofits. This will ensure the efficient delivery of health information, health promotion and disease prevention and screening services.
- Ensuring Exchange Stability — If insurers and brokers have the power to steer less-healthy patients onto the Exchange, so that they can keep healthier, more profitable enrollees outside of it, premiums in the exchange could become very expensive, threatening its stability. The State must guard against the segregation of people by their health status. The same rules must apply to plans both inside and outside of the Exchange. The Exchange must set market protections to prevent insurers and brokers from cherry-picking healthy enrollees or steering them onto or off the exchange.
- Overview of "Making Health Care Reform Work: The NJ Health Insurance Exchange"
- Fact Sheet on what a health insurance exchange is.
- List of our exchange principles.
- Media Coverage: "Taking The First Steps Toward A New Jersey Health Exchange" (NJ Spotlight — September 15, 2011)
VICTORY! Proposed Conversion of Horizon BCBS of New Jersey
Legislation (S 375) requiring that Horizon BC/BS conduct multiple public hearings concerning its conversion application and requiring the NJ Department of Banking and Insurance conduct a Health Impact Analysis as part of its evaluation of a conversion application passed the NJ State Senate with overwhelming bi-partisan support on May 20, 2010. The vote was 38-2. See how your senator voted.
This is a major victory for consumers everywhere! Your testimony, calls, letters and emails to the legislature worked! Thank you to everyone!
AND BIG NEWS: The Star-Ledger reports that Horizon will not pursue the conversion application during the Christie Administration! Between last year's election, national health care reform, our call for a health impact study and the scrutiny they are now under for giving themselves and their executives whopping pay increases, it appears they've decided to back off the application all together.
But their self-serving pay increases have caused more than the proverbial eyebrow to be raised, as reported in the Asbury Park Press. Now, Senate President Steve Sweeney is calling for a formal investigation of their compensation practices and how such whopping pay increases can happen as their customers are being hit with 30%, 40% and higher rate increases.