Healthcare in Flux


NJ Spotlight | Opinion: Active or Passive, That Is the Question.

The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, mandates that states must have health exchanges (HE) in place by January 2014 but they must tell the US government one year in advance whether they will be able to do so or the federal government may set the HE for them. Although the New Jersey Legislature is ready to pop up a bill creating the exchange, there are conflicting views on what the bill should establish as criteria for inclusion in the HE. Some advocate for a very active government role allowing only the best plans although the criteria for determining what is “best” appears to be ill-defined. Others would like to see a marketplace open to all plans and let the customer select.

There is a very good possibility that the New Jersey HE bill will be lacking in detail regardless of what position it takes on the screening of permissible plans. The N.J. Legislature is notorious for producing an astronomical number of bills with little or no debate. If the bill takes the most active role denying access to some plans, those insurers left out are likely to sue unless the HE has an iron-clad system of selection. The latter is rather unlikely to be the case. On the other hand, a HE where the government simply makes a list of plans without screening would leave patients abandoned facing a maze of confusing information and rates. Many patients could make the wrong selections for them.

Although initially I was inclined to support the most active HE possible, the possibility that such an approach will be viewed by many as government interference has made me reconsider. I believe now , after tapping on the expertise of others, that the best approach would be the middle of the road: One HE where all plans are accepted but at the same time the government adds a value table to advise buyers. The table could even include several  scales following different parameters such as lowest cost, or abundance of providers, etc. As Joel C, Cantor says above: “It is important to get it right this time.”

ACA already defines the role of the HE to a great extent: The HE must review and certify for offered health plans based on their scope of benefits, marketing practices, provider network adequacy, inclusion of safety net providers, enrollment practices, quality measurements, etc. The only thing New Jersey has to do, I believe, is to follow those guidelines and make the subsequent analysis available to the public in the most clear and concise manner – sort of like the nutrition labels in food

Since there is already a healthcare market that pre-exists the formation of the HE. the latter will be a parallel market where many of its patients will receive federal subsidies. Should the two markets compete or be balanced? ACA opens the door to competition between the two by 2017. And more importantly: Should we have a public option, like a New Jersey Health Benefits Plan for the private sector? I must indicate here that I favor the latter idea.

Complicating the situation somewhat, governor Christie does not want to sign any legislation creating the New Jersey HE until the US Supreme Court decides the fate of ACA. Because of his reluctance, New Jersey has already lost some grant money from the the U.S. ($30 or 40 million) and may  lose even more.

In any event, we must understand that healthcare is one of the greatest factors influencing both economic growth and quality of life. Together with medical tort reform (already in my proposals since 2010) the operation of the HE is at the center of my program for New Jersey.

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