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

2. 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.

3. Second Attempt • Exchange Legislation is (A2171/S1319) is passed by the Democratically controlled Legislature in May of 2012. • 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.

4. 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 2012. • In December of 2012 Gov. Chris Christie again vetoes the exchange legislation. • Gov. Christy sets out several factors underlying the veto.

5. 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. 2135 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.”

6. 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 MCO’s - • Supported MD/DO representation on the Board of the Exchange • Alternatively supported clinical advisory panel to the Board.

7. 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 state’s “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.

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