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New Jersey & The Affordable Care Act

What The Affordable Care Act Means For New Jerseyans
New Jersey (image credit: Thinkstock)

New Jersey (image credit: Thinkstock)

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For more information about the Affordable Care Act, visit CBSPhilly.com/ACA.

In 2007, 12 percent of adults in New Jersey reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, New Jersey families saw their insurance premiums increase 35 percent to an average annual cost of $13,750. Single policyholders saw their rates rise 29 percent over the same period. [1] Of the New Jersey residents who do have health insurance, 54 percent are covered through their employment, four percent purchase individual policies, and 25 percent are covered through the public programs Medicaid and Medicare. This leaves 16 percent of the New Jersey population, or 1,349,700 people, uninsured. [2]

Who are the uninsured in New Jersey?

Children, ages 18 and younger, are uninsured at a rate of 10 percent in the Garden State. This figure more than doubles to 21 percent among children living in households with incomes less than 139 percent of the Federal Poverty Level. Non-elderly adults in households at this income level are uninsured at a rate of 44 percent. The rate of uninsured among the non-elderly Hispanic population is 33 percent; non-elderly Blacks in New Jersey are uninsured at a rate of 24 percent, and 10 percent of the non-elderly White population lacks health insurance in the state. [3]

How does the Affordable Care Act affect New Jersey residents?

The Affordable Care Act (ACA) requires that states provide its citizens access to a health insurance marketplace where they can shop for and enroll in quality health plans. States have the options of creating their own exchanges, turning operation of an exchange over to the federal government or running an exchange in cooperation with the federal government.

Under the ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits including hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.

The New Jersey Health Insurance Exchange

In March of 2012, the New Jersey State Legislature passed the “New Jersey Health Benefits Exchange Act” establishing a state exchange. This legislation was vetoed by Governor Chris Christie on May 10, 2012. A second bill establishing a New Jersey exchange was passed Oct. 18, 2012. Citing lack of federal guidelines necessary to determine if a state-run exchange would be in the best interest of New Jersey, Governor Christie vetoed this bill as well. Therefore, the New Jersey health insurance exchange will be operated by the federal government.

Plans offered to New Jersey residents on the exchange are based on the Horizon Blue Cross/Blue Shield of New Jersey HMO Access HSA Compatible plan. Individual policies on the exchange are offered by Horizon Blue Cross Blue Shield, AmeriHealth New Jersey and Health Republic Insurance of New Jersey. As of October 1, New Jersey residents may compare plans, determine eligibility for subsidies and tax credits, and purchase health insurance policies through the federal website HealthCare.gov.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. New Jersey small business owners may access SHOP through HealthCare.gov.

External resources for New Jersey residents

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Sources:

[1] http://www.commonwealthfund.org/Publications/Issue-Briefs/2010/Dec/State-Trends-Premiums-and-Deductibles.aspx
[2] http://kff.org/other/state-indicator/total-population/?state=NJ
[3] http://kff.org/state-category/health-coverage-uninsured/?state=NJ

Gillian Burdett is a freelance writer in New York. Her writing focuses on education, public policy and family issues. Her work can be found here.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.

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