While Governor Christie isn’t talking about what the state might do to implement federal health care reform — except to say he won’t do anything until after the presidential election — few believe he will ultimately reject the billions in federal dollars that come with the reforms.
Now that the U.S. Supreme Court has upheld President Obama’s sweeping plan for the nation’s health care system, Christie and other governors throughout the country are under pressure to decide how to react.
For New Jersey, that means Christie must decide whether the state implements a health insurance exchange — a marketplace for affordable health coverage required under the law — and if it will accept $21 billion over 10 years to expand Medicaid, which some GOP governors on Friday pledged not to enact.
The decisions are tricky for Christie who has openly criticized the reforms and is a prime backer of Mitt Romney, who has pledged to try to overturn “Obamacare” if he is elected president in November.
Still, among lawmakers and political insiders in Washington and Trenton, most believe Christie will act to secure the federal Medicaid dollars, despite his loud and public denunciation of the health care law as a tax on the middle class.
“In the current fiscal climate, it’s hard to imagine a scenario where the governor would not maximize the amount of federal dollars that come in for health care,” said Ben Dworkin, director of the Rebovich Institute for New Jersey Politics at Rider University.
A ‘stupid’ mistake?
Rep. Frank Pallone, D-Monmouth, an architect of the sweeping federal health care reforms put it more succinctly, calling it “incredibly stupid” to opt out.
While Christie mulls his options, he will face extraordinary pressure from hospitals, patient advocates and other groups to move ahead with the reforms that have the potential to provide affordable insurance to more than 850,000 uninsured New Jersey residents.
“There are plenty of childless adults … who need coverage,” said Jeff Brown, health care campaign coordinator for New Jersey Public Citizen, which has aligned with 70 other groups to lobby for health care reform.
“These are adults who go and use the emergency room and charity care dollars,” he said. “We’re paying regardless of doing these things. It’s beyond stupid not to expand Medicaid — it’s irresponsible and reckless not to take the money.”
Sen. Joseph Vitale, D-Woodbridge, who has pressed to have laws in place to enable a key part of that reform, said he will be meeting with the administration soon to discuss the governor’s options. Vitale, chairman of the Senate Health Committee, had sponsored a bill to create the health care insurance exchange, which Christie vetoed.
New Jersey must pass a law creating the exchanges by Nov. 16. By October 2013, the system must be ready to begin. If the state fails to act, the federal government will step in to set one up.
Christie also said that he’s in no rush to act on the requirement that states create the exchanges and that if the Legislature sends him a bill to do it, he’ll veto it — again.
“I’m in no hurry to do that, especially because we’ve got an election four months away,” he said Thursday night. “Let’s see what’s going to happen.”
But meeting the federal government’s deadline would take significant preparation, Vitale said. His effort to draft the exchange legislation took around four months.
“That was with full input from lots of stakeholders,” he said.
On Friday, Louisiana Gov. Bobby Jindal, Wisconsin Gov. Scott Walker and other Republicans announced they were refusing to implement the reforms and would instead work to elect Romney.
Christie, who has been pegged as a potential vice presidential candidate and has campaigned for Romney, has signaled his frustration with the reforms but doesn’t go as far as his GOP brethren. His spicy rhetoric on the health care reforms make headlines but doesn’t always translate into such strident action at home, said Brigid Harrison, a political science professor at Montclair State University.
“It’s a consistent behavior pattern,” said Harrison. “He’s very concerned about couching whatever he says to a national conservative audience, but what he’s saying isn’t necessarily what he does.’’
In fact, Christie has accepted aspects of Obama’s health care plan when he deems it in the state’s best interest.
As The Record reported last October, an analysis of Christie’s pensions-and-benefits reforms showed that one new program — the Employee Group Waiver Program available through Obama’s health care law and included in the first year of Christie’s reforms for public-workers’ benefits — saved the state an anticipated $90 million in retiree prescriptions.
If he wasn’t playing to a national audience with his rhetoric, Christie’s decision on Medicaid would be an easy one, observers said.
Slightly more than a third of the 1.1 million uninsured New Jersey residents would be eligible for insurance under the Medicaid expansion, initially at no cost to the state, according to estimates prepared by the Urban Institute. The federal government covers 100 percent of the cost through 2016, then gradually cuts back to 90 percent by 2020 when the program is fully implemented.
That’s money flowing to hospitals — as well as doctors — that care for Medicaid patients. Those hospitals turn to the state when they face financial problems or declare bankruptcy. They are also the hospitals that receive the bulk of charity-care payments, which will be reduced when the federal government cuts back its contribution in 2014.
New Jersey is ahead of many other states in expanding insurance enrollment options for needy residents. It already provides coverage for children and families with incomes up to 133 percent of the poverty line, or $30,657 for a family of four.
“Since we already cover kids and parents up to [133 percent of poverty] that number, I don’t believe it’s as big a decision for our state as it would be in other states,” said Suzanne Ianni, executive director of the Hospital Alliance of New Jersey, representing many of the state’s urban and safety-net hospitals. “I hope Governor Christie would allow childless adults to have access to care through Medicaid expansion.”
Even if the young adults who would benefit from a policy don’t have a lot of clout, the hospitals that care for them do. They’re often the largest employer in a county and are accustomed to making their case.
Lobbyists for the New Jersey Hospital Association were in Trenton on Friday trying to protect the state’s charity care appropriation from the governor’s budget ax. Those funds provide immediate relief, while the Medicaid expansion wouldn’t be implemented until 2014.
Providing coverage to uninsured people ultimately will reduce the need for charity care — sparing hospitals the annual stress over the state budget, while also improving patients’ health.
The hospital association is optimistic the governor will go ahead with the Medicaid expansion.
“Over the years, we’ve had many good conversations with the state to make sure that New Jersey is not leaving federal matching dollars on the table,” said Kerry McKean Kelly, a spokeswoman. “I’m sure the state will take a very close look at this.”
State House Bureau correspondents Juliet Fletcher and Melissa Hayes contributed to this article.