TRENTON, N.J. (AP) — A plan by President Donald Trump and the Republican-led Congress to replace the Affordable Care Act promises to dominate debate in Washington in the coming weeks.
The discussion is having ripple effects in New Jersey, where nearly 1 million residents gained insurance under former President Barack Obama's signature bill and where Democratic and Republican candidates to succeed Republican Gov. Chris Christie have begun to tackle the issue.
A new Quinnipiac University poll out this week ranked health care above the budget as an issue but below taxes, education and ethics in government. The poll surveyed 1,098 New Jersey voters and had a margin of error of plus or minus 3 percentage points.
About a half-million New Jersey residents have coverage through Medicaid expansion, and about 300,000 more have coverage through the marketplace set up under the Affordable Care Act. It's unclear exactly how the GOP plan under consideration in Congress would change those figures in New Jersey, and Christie's administration has declined to detail the proposal's effects.
The bill would keep Medicaid expansion funds through 2019 but after that would offer states enhanced funding only for those already covered. The plan would also reduce subsidies used to buy insurance.
The issue straddles a major federal-state fault line that the next governor will have to deal with but that won't be entirely within his or her control.
CANDIDATE POSITIONS AND PROMISES
Democratic front-runner Phil Murphy has called on Christie to defend the ACA and come out as an opponent of the GOP plan, which he calls "Trumpcare." During a recent candidate forum he said that if the GOP plan takes health care away from residents, he would consider a universal-coverage system "to get health care to everyone."
Former Clinton administration official and Democrat Jim Johnson called the GOP plan "unacceptable" and said, "Access to health care is a universal right." He favors changing the ACA to expand coverage.
Democratic Assemblyman John Wisniewski is calling for a Medicare-style, universal coverage system in New Jersey. He says it could be financed through federal funds, worker-and-employer payroll deductions and cost-savings gained through negotiating drug costs.
Democratic state Sen. Ray Lesniak said he backs universal health care but it's difficult to finance. So he instead called for tweaking the ACA by requiring participation in accountable care organizations.
Republican Lt. Gov. Kim Guadagno has called for waiting to see what comes out of the debate in Washington. She said through a spokesman that the result should be a "better plan that ensures quality affordable healthcare."
GOP Assemblyman Jack Ciattarelli called the ACA flawed and failed and wants to see an improved Medicaid. He did not give details but said the poor shouldn't lose access.
Republican Nutley Commissioner Steve Rogers said he supports the GOP health care plan and called it a "big improvement" over the ACA.
WHAT THE EXPERTS SAY
Most New Jersey residents get their health coverage through an employer-based plan, so the Medicaid expansion and ACA exchange overhauls would affect a fraction of the state. But where the issue affects more residents is in the annual budget, which has seen state costs come down because of federal funds.
The debate among experts breaks down along ideological lines, with liberals favoring a plan to cover more residents and conservatives calling for lower costs and patient choice.
"If we can fight back repeal and preserve the ACA, having a governor who understands the opportunity and benefits of the ACA would bode well for the people of New Jersey," said Maura Collinsgru, health care program director at the liberal-leaning New Jersey Citizen Action.
Erica Jedynak, New Jersey director for the conservative-leaning Americans for Prosperity, said there's not much the state can do while Congress and the White House debate the issue, but she called the ACA a "failed attempt to micromanage" health care. The state should leave Medicaid expansion next year instead of 2020 as the GOP plan calls for, she said. And New Jersey should focus on lowering costs.
"There is no silver bullet for health care reform, but holding onto Obamacare is Russian roulette," she said.
This is the second in a weekly series that will look at issues facing New Jersey ahead of the June 6 primary. The general election is Nov. 7. Contact Catalini at https://www.twitter.com/mikecatalini.