Advocates for the poor are making their case that New Jersey should expand the ranks of people eligible for Medicaid in what could be the next big decision on how the federal health insurance overhaul plays out in New Jersey.
They say it will save state taxpayers money and give far more low-income people health coverage. But doctors are apprehensive, and hospitals are not pushing hard for the change, which some anti-big government groups oppose deeply.
New Jersey Gov. Chris Christie has not said whether he's willing to let more people be eligible for Medicaid. But many observers expect he'll announce his decision by late February, when he is scheduled to present his state budget proposal. A spokesman for Christie did not comment for this article.
The decision is a big one for each state government to make under President Barack Obama's 2010 overhaul of health insurance laws. Originally, states were going to be required to expand Medicaid, the joint state-federal insurance programs for low-income people, or face penalties.
But last year, the U.S. Supreme Court threw out the penalties, leaving it up to each state to decide whether to participate. The federal expansion is effective Jan. 1, 2014.
"I'm starting to feel more optimistic to convince him here," said Dena Mottola Jaborska, program director at New Jersey Citizen Action, one of several liberal groups participating in NJ for Heath Care Coalition, which is campaigning for the expansion. "The governor does care about working people who work hard and play by the rules."
New Jersey now is relatively generous when it comes to insuring children and their low-income parents.
But only a small number of non-senior, non-disabled adults with no children qualify for the government-run insurance known as NJ FamilyCare. A single person would have to make less than $2,800 per year to qualify for Medicaid now. As of December, there were 1.3 million people in New Jersey on Medicaid and FamilyCare, including 44,000 non-disabled, low-income adults on Medicaid.
Under the federal Medicaid expansion, someone in that situation earning up to $15,415 would be eligible. In an analysis of census data, the think tank New Jersey Policy Perspective, part of the NJ for Health Care group, found that about 176,000 New Jersey residents — about one-fourth of the state's 700,000 uninsured adults — would be eligible for an expanded Medicaid program. Higher-income uninsured people are being steered into the health insurance exchange that's scheduled to start running later this year.
New Jersey Policy Perspective says in its report that most of those who would be newly eligible for an expanded Medicaid system are people working in low-wage jobs in such businesses as food service and landscaping.
Danielle Sacripanpe, a 55-year-old graphic designer who lives in Ewing, has not had a full-time job for more than three years. She has been cobbling together part-time jobs in her own field, in retail and even by modeling nude for art students, and has been making $15,000 to $20,000 a year.
In her leanest years, she would have qualified for an expanded Medicaid program. But as it is, she has been without health insurance except for a short period when she was working part-time for $8.75 an hour and paying about $100 a month for a limited plan.
Sacripanpe is using a charity-care program to pay for hip surgery next month but would like to be able to have some insurance plan. She would prefer that it come through a job, but she has found it hard to find a full-time one despite deep searching.
"Everyone's under the impression that everyone has a $50,000-a-year job and it's just not true," she said. "There are so many people out there that need health insurance."
Under the Affordable Care Act, the federal government says it would pay all the costs of the expansion from the time it is to launch in 2014 through 2016 and at least 90 percent after that. Further, the federal government would for three years pay the full cost of covering people already on Medicaid — a cost currently shared with the state.
Raymond Castro, the former state human services official who wrote the New Jersey Policy Perspective report, said he believes there will be immediate and lasting savings for the state government, not only because of the larger federal contribution, but also because the state could cut its payments to hospitals that provide charity care to the uninsured. Also, a provision of the federal law would let eligible people be signed up for Medicaid at any time — including at a hospital.
With more people covered, he said, there would be less of a need for those charity-care funds. And that's what makes hospitals a bit apprehensive.
"We've admittedly been delicate with our approach to the issue," said Randy Minniear, a senior vice president at the New Jersey Hospital Association. "By and large, in principle, we do support the concept of expanding Medicaid."
But he said the group wants to make sure the finances work — it has commissioned a study of its own — before advocating it more aggressively.
Doctors have reservations, too.
Mary Campagnolo, president of the Medical Society of New Jersey, said she is concerned that expanding Medicaid will not help with another problem in New Jersey: a shortage of primary care doctors, especially those accepting patients using Medicaid.
"If we were to expand Medicaid without enough access, it's going to be very difficult," she said.
Even a provision of the Affordable Care Act that would more than double Medicaid payments to primary care doctors might not relieve that problem, she said. The bigger payments would be guaranteed for only two years.
There's another, blunter criticism of the expansion: The state would eventually have to pay some of the costs of expanded coverage. A study last year found that the expansion would cost New Jersey nearly $1.5 billion from this year through 2022. And if there are not the promised offsetting savings, taxpayers would have to pick up that bill.
And Steve Lonegan, state director of the New Jersey branch of Americans for Prosperity, one of few groups actively campaigning against expanding the entitlement, believes the state, with its history of debt, would not have the discipline to save money any money.
"At some time, people have to suck it up and fend for themselves, just like my grandparents did when they came here from Italy," said Lonegan a former mayor of Bogota and a two-time candidate for governor.