The decision means that more low-income New Jersey residents can be covered under the joint federal-state health insurance program. If lawmakers agree—and in New Jersey, they almost surely will—the coverage becomes effective on Jan. 1, 2014.
There is not a clear consensus on how many residents will benefit. Christie said 104,000 would be added to Medicaid rolls. But other studies expect that number to grow. The liberal New Jersey Policy Perspective says that about 300,000 of the estimated 1.3 million uninsured residents of the state would be eligible.
Christie had not given many hints about how he would handle the major decision. His path was cleared a bit as seven other Republican governors have endorsed the expansion despite misgivings about the overall healthcare changes.
Christie emphasized that he's willing to undo the expansion if conditions change. And he reminded lawmakers in his address Tuesday that he has rejected having the state run a health insurance exchange and is instead letting the federal government handle it.
Including New Jersey, 22 states and the District of Columbia have signed on to the expansion and 13 states have rejected it. The rest are still considering what to do.
Under 2010 federal law, Medicaid expansion was initially mandatory. But the U.S. Supreme Court made it optional for states.
The federal government offers a major incentive: It has agreed to pay the full cost of the expansion for three years and 90% of the cost after that.
"It's a wise decision and it will provide affordable healthcare for tens of thousands of New Jerseyans," said Sen. Joe Vitale, a Democrat who is chairman of the Senate committee that deals with healthcare. "It's long overdue."
Under current policy, only very low-income childless, non-senior, non-disabled adults — those earning less than about $2,800 per year—qualify for Medicaid in New Jersey. The federal law is using health insurance exchanges to allow higher-income people to buy health plans. But without the expansion, there would be a group of people who would likely go uncovered. With the expansion, an adult without children earning up to $15,415 can be added to Medicaid.
In New Jersey, advocates for the poor were pushing the state to join, saying it would expand healthcare access and help the state's economy because of the influx of federal healthcare spending. The New Jersey Policy Perspective study says that the expansion would save the state nearly $2.5 billion by 2012, mostly because of the federal government picking up Medicaid costs.
"Gov. Christie—much like he did in the aftermath of Superstorm Sandy—has demonstrated the leadership and independence of a governor who is willing to place the interests of New Jerseyans above partisan politics by opting to expand Medicaid under the Affordable Care Act," said New Jersey Policy Perspective senior analyst Raymond Castro.
Groups representing cancer patients and others also praised the expansion.
Many groups in the medical world, such as doctors and hospitals, like the concept, but have concerns about how it will work.
Still, on Tuesday, the New Jersey Hospital Association, which was not particularly vocal about its support for the expansion, applauded Christie.
"Gov. Christie's decision to expand Medicaid is tremendous news for New Jersey—not just for those struggling without health insurance but also for the state overall in terms of improved health, increased federal funding and the economic ripple effects that go along with it," said Betsy Ryan, president and CEO of the group.
Some worry that with a shortage of doctors there will be more patients with insurance but not significantly increased access to care.
And hospitals worry that their charity-care funding from the state will be slashed even though a significant uninsured population—largely illegal immigrants—will remain.