March 29, 2019

In This Issue
Fast Facts
Leading House Democrats Unveil New Plan to Fortify ACA
NAHU Submits Comments on RFI for Grandfathered Plans
House Energy & Commerce Health Subcommittee Passes a Dozen Healthcare Bills
2020 Plan Year Announcements from CMS on Grandmothered Plans and AV Calculator
U.S. District Court Rules Administrationís AHP Final Rule as Illegal
NAHU Weighs in on Surprise Billing with HELP Committee
Senate HELP Committee Holds Hearing on Electronic Health Records
Healthcare Happy Hour
State Spotlight: Governor Phil Murphy Announces that New Jersey Will Move to a State-based Exchange
HUPAC Roundup
What We're Reading
E-mail the Editor
Visit the NAHU Website
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State Spotlight: Governor Phil Murphy Announces that New Jersey Will Move to a State-based Exchange
This week’s state spotlight is on New Jersey, where Governor Murphy announced that the state will seek to run its own ACA marketplace in 2021 to allow greater control over its health insurance market. New Jersey took this step to “protect New Jersey from actions taken by the Trump Administration to roll back the hard-fought protections afforded by the ACA,” according to Governor Murphy.  

Running a state-based exchange will give the state more control over different aspects of the market. These aspects include having control over the open enrollment period, having more access to data, the ability to conduct targeted outreach, and allowing user fees to fund exchange operations, consumer assistance, outreach and advertising.

New Jersey has already passed a few laws that have decreased average rates by 9.3% in 2019. The laws include an individual mandate, a reinsurance program, and legislation that protects consumers from surprise balance billing. The individual mandate’s penalty is related to the average cost of a bronze plan in New Jersey, and will be assessed on state tax returns. The revenue collected from this penalty will go into state funding for the reinsurance program. The reinsurance program was approved by CMS in August 2018. The reinsurance program reimburses insurers for 60 percent of the cost of claims over $40,000, up until claims reach $215,000.

New Jersey is also proposing codifying major ACA provisions into state law. The protections the Murphy Administration is looking into codifying include:
  • prohibiting preexisting conditions exclusions
  • requiring dependent coverage to age 26
  • requiring coverage of Essential Health Benefits
  • prohibiting lifetime and annual limits
  • requiring coverage without cost sharing for preventative services
New Jersey’s announcement that they will run a state-based exchange comes at a time when President Trump’s Administration has declared that it backs a full invalidation of the ACA. This position furthers the earlier decision by the administration when the Justice Department argued that there were only grounds to strike down the ACA’s consumer protections.
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