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New Jersey Department of Banking and Insurance New Jersey Department of Banking and Insurance REPORT ON EXECUTIVE ORDER NUMBER 4 Commissioner Marlene Caride August 31, 2018 *CONFIDENTIAL – ADVISORY, CONSULTATIVE AND/OR DELIBERATIVE* State of New Jersey DEPARTMENT OF BANKING AND INSURANCE PHIL MURPHY OFFICE OF THE COMMISSIONER Governor PO BOX 325 TRENTON, NJ 08625-0325 MARLENE CARIDE Commissioner SHEILA OLIVER TEL (609) 292-7272 Lt. Governor August 31, 2018 Dear Governor Murphy: The Patient Protection and Affordable Care Act established the foundation for ensuring quality affordable health care for millions of Americans. States must take a leadership role in ensuring the policies and protections provided by the Affordable Care Act are maintained and that all residents have access to quality affordable health coverage. The Department of Banking and Insurance has a crucial role to play in this effort in New Jersey, and has acted to improve the health insurance market in the state and to promote public education related to the Affordable Care Act and the health insurance options available to New Jersey residents. In accordance with Executive Order Number 4, I am pleased to submit this report which sets forth the actions taken by the Department to date and, building on these efforts, makes recommendations to propel New Jersey forward and connect residents to the coverage and care they need. Sincerely, Marlene Caride Visit us on the Web at dobi.nj.gov New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable *CONFIDENTIAL – ADVISORY, CONSULTATIVE AND/OR DELIBERATIVE* TABLE OF CONTENTS CONNECTING NJ TO QUALITY AFFORDABLE COVERAGE ................................................................. 3 Introduction ................................................................................................................................................ 3 Historical Perspective ................................................................................................................................. 4 SECTION I - DEPARTMENT OF BANKING AND INSURANCE ACTIONS ............................................. 5 STRENGTHENING & STABILIZING THE MARKET ............................................................................ 6 Plan Management ....................................................................................................................................... 6 Section 1332 Waiver .................................................................................................................................. 6 Cost Sharing Reduction Guidance ............................................................................................................. 7 State Flexibility Grant ................................................................................................................................ 7 Comprehensive Rules Review for ACA Compliance ................................................................................ 8 Department of Banking and Insurance Comments on Proposed Federal Regulations ............................... 8 Short-term, Limited Duration Plans .............................................................................................. 9 Association Health Plans ............................................................................................................... 9 DOBI PUBLIC EDUCATION & OUTREACH ............................................................................................ 10 Promoting ACA Marketplace & Special Enrollment ................................................................................. 10 Promoting ACA, Individual Market Special Enrollment Period for Puerto Rico and U.S. Virgin Island Evacuees ..................................................................................................................................................... 10 Department Education and Outreach ........................................................................................................ 11 SECTION II – DEPARTMENT OF BANKING AND INSURANCE: PROPOSED PLAN FOR OPEN ENROLLMENT ................................................................................................................................................... 12 A STATEWIDE PLAN OF ACTION ............................................................................................................ 13 Designate an ACA Outreach Coordinator to Lead a State ACA and Health Coverage Education and Outreach Program ...................................................................................................................................... 13 Establish a Health Coverage Education and Outreach Working Group to Oversee State Efforts ............. 13 DOBI PUBLIC EDUCATION & OUTREACH ............................................................................................ 14 CONCLUSION ...................................................................................................................................................... 14 *CONFIDENTIAL – ADVISORY, CONSULTATIVE AND/OR DELIBERATIVE* CONNECTING NJ TO QUALITY AFFORDABLE COVERAGE Introduction The Patient Protection and Affordable Care Act was a historic step in ensuring that all Americans have access to quality affordable health care. In signing the legislation, President Barack Obama said he was enshrining in law the “the core principle that everybody should have some basic security when it comes to their health care.” From 2010 to 2016, millions of Americans gained health coverage and the financial and personal security provided by access to quality affordable health care. The uninsured rate in the United States dropped from 16 percent to 8.61 percent during that time. In New Jersey, the ACA resulted in hundreds of thousands of residents obtaining coverage under the Affordable Care Act. From 2013 to 2016, the uninsured rate in New Jersey fell from 13.2 percent to 8 percent.2 An estimated 240,0003 residents currently receive health insurance coverage on the federal marketplace created under the ACA and more than 550,000 additional residents have coverage as a result of Medicaid expansion. The progress made in New Jersey and nationwide is threatened by the Trump Administration, which has advanced policies that undermine the 2010 law, significantly reducing resources for education and outreach and destabilizing the health insurance market. As stated in Executive Order Number 4, actions by the federal government included cutting the advertising budget for the Affordable Care Act enrollment period by 90 percent, from $100 million in 2016 to $10 million in 2017; slashing funding for navigators by 62 percent resulting in New Jersey receiving over $1 million less to conduct outreach; and cutting the enrollment period in half in 2017, allowing only six weeks for enrollment rather than the three-month period held during the fall of 2016. In addition, the Trump Administration halted funding for Cost Sharing Reduction (CSR) payments, permitted the sale of expanded short-term limited duration plans and encouraged association health plans that do not comply with the Affordable Care Act. In a historic move aimed at dismantling the ACA, Congress and the Trump Administration repealed the individual mandate as part of the federal Tax Cuts and Jobs Act enacted in December of 2017. States across the country are increasingly challenged in their efforts to ensure residents have access to quality affordable coverage provided them under the ACA and to protect against disruption in the market. I am proud to be part of an administration that is taking action to defend access to coverage and care. At your direction, and in accordance with Executive Order Number 4, the Department submits this report as part of the state of New Jersey’s efforts to protect residents and better ensure their health care needs are met through access to quality affordable health coverage. 1 Cohen RA, Martinez ME, Zammitti EP. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January – March 2016. National Center for Health Statistics. September 2016. Available from: http://www.cdc.gov/nchs/nhis/releases.htm or at https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf. 2 Current Population Reports, P60-260, Health Insurance Coverage in the United States: 2016, U.S. Government Printing Office, Washington, DC, 2017: https://www.census.gov/content/dam/Census/library/publications/2017/demo/p60-260.pdf 3 Department of Banking and Insurance, News Release, Health Insurance Enrollment in NJ Individual Market Down 10 Percent in First Quarter of 2018, June 20, 2018: https://www.state.nj.us/dobi/pressreleases/pr180620.html 3 *CONFIDENTIAL – ADVISORY, CONSULTATIVE AND/OR DELIBERATIVE* Historical Perspective New Jersey has experienced significant variances in individual and small employer enrollment since it first reformed its markets, starting in 1993. At its peak, approximately 1 million people were covered between the individual and small group markets, with the vast majority enrolled in small employer coverage (4Q99). As of 4Q13, immediately prior to the January 1, 2014 effective date of ACA plans, total market enrollment was 793,616, with 146,242 people covered in the individual market, and 647,374 covered in the small employer market. As of 4Q17, total market enrollment between the individual and small employer markets was 681,065, with 309,521 people covered in the individual market, and 371,544 covered in the small employer market. Total enrolled
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