Kim’s first bill would fund state-based health care sites
Congressman Andy Kim on Thursday introduced his first bill since taking office, and it’s intended to help bring down the cost of health care in states like New Jersey and Pennsylvania, which rely on the federal government to manage an online insurance exchange in which their consumers can shop for and sign up for coverage.
Kim’s bill, known as the SAVE Act, would authorize $200 million in federal aid for states that use the HealthCare.gov site to set up their own exchanges.
The freshman Democrat announced the legislation during a speech on the House floor, saying states with their own exchanges have had more success in enrolling consumers in need of coverage than those relying on the federal site.
“This is bipartisan legislation that would help states establish state-based exchanges that would increase access and drive down costs,” Kim said. “These are solutions that we know work.”
The federal exchange and state-based exchanges are a key to the Obama-era Affordable Care Act and its goal of expanding access to coverage. The online sites function as a one-stop location where consumers who don’t receive health care from their workplace or federal programs like Medicare and Medicaid can shop for coverage, often with federal assistance to try to keep premiums affordable.
Under the law, states had the option of creating their own exchanges or using the federal government’s. New Jersey and Pennsylvania were among 39 states that opted for the latter.
Kim stressed that states with their own exchanges have had more success in enrolling consumers and enjoy more affordable coverage.
According to data published by Massachusetts-based consulting firm Day Health Strategies, enrollment in the 12 states with their own online exchanges increased slightly for this year, compared with the 39 states that use the federal exchange, where enrollment dropped on average 4 percent.
In New Jersey, enrollment decreased about 8 percent this year, to 256,674.
States that run their own marketplaces have more control over their health plans and are able to offer a longer enrollment period and more assistance. Those states also on average have less expensive premiums, according to the Common Wealth Fund, a think tank and foundation dedicated to health care policy.
The average premium on state-based marketplaces in 2018 was $526 in 2018, compared with $633 in federal marketplace states.
State-based marketplaces are able to charge slightly lower user fees to insurers that sell plans on their exchanges compared with the federal government, and those states also have the flexibility to offer more tailored plans, said Ray Castro, director of health policy for New Jersey Policy Perspective, a left-leaning think tank.
Castro cited Massachusetts, which offers its own subsidized basic plan to low-income consumers that has no premium, as well as New York, which allows year-round enrollment. Both have their own exchanges.
″(The federal exchange) is a very tightly regulated program, so without a state exchange we’re very limited,” he said. “There’s a lot we’d like New Jersey to do, but the (federal government) makes it very difficult.”
New Jersey opted not to create its own exchange when Republican Chris Christie was governor. The Democratic-controlled Legislature approved legislation to create one, but Christie vetoed it, citing his objections to the ACA and litigation challenging the law’s constitutionality.
Democratic Gov. Phil Murphy has pushed for the state to boost efforts to enroll more residents through the federal exchange. Murphy also signed legislation to create New Jersey’s own mandate requiring most residents to get health insurance or face a fine, as well as a reinsurance program to help cover high-risk residents and their costliest claims.
Castro expects Murphy will support creating a New Jersey exchange, although he cautioned that the cost could create challenges. He said Kim’s legislation would provide help, but he questioned whether the proposed $200 million would be enough for all 39 federal exchange states.
“I do think (Murphy) would be interested in doing it. But the funding has always been an issue,” he said.
Republican efforts to repeal and replace “Obamacare” failed in 2017 but helped fuel last fall’s so-called “blue wave” election cycle that resulted in the House flipping to Democratic control.
Kim, who served as a national security adviser in Obama’s White House, has said he decided to run for his 3rd District seat because of the GOP attack on the Affordable Care Act and its protections for people with pre-existing health conditions. He defeated incumbent Tom MacArthur, who helped author a key component of the GOP health care bill.
Maura Collinsgru, health program director for the progressive group, New Jersey Citizen Action, said Kim’s legislation could help the state combat actions by the Trump administration that have stifled health care enrollment across the country.
“Things like shortening the enrollment period from 12 to 6 weeks, cutting funding for outreach and enrollment assistance, and anti-immigrant rhetoric that has made many of our residents hesitant to enroll in coverage. If we operated our own exchange we could take steps to combat the sabotage more effectively,” Collinsgru said.
Kim introduced his legislation the day after Democrat Rep. Pramila Jayapal, of Washington, unveiled controversial “Medicare-for-all” legislation seeking to expand the program for people age 65 and older to all Americans.
Kim was repeatedly asked whether he would support such a single-payer system during his campaign, and the issue has followed him into office.
During a town hall meeting a few weeks ago in Ocean County, Kim said that he supported making health care accessible to all Americans, but that he wasn’t ready to back a Medicare-for-all plan. Instead, he planned to seek more moderate reforms that Republicans might support, including legislation to reduce the cost of prescription drugs for Medicare recipients.
On Thursday, Kim indicated that the SAVE Act could be another measure for which Congress could find common ground and make progress to reduce health care costs.
“Right now, there are a number of states who haven’t set up their own exchanges. That’s tens of millions of people, including millions throughout New Jersey, who stand to benefit,” he said.
The legislation already has one Republican co-sponsor, Rep. Brian Fitzpatrick, of Pennsylvania, who has criticized parts of the Affordable Care Act in the past, but voted against 2017′s repeal and replace bill.
“We have the opportunity to make needed reforms to lower costs and increase access to health care. With skyrocketing premiums in the federal marketplace, state-based exchanges have proven to be more effective at increasing the rate of coverage and lowering costs,” Fitzpatrick said in a statement Thursday. “This bipartisan legislation will give states more options and help families access affordable health care so they can get the care they need.”