Some Democrats were peeved after the governor twice rebuffed their efforts to create a state health insurance exchange, and Trenton health policy sources weren't surprised to see the Legislature asserting its role by creating a monitoring task force that could be approved as early as this week.
It is well within the Legislature's purview to conduct oversight, even though the exchange is a federal program, said Senate Commerce Committee Chairwoman Nia H. Gill (D-Montclair) who twice sponsored bills — both vetoed by Gov. Chris Christie — to empower New Jersey to create, run and regulate its own exchange.
“We have the legislative authority of oversight,” she said. “We are not foreclosed from having an ongoing conversation with the federal government with respect to how the exchange will unfold.”
Gill sponsored the exchange oversight task force resolution, which doesn't need Christie's signature. The bipartisan task force will have a Democratic majority, with four of its 12 members appointed by the Republican leaders of the Assembly and Senate.
The task force would monitor the new health insurance exchange marketplace the federal government is launching in New Jersey, where individuals and small businesses will buy government-subsidized health coverage insurance under the Affordable Care Act. Gill and other supporters said the task force will position the state to eventually take over the exchange — something the federal government would welcome.
Christie joined 25 other states that opted to cede control over their state's exchange to the federal government.
The task force would report quarterly on its findings and its recommendations for legislation or administrative action. Legislative oversight is critical, Gill said: “Because we don't have a state-based exchange, we need to get information from the marketplace, from the insurance companies, from the health care companies — we need that dialogue to help us determine how this is working.”
Gill cited estimates that several hundred thousand New Jerseyans will buy coverage on the exchange “over which we have little or no control, because it is not state based.” If the state decides later on to take over the exchange, “we will not be scrambling to find out what happened and what we should do.”
Sen. Joseph F. Vitale (D-Woodbridge) chairs the Senate health committee and will serve on the task force.
“Since the governor opted for a federal exchange, New Jersey needs to develop ideas for how this will work — how we will handle outreach and enrollment,” he said. The state Department of Banking and Insurance will continue to regulate health insurers, “but legislators and other policymakers do this for a living, as well, and we have ideas and we have a responsibility to protect our constituents.”
Vitale said he is confident the federal government will get a good exchange up and running. The exchange is expected to be open for business Oct. 1, so insurers can start selling policies that take effect Jan. 1, when the ACA's “individual mandate” requiring most Americans to get health coverage kicks in.
Seton Hall Law School professor John V. Jacobi, a health care law expert, predicted the federal government will welcome New Jersey involvement in the exchange. The guidance from the federal government so far “makes it clear that they would like to partner with state agencies and state government as much as possible,” Jacobi said. “The feds have indicated that for some things, like consumer complaints and enrollment and retention, the states are going to be better able to understand how to go about these activities.”
He said the federal government “has been quite clear that it is hoping that states that are currently unwilling to run their own exchange will agree to become more involved in the exchange management.” And he said the task force “would be in a position to gather information to further that goal, to develop expertise and even serve in an ombudsman fashion.” If the task force has concerns about the exchange's performance, “they could step in and provide a very high-profile connection with the federal exchange.” The goal, he said, “is to make sure that all the insurance companies are on a level playing field and consumers are getting value for their money.”
An official of the federal Department of Health and Human Services, which will run New Jersey's exchange, said, “Every state will have a marketplace (exchange) open to its residents come January 2014, and we look forward to working with state leaders from across the country in setting up each marketplace.”
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