New Jersey Blueprint for Reform

1
New Jersey Blueprint for Reform

• Prepared by the Office of Governor Jon S. Corzine
• for presentation to the
• Coverage Institute
• September 25-28, 2007

2
New Jersey Landscape

• Good News
• Highly regulated commercial insurance market
  (guaranteed issue, modified community rating,
  uniform plan design), healthy small business pool
• National leader in state experimentation SCHIP
  child eligibility to 350 FPL and parent
  eligibility to 133 FPL
• -- Publicly funded charity care system
• Bad News
• State budget Constraints
• Uncertainty re SCHIP

3
The Uninsured in NJ

• Approx. 1.3 million uninsured 1 million adults
  and 250,000 children
• Both a low income and high income concern --
• 516,000 lt 200 FPL
• 378,500 gt 350 FPL
• Many are eligible for existing programs but not
  enrolled
• 167,000 children and 83,000 adults
• Citizenship presents a challenge for estimated
• 22,000 children and 367,000 adults

4
Goals

• Long Term Goals
• (1) Create a system for universal coverage for
  all in New Jersey
• (2) Ensure system is sustainable
• Short Term Goals
• (1) Improve and maximize existing public and
  private health insurance systems and markets
• (2) Create systems capacity to achieve universal
  insurance

5
Improve and Maximize Existing Public Programs

• Insure children and adults who are eligible for,
  but not enrolled in, Medicaid and FamilyCare
• --Streamline eligibility
• -- NYC facilitated enrollment model
• Strengthen provider networks to create access to
  care.
• Increase provider quality and improve eligibility
  process through integration of technology.

6
Expand Medicaid and FamilyCare

• Enroll parents to 200 FPL (from 133)
• Enroll childless adults to 100-200 FPL
• Implement the FamilyCare Advantage Buy-In Program
  for children in families with income over 350 FPL

7
Move to Universal Coverage Short Run

• Strengthen our commercial insurance market so as
  to make insurance more affordable and accessible
  through the private sector.
• Merge the individual and small employer markets
• Provide reinsurance for high cost claims
• Reduce broker/agent commissions
• Reevaluate medical loss ratios
• Change participation requirements in the small
  employer market
• Require Section 125 plans

8
Move to Universal and Portable Coverage Long Run

• Still under discussion elements under
  consideration include
• Individual mandate, with subsidies for low income
  population
• Self-funded state run plan
• Commercial carriers as ASOs with commercial rates
  to providers
• Collaborative care systems for the undocumented
  and hard to serve

9
Building a Sustainable System

• Develop chronic care protocols
• Develop insurance payment methodologies to
  redirect reimbursement to primary care doctors,
  case managers, nurses, and specialists
  collaborate with carriers and physicians
• Develop Health Information Technology strategies
  and infrastructure