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Opinion: Gov. Chris Christie's health care choices show he's not an 'ultra-right-wing extremist'

The Times of Trenton Newapape
By Irwin Stoolmacher

Two recent actions Gov. Christie took with regard to health care will aid him in his run for governor in a blue state. These actions will help to blunt the criticism he will face from some quarters for increasing taxes on working families to provide tax cuts for the wealthiest New Jerseyans.

On Feb. 16, the governor gave formal notice to federal officials that New Jersey had decided to put in place a federally administered health insurance exchange to comply with the mandates of the Patient Protection and Affordable Care Act (ACA). Twenty-six states, including New Jersey, opted to cede control and oversight to the federal government, 17 states and D.C. opted to operate their own exchanges and seven states opted for a hybrid federal-state partnership.

With only a few exceptions, the vast majority of Republican governors did not opt to implement the online marketplaces at the state level. Instead, they decided to hand over responsibility for creating the exchanges to the federal government. Susan K. Livio in the Star-Ledger wrote: “With the decision, the Republican governor is once again distancing himself from Obama’s Affordable Care Act. ... [The] decision was not a surprise. Christie has twice vetoed legislation directing the administration to create the exchange for New Jersey.”

According to Timothy S. Jost, a professor at Washington and Lee University School of Law who specializes in health care, “it’s not what the drafters of the bill had hoped would happen.” They hoped individual states would run their own exchanges so they could tailor services to each state’s unique needs.

In his veto statements, the governor emphasized that the U.S. Department of Health and Human Services had failed to answer questions regarding how much the exchange would cost state residents. He suggested that cost uncertainty was one of his key concerns.

There seems to be a general consensus that the governor’s decision will probably not make much difference in the range of insurance plans that will be available in New Jersey beginning next Jan. 1. However, health-care advocates stressed that the state still has a vital role to play in promoting the exchange in New Jersey.

According to Raymond Castro, senior policy analyst at New Jersey Policy Perspective (NJPP), “New Jersey will not achieve full economic and health benefits of this legislation unless it provides effective outreach. The federal funding, and the number of newly insured, will be reduced by about a third without outreach, based on estimates from the Urban Institute. Thus, New Jersey would lose about $690 million in federal funds annually, and 186,000 fewer New Jerseyans would obtain health insurance if the state doesn’t invest in outreach.”

Dena Mottola Jaborska, organizer for NJ for HealthCare, a coalition of consumer and family advocacy groups, emphasized that promoting the exchanges to New Jersey’s large Hispanic population would be a “formidable challenge without state cooperation to communicate with the many hard-to-reach people in our urban centers and those who do not speak English as their primary language.”

In his budget message, Gov. Christie announced that he would become the eighth Republican governor to sign on to an expansion of Medicaid, another provision of the ACA. “Expanding Medicaid will ensure New Jersey taxpayers will see their dollars maximized. Federal funding will cover 100 percent of the cost of this expansion for the first three years and then leveling to 90 percent in 2020. Let me be clear: Refusing these federal dollars does not mean they won’t be spent. It just means that they will be used to expand health-care access in New York, Connecticut, Ohio or somewhere else. Accepting these federal resources will provide health-care access to tens of thousands of low-income New Jerseyans [104,000 the first year and as many as 300,000 over nine years], help keep our hospitals financially healthy and actually save New Jersey taxpayers money. In fact, taxpayers will save approximately $227 million in FY2014 alone.”

In a report issued just prior to the governor’s budget message, NJPP revealed that “New Jersey could reap billions of dollars in budget savings over the decade by expanding Medicaid under the ACA and that not expanding Medicaid would result in billions of dollars of new costs to the state.” In addition, the report showed that accepting Medicaid dollars would stimulate much-needed job creation and produce major savings in the state budget.

While it appears that the decision to expand Medicaid was clearly the right choice, that wasn’t the case for ultraconservative Wisconsin Gov. Scott Walker, who opted to reject additional federal Medicaid funding for a “hybrid” alternative that includes tighter income eligibility for Medicaid, lifting a cap on a program that covers childless adults and forces more people to buy insurance through a government-run exchange.

There is no question that Gov. Christie has generally governed from the right in New Jersey — he is anti-tax, anti-gay marriage, anti-abortion and anti-increasing the minimum wage. He is not, however, an ultra-right-wing extremist. He made the right choice when he expanded funding of his drug court initiative for nonviolent, drug-addicted offenders and he made the right choice when he agreed to accept federal funds to expand Medicaid.