Health Insurance Coverage and Marketplace Enrollment in New Jersey

Uninsurance drops 38% among non-elderly adults: Health insurance coverage and Marketplace enrollment in New Jersey.

New data show that the proportion of nonelderly adults in New Jersey who report being uninsured has decreased 38 percent - from 21.2 percent in September 2013 to 13.2 percent in March of 2014. This decrease is statistically significant (p=.05) and suggests there has been an estimated gain in insurance coverage by more than 430,000 people.

Table 1

These new data come from the Health Reform Monitoring Survey in New Jersey (HRMS-NJ), a New Jersey supplement of a nationally-representative survey conducted by the Urban Institute. A quarterly survey of the nonelderly, it is designed to provide timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes.  

The first quarter 2014 survey was largely out of the field by March 6, so the estimate most likely does not capture the large surge in enrollment that took place throughout the month of March. These early results are therefore all the more impressive. If sustained, these findings suggest that uninsurance in New Jersey is at its lowest level since 1990.

These findings are among the first 2014 coverage data to be released for an individual state. However the pattern they display is consistent with national trends showing an increase in coverage among nonelderly adults, which have been reported widely elsewhere.

Table 2

Source of coverage

Due to the size of the quarterly samples for New Jersey, it is not possible to analyze the trend in coverage by source. However, nine percent of respondents in the March 2014 New Jersey survey reported that they obtained coverage through the Health Insurance Marketplace, or healthcare.gov. Approximately two-thirds of these respondents reported that they had enrolled in Medicaid, while the rest reported that they had obtained a marketplace plan.

Enrollment in New Jersey

These survey reports are broadly consistent with enrollment data reported by the Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) for the period of October 2013 through April 2014, which found that 161,775 New Jersey residents enrolled in marketplace plans. The number of new Medicaid enrollees reported by ASPE between January and April 2014 is approximately 98,000. However, this number does not take into account the considerable backlog of applications facing many New Jersey counties, as well as the fact that the New Jersey Medicaid expansion began in 2013.

Characteristics of marketplace enrollees in New Jersey

ASPE reported that of the enrollees in marketplace plans in New Jersey, 85 percent qualified for a tax subsidy and 69 percent chose a silver plan. Approximately 25 percent of enrollees were between the ages of 18-34, and slightly more than half were female. These patterns are very similar to those observed in other states. The race and ethnicity composition of enrollees suggests that Latinos may have under-enrolled, relative to their share of the total population. For example, while 63 percent of enrollees were non-Hispanic Whites, the next largest race-ethnicity group (16.3 percent) were Asian, 13.2 percent were African-American and 6.7 percent were Latinos.  For the state as a whole, however, Latinos comprise the second largest race-ethnicity group, nearly 20 percent of residents.  Relatively low enrollment numbers among Latinos have been reported by a number of states.

Projected and actual enrollment

The Urban Institute estimated that approximately 603,000 New Jerseyans are eligible for marketplace plans.  The enrollment reported thus far constitutes approximately 26 percent of that projection. New Jersey’s share of the eligible universe that enrolled is roughly comparable to neighboring states such as Pennsylvania, where about 22 percent of the estimated eligible population enrolled, and New York, where approximately 28 percent of eligible enrolled. By the end of 2016, the Urban Institute projects that the number of marketplace enrollees in New Jersey will more than double, to nearly 400,000, which would constitute approximately 65 percent of the estimated eligible population.  New Jersey’s current and projected marketplace enrollment as a share of the estimated eligible population as compared to other Northeastern states can be seen in the figure below. 

Table 3

Enrollment in a federally facilitated marketplace state

Despite the fact that New Jersey did not build its own exchange and did relatively little at the state level to promote the Affordable Care Act, New Jersey’s enrollment performance was not significantly different than that of New York, Rhode Island, and Connecticut, three states that are considered to have built successful state marketplaces. Based on the Urban Institute’s enrollment projections, New Jersey was predicted to have similar enrollment to these other states, due to basic similarities in the demographic characteristics of the eligible population. New Jersey had similar projections but better performance than Massachusetts, which had a notoriously unsuccessful experience with their exchange. New Jersey also had similar projections but poorer performance as compared with Vermont, which has already enrolled about 70 percent of their estimated eligible population and leads all states in this regard.

It is interesting to note that as a state with a federally-facilitated marketplace (FFM), New Jersey had access to far fewer resources devoted to outreach and enrollment as compared to states with state-based exchanges. In fact, a recent analysis of federal consumer assistance funds shows that New Jersey had approximately $6 per uninsured resident as compared with at least $17 per uninsured resident in other Northeastern states who created their own exchanges.

This similarity in enrollment between New Jersey and other Northeastern states is consistent with prior analysis of the HRMS-NJ, which showed that New Jersey residents were like their regional peers in terms of their awareness of the coverage opportunities made available by the Affordable Care Act and their likelihood of visiting the Marketplace. New Jersey residents were less likely, however, to report that the Marketplace was easy to use, and also had lower levels of health insurance literacy, relative to other residents of Northeastern states.

Looking ahead

The general increase in health insurance coverage among nonelderly adults observed nationally has also been seen in New Jersey, and while it is not possible to break down this trend by coverage source, approximately nine percent of respondents reported obtaining coverage from the Marketplace, an estimate which seems broadly consistent with enrollment numbers reported by ASPE.  It is not currently known what share of those who obtained coverage in the Marketplace were previously uninsured; nor is it known what share of those who enrolled in marketplace plans have actually paid their premiums and maintained their coverage.

Looking ahead, there are many questions to be answered regarding access to care, cost sharing, and premium levels for those with marketplace plans, and it remains to be seen whether coverage levels will increase further, stay the same, or decline. But at the end of the first open enrollment period, early data suggests that New Jersey’s experience with the Affordable Care Act has been similar to that experienced elsewhere. There have been increases in insurance coverage like those observed nationally, and trends in enrollment that are comparable to other Northeastern states. The fact that New Jersey, unlike many other Northeastern states, did not create a state exchange, yet appeared to achieve comparable results, raises interesting questions about the relative importance of exchange characteristics versus demographic characteristics, at least for this early phase of enrollment.

Disclaimer: The Health Reform Monitoring Survey (HRMS), a quarterly survey designed to support timely monitoring of the Affordable Care Act (ACA) for the nation and select groups of states, was developed by the Urban Institute, fielded by GfK, and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation, and the Urban Institute.  The Urban Institute has allowed other organizations to fund supplemental surveys with state-specific oversamples based on the HRMS, including the oversample for New Jersey that is used in this work.  The analyses and conclusions based on HRMS-New Jersey are those of the authors and do not represent the views of the Urban Institute, the Robert Wood Johnson Foundation, or the Ford Foundation.