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.
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.