If New Jersey officials are taking any steps to prepare for subsidies disappearing from the federal health exchange, they’re not sharing it with the public.
Asked about contingency plans if the U.S. Supreme Court strikes down the key provision of the Affordable Care Act, Gov. Chris Christie said it would be up to Washington, not Trenton, to fix Obamacare.
"Congress and the President created the statute," he said during a campaign stop in New Hampshire. "They should fix it."
About 175,000 of the roughly 215,000 Garden State residents with Obamacare coverage receive subsidies to make monthly premiums affordable. Without those subsidies, experts say people — especially young, healthy people — would drop out of the exchange in droves. Because Christie chose not to open a state insurance exchange, it is vulnerable to the current court challenge, which only targets the subsidies of federal exchanges.
"When the young and healthy leave, premiums will go up, creating a spiral where the market gets sicker and older and premiums keep going up," said Joel Cantor, director of Rutgers University's Center for State Health Policy. He said this would ripple through New Jersey' insurance market, even driving out many of the almost 150,000 people who have individual policies without subsidies.
Maplewood resident Jolie Solomon said she would try to continue buying insurance without a subsidy, but she's not sure how that would be possible. She now pays $342 dollars for her monthly premiums, after a roughly $800 subsidy is applied.
"I’m barely getting by with the subsidy," she said. "Without it, I just can’t picture what will happen."
In the years before the Affordable Care Act took effect, the former Wall Street Journal reporter and her daughter both had chronic illnesses that ate up 35 years of her savings. Solomon is now effectively broke. She expects to lose her house to foreclosure later this year or in 2015, and is not sure where she can find a rental she can afford and still have enough left to pay ongoing medical bills that Obamacare doesn't cover.
"If I had any medical care and paid for it, I’d have to live in a shelter," she said. "In a shelter, you can’t even stay there during the day, and I need to be in bed a lot of the time, so trying to imagine my life without the subsidized health care is impossible."
The Supreme Court case known as King v. Burwell hinges on the legitimacy of subsidies in the federal exchange, which New Jersey and 33 other states use. New York and Connecticut and the remaining states have their own exchanges, where subsidies — though they originate in Washington — are not in question.
New Jersey State Senator Nia Gill (D-Essex) said state lawmakers should be prepared to call a special session to create a state exchange, if the Supreme Court invalidates subsidies. Christie has vetoed earlier efforts to create a New Jersey marketplace, but this time Gill thinks there could be support from across the aisle.
"I think if they’re faced with this kind of Draconian situation, at least some Republican legislators will find the will to stand against the governor and for the people," she said.
Gill would also support a hybrid, where New Jersey wouldn't create anything new, other than a loose structure it could call its own but that would effectively be operated and funded by the existing federal exchange, healthcare.gov. Oregon, Nevada and New Mexico already do this, and Pennsylvania, Delaware and Arkansas are conditionally approved to take this step.
In the Assembly, Republican minority leader Jon Bramnick says it’s too soon to talk about legislative remedies to a Supreme Court ruling. He says he’d need to read the decision first. Overall, though, he agrees with Christie that it would be Washington’s problem, not Trenton’s.
"At this point, based on what we know today, I don’t favor a New Jersey exchange," he said. "But then again, I have to see what happens down the road."
Many observers have suggested Republicans would have to come up with a solution to rescue the subsidies, because despite widespread ambivalence about the Affordable Care Act, taking away the new entitlement would be politically risky.
"They’re going to have to accept some kind of compromise," said political science professor Brigid Harrison, from Montclair State University