New Jersey Gubernatorial Election: A Health Care Prescription for the Next Administration

New Jersey Gubernatorial Election: A Health Care Prescription for the Next Administration

Joel Cantor, distinguished professor and director of the Rutgers Center for State Health Policy
Photo: Nick Romanenko, Rutgers University

The debate over the future of the Affordable Care Act has wide-ranging implications for the states and will be an issue likely to affect policy decisions for the next New Jersey governor. Although recent repeal efforts were not successful, uncertainty remains over the fate of the law. Rutgers Today talked with Joel Cantor, distinguished professor and director of the Rutgers Center for State Health Policy, about why the future of the Affordable Care Act matters to New Jersey and what the next governor can do to maintain affordable coverage for the state’s residents.

In light of the recent failed attempt to repeal the Affordable Care Act, do you think the fate of the health care law is secure, and how does this affect New Jersey?

Cantor: It appears that the ACA will remain the law of the land for the coming months and perhaps years, but it is already clear that actions by the Trump administration are working against the ACA goal of covering more uninsured people. The administration has not committed to fully funding the subsidies that help modest-income families buy coverage. It has cut funding for public education and enrollment assistance and shortened the period of time people have to sign up for coverage. These changes will greatly increase premiums for millions of people. They also make action in the states more important than ever.

What are some things the next governor can do to keep health care accessible and affordable in New Jersey in the face of continued uncertainty?

Cantor: Among the most important things that the next governor can do is to send the message that the New Jersey ACA insurance marketplace is in good shape and open for business during the open enrollment period.  (This year the enrollment period starts November 1; go to for more information.)  Very affordable coverage is available to thousands who are eligible for subsidies. 

Modest state funding for a public education campaign and assistance for folks to sign up would not cost much but would go a long way. Not only would more of the uninsured gain coverage, but a robust outreach effort would help stabilize the market risk pool and push premiums down, or at least prevent them from rising quickly. People with expensive health conditions will sign up for coverage no matter what, but a strong outreach campaign is needed to bring in younger and healthier people.

If the federal law is eventually repealed, what could the governor do to prevent people from losing their insurance in New Jersey?

Cantor: Unfortunately, the new governor will have little freedom to replace what the ACA is currently funding. The state simply lacks the ability to pay. It may be possible for the next New Jersey administration to modestly preserve some gains of the ACA by increasing state funding for Medicaid, for example, but a major roll back in coverage seems inevitable if the federal law is repealed.  

Although most of the headlines have focused on the future of the ACA, what are some of the other pressing health care issues in New Jersey that might not be getting attention?

Cantor: Medicare and other programs are changing the way they pay doctors and hospitals, rewarding better care and penalizing poor performance. Patients in New Jersey have benefited from those incentives. The state can further strengthen quality improvements and cost containment in health care. We can, for example, accelerate development of the statewide infrastructure needed for doctors and hospitals to securely share patient information. The state also can leverage the purchasing power of Medicaid and state employee benefit programs to put more muscle in incentives.

The new administration should also continue to address the epidemic of opioid addiction, especially by investing in new treatment capacity, and be ready for other public health emergencies.

Your area of expertise is New Jersey health care policy. What are some issues you would like to see the next governor tackle?

Cantor: Tackling costs almost certainly requires a stronger state regulatory role. Some states, like Massachusetts and Maryland, are using strong financial incentives to promote better population health outcomes and reward cost savings. Innovative approaches like these are replicable in New Jersey but would disrupt the status quo. State policymakers have to engage with health care providers and other stakeholders to work toward consensus on the best path forward.