New Jersey has a Democratic trifecta since January 2018. The legislature and governor have been active.
- Reinsurance waiver funded by
- State based mandate
- Transitioning to a State-Federal Partnership exchange
So what are the effects?
— Charles Ghoulba (@charles_gaba) October 7, 2019
This is a bit convoluted. New Jersey projects that without the policy changes, that started in 2019, 2020 premiums would be 30% higher in 2020 than they are in 2019 instead of the 8.7%.
The transition to their own exchange is also having impact:
NJ was set to receive just $300k in Navigator $$ from the Fed govt. the move to become an SMB (although reliant on the fed enrollment platform) gave the state control of outreach funding.. https://t.co/cWBpkPB5D4
— Amy Lotven (@amylotven) October 7, 2019
One of the big advantages of a state running their own exchange is that they don’t count on federal advertising or outreach funds. Instead, locally raised money can be spent locally to achieve state objectives. In 2018 and 2019, New Jersey had a “small” dose of navigator and advertising dollars. In 2020, the navigator dose will be six times larger and potentially better targeted. The same may be true for advertising dollars where there will be more spent and potentially spent more effectively.
The theory of change is that this will lead to more enrollment and lower premiums than if New Jersey had stayed on Healthcare.gov. The idea is that the most marginal buyers who are currently flipping a coin and having it come up tails and therefore they are deciding to not buy any insurance are relatively healthy and cheap to cover folks. Advertising and navigation assistance will change the weight of the coin and push at least some of these marginal decision makers into the ACA pool where they will cost significantly less than average which brings down premiums. California claims that their advertising and outreach delivers massive premium reductions through this mechanism.
From a causal identification strategy point of view, the boundary states provide a lot of potential matched pairs for a difference in difference analysis. Pennsylvania and Delaware are constant Healthcare.gov states with no changes in governing structure since 2017. Maryland and New York run their own exchanges. Maryland will be changing their enrollment process by easing administrative burden next year. Since New Jersey has rolled out some of the policy changes in stages (mandate/reinsurance 2019, more advertising/navigation 2020…) dis-entangling impact should be easier than if all of this happened at once.
New Jersey should be the source of a dozen really cool papers by 2023 that will bring insight into what drives individual market enrollment.