Healthcare Reform in California vs. New Jersey

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Table of Contents

Comparison of Health Insurance Markets
Health Statistics
Positions on Healthcare Reform
Professional Nursing Practice
References

Comparison of Health Insurance Markets

New Jersey (NJ) and California (CA) have similar insurance regulations and coverage rates. According to recent statistics, 93% of the total population in CA is covered at the present moment, compared to 92% in NJ (Sheen, 2019; “New Jersey,” n.d.). Relatively high coverage rates may be due to individual mandates passed in both of the states and their acceptance of the Medicaid expansion. It is observed that within just 3 years after the expansion initiative took effect in CA, the uninsured rate has decreased by about 60% (Norris, 2018a). As for NJ, the after-expansion Medicaid enrollment rate has increased there by 36% (Norris, 2018b). At the same time, while NJ has adopted the legislation requiring all residents either to get health insurance or to pay a tax penalty in 2018, CA has enforced the same legislation just recently, in July 2019 (Norris, 2019; Sheen, 2019). According to Norris (2019), insurance premiums have decreased in NJ due to this measure. Thus, it is valid to presume that monthly premiums in CA may drop in the future as well.

As for major differences in the healthcare markets in the selected states, they are the number of carriers and the starting monthly coverage costs. According to Norris (2019), there are just three insurers in NJ at the present moment. In contrast, the number of major actors in CA exchange is 8 (“How much does health insurance cost,” n.d.). When it comes to monthly premiums, coverage in CA is more affordable than in NJ, and the cheapest plan price there is currently USD 187, whereas in NJ, the minimum price is UAS 375 (“How much does health insurance cost,” n.d.). It means that a greater variety of insurance plans is available to CA residents.

Health Statistics

The selected states are very close to each other in terms of their health rankings. In 2018, CA was ranked 12th, whereas NJ was ranked 11th (United Health Foundation [UHF], 2018). The states also have commonalities in terms of the leading causes of death in their populations. They include heart disease, cancer, stroke, chronic lower respiratory diseases, accidents, influenza/pneumonia, and diabetes (National Center for Health Statistics [NCHS], 2017a; NCHS, 2017b). Nevertheless, NJ residents also often die as a result of Alzheimer’s disease, septicemia, and kidney disease, which are less common among CA residents (NCHS, 2017a; NCHS, 2017b). In their turn, people living in CA frequently die due to hypertension and chronic liver disease/cirrhosis (NCHS, 2017b). Partially, these differences may be explained by dissimilarities in environmental and lifestyle factors.

The selected states have some unalike public health strengths, and their residents face a few disparate health-related challenges. For instance, NJ enjoys a low level of infant mortality (only 4.4 deaths per 1,000 live births) and has a high rate of practicing dentists (UHF, 2018). Infant mortality is also insignificant in CA and equals 4.3 deaths per 1,000 live births (UHF, 2018). However, besides that, CA has low occupational fatality rates and a small prevalence of adult obesity (UHF, 2018). When it comes to challenges, the states share a low level of immunization coverage among children: merely 68.6% in CA and 69.3% in NJ (UHF, 2018). As for their differences in this category, CA residents face increased health risks due to excess air pollution, while the health of individuals living in NJ is threatened by the predominance of physically passive lifestyles, as well as weak per capita public health funding (UHF, 2018). The latter of the identified challenges indicates that the overall quality of healthcare may suffer in NJ.

Positions on Healthcare Reform

The Affordable Care Act (ACA) was the last and the major healthcare reform passed in the United States in the modern era. One of ACA’s major provisions was Medicaid expansion, and as it was already mentioned in Section I, both CA and NJ accepted it. However, the public debate regarding the value and effectiveness of ACA, as well as possible alternatives to the act, continue to gather momentum, whereas present positions of the selected states on the reform are rather uncertain.

All states’ views on healthcare reform and ACA expansion are substantially correlated with their overall political ideology and orientations. According to Callaghan and Jacobs (2016), Democrat-leaning states were the first to adopt Medicaid expansion, while the states where Republicans had greater control over the government tended to reject it. As the state belonging to the former category, NJ initially had a positive perception of the ACA. However, CA, which is run by the Republican administration for a long time, was rather an exception. The reform was quickly to take effect there due to many operation inefficiencies in its previously established insurance system and the lack of another viable solution to them (Weinberg & Haase, 2018).

When it comes to the present-day situation, the majority of NJ residents tend to have a negative outlook on ACA. Results of a recent poll indicated that 52% of NJ citizens believe that the insurance system is on wrong track and that the majority of people are worried about excessive coverage costs (“As Obamacare debate rages,” 2018). The affordability of individual coverage plans under the ACA concerned CA legislators in 2017-2018 as well and the state’s officials were pondering about alternative statewide independent reforms for a long time (Weinberg & Haase, 2018). However, since CA has just passed the individual mandate that may help to stabilize the situation in its insurance market, it is valid to presume that the enactment of those alternatives is now postponed.

Professional Nursing Practice

The effects of the healthcare reforms on nursing practice in the selected states seem to be similar to a substantial degree. First of all, it is worth noting that Medicaid expansion fostered better coverage of vulnerable populations and, in particular, lower-income individuals that were not eligible for insurance before and could not afford individual insurance. An analysis of data from CA National Health Interview Surveys gathered throughout 2006-2013 revealed that Medicaid expansion resulted in a 7% increase in coverage among lower-income adults in the state (Golberstein, Gonzales, & Sommers, 2015). It means that members of this population group commenced utilizing medical services more often. Therefore, nurses now must acquire a more advanced understanding of those patients’ peculiar needs and peculiar and respond to them well. Moreover, when working with Medicaid beneficiaries, nurses must aim to increase the cost-effectiveness of all treatment/intervention tactics and strategies (Oliver, Pennington, & Rantz, 2014). It is valid to state that these requirements apply to the practice of nurses in both CA and NJ.

Secondly, the reform and the pending substitution of the ACA emphasize the significance of nurses’ roles as advocates. For example, while NJ residents grow increasingly disappointed with their insurance system, local nurses strongly oppose the proposed legislation aimed to replace the ACA (New Jersey State Nurses Association [NJSNA], 2017). Nurses have an insight into how the healthcare system works and a profound understanding of patients’ vital needs/interests. Therefore, similarly to the members of the NJSNA, all nurses can and ought to play a major role in the advocacy for the betterment of the healthcare system and the prevention/elimination of healthcare disparities (NJSNA, 2017). It means that nursing practitioners in NJ, CA, and across all other states need to improve their research, advocacy, and public communication skills to influence legislators’ votes and foster a favorable change in the US healthcare.

References

As Obamacare debate rages, most in N.J. say health insurance system ‘on wrong track’. (2018). True Jersey. Web.

Callaghan, T., & Jacobs, L. R. (2016). Interest group conflict over Medicaid expansion: The surprising impact of public advocates. American Journal of Public Health, 106(2), 308-313.

Golberstein, E., Gonzales, G., & Sommers, B. D. (2015). California’s early ACA expansion increased coverage and reduced out-of-pocket spending for the state’s low-income population. Health Affairs (Project Hope), 34(10), 1688-1694.

How much does health insurance cost in your state?(n.d.). Web.

National Center for Health Statistics. (2017a).Stats of the state of New Jersey. Web.

National Center for Health Statistics. (2017b). Stats of the state of California. Web.

New Jersey medical insurance statistics. (n.d.). Web.

New Jersey State Nurses Association. (2017). New Jersey State Nurses Association strongly opposes new health care reform bill.NJSNA. Web.

Norris, L. (2018a). California and the ACA’s Medicaid expansion.Healthinsurance.org. Web.

Norris, L. (2018b). New Jersey and the ACA’s Medicaid expansion.Healthinsurance.org. Web.

Norris, L. (2019). New Jersey health insurance marketplace: History and news of the state’s exchange.Healthinsurance.org. Web.

Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447.

Sheen, R. (2019). California passes new state-wide healthcare individual mandate.The ACA Times. Web.

United Health Foundation. (2018). America’s Health Rankings analysis of America’s Health Rankings composite measure. Web.

Weinberg, M., & Haase, L. W. (2018). Health care reform in the balance: California and the future of the Affordable Care Act. Web.

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