The Murphy administration and Democrats in the Legislature are doing what they can to shore up and protect the federal Affordable Care Act in New Jersey, as policies implemented by the Trump White House — and continued threats of repeal — are starting to take a toll on the landmark law.

Gov. Phil Murphy announced last week that state regulators would take a more active role in reviewing some ACA plans and has committed more state funding to expand coverage and continue outreach for the program, ordering state departments to actively promote enrollment soon after he took office in January.

He is also expected to sign legislation to strengthen the individual and small-business insurance market, including a bill that would make New Jersey the second state in the nation to implement its own individual mandate for health insurance — with a resultant tax penalty for not doing so.

And on Thursday the state Assembly advanced a Democratic-sponsored measure to require hospital staff to play a more active role in connecting patients with insurance. While many facilities already work to enroll uninsured patients with Medicaid, if they qualify, the legislation would also require employees to help people sign up through the ACA’s marketplace, which sells discounted commercial policies to working poor residents who don’t have coverage through their jobs.

“A primary goal of the Murphy Administration is to ensure that every New Jerseyan has access to affordable health insurance and that all our residents are able to see a doctor when they are sick. New Jersey is committed to increasing enrollment to ensure as many individuals are covered by health insurance as possible. My administration also believes it is critical that the health insurance offered in the state contains all the protections required under New Jersey law and the Affordable Care Act,” Murphy told the federal Centers for Medicare and Medicaid Services in a May 11 letter announcing the state’s intention to take control of some aspects of marketplace management.

800,000 more NJ residents insured since 2014

The ACA, or Obamacare, has helped more than 800,000 additional Garden State residents get insurance since it took effect in 2014; 500,000 through the expansion of Medicaid, or FamilyCare, and another 300,000 thanks to marketplace policies. As a result, the uninsured rate has dropped from 13.2 percent to 8.7 percent, the lowest in decades. But that still leaves hundreds of thousands of Garden State residents without coverage, including 70,000 children, according to research by New Jersey Policy Perspective.

In addition, new national studies suggest that some of the Obamacare gains have started to backslide. A study released earlier this month by the Commonwealth Fund, a left-leaning policy group, found that some 4 million working-age people have lost coverage since 2016 and the uninsured rate among lower-income adults has increased by more than five points in two years, with more than one in four lacking coverage as of 2018.

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Commonwealth said the dip is largely a result of the Trump administration’s efforts to weaken the law by cutting outreach funding by 90 percent, repealing the federal tax penalty for no coverage (starting in 2019), and allowing insurance companies to sell less robust policies. General confusion over the law’s status also contributes to these declines, researchers said.Pending regulatory changes are likely to continue or even exacerbate this trend, research by Princeton University’s Woodrow Wilson School suggests. An analysis, published in April by the State Health & Value Strategies project, noted that the Trump administration will allow the current essential health-benefit requirements to be changed — allowing insurance companies to offer less expensive, lower-quality policies, easing restrictions on rate increases and earnings caps, and making it easier for public officials to deny coverage to those who can’t easily document their income level.

Tweaks large and small

Murphy is hoping that, with small and larger policy tweaks on the state level, New Jersey can protect the gains it has made through the ACA and prevent any regression. The governor’s decision to have the state Department of Banking and Insurance play a larger role in reviewing ACA marketplace plans is one way to protect benefit standards in New Jersey, advocates noted. While this change does not make New Jersey’s a state-run exchange, like programs in Massachusetts and New York — which have greater flexibility with the enrollment process and other elements — they said it does help the state guard against further federal attacks.

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute — who has worked for Horizon Blue Cross Blue Shield, the state’s largest insurance provider, and at DOBI — said that Murphy’s order does not involve a major shift for insurance companies or regulators, who have been doing this type of work for decades, but it fits well with his larger efforts to protect the law.

“The Governor’s decision makes sense,” Schwimmer said. “With the pending creation of the state-based individual mandate and reinsurance program, this is a logical move.”

The Assembly bill (A377), which dates back several years, is another attempt to embrace the ACA and build on its benefits in New Jersey. Sponsored by Assemblywomen Shavonda Sumter (D-Paterson), the Democratic leader, and Angelica Jimenez (D-Hudson), with Assemblyman Herb Conaway Jr. (D-Burlington), the health committee chair, the measure would require trained hospital employees to interview an uninsured patient prior to discharge to determine their insurance status. If the patient is incapacitated, the employee would work with a family member.

If needed, the hospital employee would be required to help the patient or family with the steps needed to enroll in the ACA marketplace, or begin the sign-up process for Medicaid, if they qualify. If the visit does not coincide with the annual marketplace enrollment period, the hospital worker must provide the information for the patient’s use at a later date.

A Senate version of the bill awaits action.