Hours before the Republican plan to replace Obamacare died in Congress Friday without a vote, healthcare experts in New Jersey gathered to discuss how the state’s healthcare system can withstand the major changes under consideration in Washington, D.C., and ensure gains made in recent years aren’t entirely lost.

Several speakers said that regardless of the fate of the Republican bill, the state needed to prepare for potential changes. Some suggested creating a state-run insurance plan that would essentially extend the existing Medicaid proposal, which now covers one-in-five New Jersey residents, or finding other ways to reduce the cost of care so more can afford to purchase commercial plans.

Participants in the NJ Spotlight roundtable — ACA Repeal and Replace: New Jersey’s Response — generally agreed that while the federal law was not perfect, it had helped some 800,000 Garden State residents gain insurance coverage and expanded the available benefits for millions more. The GOP plan — which was eventually pulled without a vote when Republican leaders realized they did not have the needed support — would have reversed these insurance gains, destabilized an already shaky commercial market, and shifted billions in additional costs to state taxpayers, they agreed.

State Sen. Joseph Vitale, (D-Middlesex), the longtime health committee chairman and the architect of earlier Medicaid expansions, said he planned to work with Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute as he had in the past to explore various options — along with other Garden State experts.

“We’re getting the band back together,” he joked.

Schwimmer stressed how the ACA also led to greater focus on the “triple aim” — improving public health, patient outcomes, and reducing costs – and urged additional reforms to focus on these same goals.

Heather Howard, with Princeton University, noted that even if this bill doesn’t pass, the Trump administration’s interest in reforming entitlement programs like Medicaid is likely to prompt other reforms.

“Healthcare is so incredibly complicated and it is a proxy for so many other social issues,” explained Howard, a former state health commissioner who served as a policy counsel in the governor’s office and the U.S. Senate. “It’s federal law, and that’s who will be debating it, but it comes down to a local issue on so many levels.”

Professor Alan C. Monheit, chair of the Health Systems and Policy department at Rutgers University’s School of Public Health, warned of the cost of reducing the scope of benefits covered. While this may save money up front, such policies only create other costs.

“I think there are false economies here,” he said.

But Schwimmer noted that reducing the cost of care overall will be key to moving forward.

That path could be informed by Medicaid 2.0, a roadmap for reform developed by the quality institute and its partners. “We did not generate this blueprint as a response to a funding change on the federal level,” explained Matthew D’Oria, the project’s chief transformation officer. “It is certainly more important now.”

D’Oria and John Sarno, president of the Employers Association of New Jersey, noted one option to increase insurance coverage would be for the state to expand its own government insurance programs. Sarno warned that competition among commercial insurance plans was diminishing as fewer companies are involved in the market and, regardless of what happened with the GOP healthcare plan, major changes to insurance law are gaining ground in Congress and could lead to drastic changes in the way plans are sold nationwide.

“These are game changers,” Sarno said. “These things are going to happen, they have a momentum of their own.”