Mikie Sherrill is set to take office January 20 as the next governor of New Jersey. What challenges will she face in the area of health care and what options does she have for addressing them? Two of the state’s former health commissioners have some thoughts to share.
The list of issues is long, including: subsidies for insurance premiums, drug prices, medicaid enrollment, vaccine guidelines, and maternal health. And it all comes a a time when Washington is cutting funding for health care, leaving the state with many holes to fill.
Heather Howard became health commissioner in 2008 when Jon Corzine was governor. She was associate director of the Domestic Policy Council during the Clinton administration and is now a professor at Princeton University. Since talking to WBGO she has been named to Sherrill’s affordable health care action team on the transition staff. She says the new governor will have plenty of cost-cutting opportunities.
"There’s the cost of your insurance, there’s the cost of your pharmacy, people get hit in the pocket everywhere they go in health care, and so I think she’ll probably be thinking about how she can address in those various arenas," said Howard.
She says New Jersey may have its own answer to the battle over extending Obamacare subsidies that was the reason for the government shutdown.
"The state has funded its own subsidies so I think the state has a track record of doing better than most other states in leaning into those programs," Howard said, "so I imagine she will take advantage of that infrastructure, it’s just gonna be harder because the federal funding has gone away."
Mary O’Dowd was the state’s health commissioner from 2011-2015 while Chris Christie was governor. She is currently the executive director of Health Systems and Population Health Integration for Rutgers Health. She agrees that the state can help make up the difference here
"New Jersey also has the opportunity thru the state budget to invest public health funding in areas where the federal government doesn’t provide funding," said O'Dowd, "and that’s something that would be a great opportunity for New Jersey in the coming year."
Sherrill has vowed to sue the Trump administration to claw back federal funds in a number of areas, including health care. And while campaigning she focused on the Medicaid cuts the budget bill signed into law in July would cause. O’Dowd says it contains provisions that would make more demands of Medicaid recipients, such as having to renew eligibility every six months. And a new federal work requirement is set to take effect in 2027 which could further complicate enrollment and likely result in people losing benefits. She says all this puts a strain on recipients and agencies.
"Some of the federal proposals include new requirements around work or submitting additional documentation," she said, "and that comes with effort on both an individual perspective but also organizations who can support individuals in enrollment."
She says the state needs to partner with those organizations to make sure those eligible for Medicaid remain enrolled. Still, she says the result may be more people with no coverage, leaving the state to find other solutions.
"There is the potential that if we see an increase in the uninsured we’ll be going back to those programs and perhaps requiring additional investment in those initiatives that support the health care providers that continue to provide services to those who are uninsured," said O'Dowd.
Those providers include hospitals and federally qualified health centers that cover those with no coverage.
The budget bill has more to say about Medicaid, specifically that Planned Parenthood will be blocked from receiving federal Medicaid reimbursements. Howard says the state will have to step up here as well.
"New Jersey has a long history of strong support for reproductive health care services and so that’s an area where Governor-elect Sherrill also can lean into the state’s history of supporting access," she said.
Howard says lowering drug prices will also be high on Sherrill’s to-do list. "I know she’s talked about, for example, going after pharmaceutical benefit managers, the middlemen who negotiate drug prices. She may have some tools to go after those middlemen and I think there are members of the legislature who also want to," she said.
Howard added that these benefit managers could find themselves out of a job.
"The state could create their own PBM and say why should there be a middleman who’s taking a significant cut? Could the state negotiate? That’s an idea that other states are considering," said Howard.
Changes in vaccine guidelines have cast doubt on their availability going forward. Howard says a multi-state approach may be the answer here.
"We’re seeing states team up with other states. New Jersey’s already been doing that and I would imagine that Governor-elect Sherrill might be interested in teaming up with northeastern states, for example on vaccines, as we’re seeing the undermining of federal support for vaccines," she said.
Vaccine availability is only half the battle though. People need information about them to be encouraged to get them, says O’Dowd.
"One of the measures that we should consider is really becoming very focused on hyperlocal vaccine education so that individuals who have concerns can learn more about the benefits and risks," she said.
With the disruption at the Centers for Disease Control that has brought changes in federal regulations in a number of areas, or no recommendations at all, O’Dowd pointed out that New Jersey has led the way at times when federal guidance was lacking, and sometimes the feds have even taken their cue from the state.
"New Jersey was the first state in the country to create and implement a newborn screening program for heart defects for newborns in the hospital," she said, "and a month later the federal government followed suit."
There are areas though where the state is failing — one being maternal mortality among Black women, who in New Jersey, Howard says, are seven times more likely than white women to die during or after pregnancy.
"New Jersey has the highest rate of black maternal mortality, so that’s been a focus for the Murphy administration and I would expect that to continue under Governor Sherrill," said Howard.
Howard cited structural racism in health care systems, as well as lack of access to health insurance and health care and hospital neglect as the causes.
This "Voices of Wellness" feature is made possible in part by a grant from the Horizon Foundation for New Jersey