More than 20,000 fewer New Jerseyans signed up through the federal marketplace for health coverage in 2018, but health-care advocates are nevertheless pleased with Affordable Care Act enrollment for the year ahead.

Health policy analyst Ray Castro of New Jersey Policy Perspective said he anticipated a big drop in participation, given criticisms of the law by President Donald Trump and some in Congress and that outreach funding had been cut by almost half.

“As a result of that, we expected a fairly low enrollment, but it was significant,” Castro said. “It was less than it was last year, so I think the undermining of the Affordable Care Act did have some effect, but the enrollment numbers are better than we thought.”

“It shows how popular this program has become,” Castro said. “This has become the law of the land. It’s become part of our culture to have these higher expectations for health-care coverage.”

Final numbers published Thursday showed 274,782 had selected plans in New Jersey for 2018. That was down around 7 percent from 2017 enrollment, more than the national drop of 5 percent and the 11th biggest decline among the 39 states that use as its marketplace.

“There is both good news and bad news in the numbers,” Castro said.

Castro said details about how many people continued to buy insurance among the roughly 100,000 New Jerseyans who obtained ACA without federal subsidies for 2017 won’t be known until March.  He said those costs rose more sharply, so it’s possible that drove down enrollment.

The newest uncertainty facing the ACA is that the federal tax reform enacted last month ends the penalties associated with the individual mandate, starting next year. Castro said that could make health coverage more expensive for those who have it but that the state can try to mitigate that.

“I think the state needs to see what they can do to support the insurers and to keep costs low,” Castro said. “I think they have to consider an individual mandate in New Jersey as well.”

Castro says that only works if insurance is affordable – which depends on federal subsidies, or perhaps introducing state subsidies as well.

“If insurance remains affordable, then the state needs to consider an individual mandate of its own,” he said. “Of course, you need the same exemptions. If you can’t afford the insurance, you shouldn’t be required to pay for it. But if it is affordable, then it’s fair to require that people apply because if they don’t, it just means the rest of us have to pay more in our charity care and hospitals.”

Castro and other health-care advocates are scheduled to join Sen. Joseph Vitale, D-Middlesex, at a Thursday news conference to discuss proposed expansions of health-care coverage for children. But he said Gov.-elect Phil Murphy and lawmakers are “in a bind” financially.

“Overall, the state really can’t afford to replace the entire program,” he said.

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