The repeal of the Affordable Care Act, if it happens, will take months to enact and years to roll out. The impact on state spending is expected to be significant, though it isn’t anticipated to hit until the budget adopted next year or beyond.

Still it’s already shaping how lawmakers are approaching the 2018 spending plan that will be adopted in three months, as evidenced by the initial reaction to a push for raises for direct care workers.

Community providers of services for people with developmental disabilities are pushing lawmakers to adjust Gov. Chris Christie’s budget plan to provide raises for direct care workers, who haven’t gotten a pay hike in eight years. The upcoming fiscal year would be the ninth.

Money was added to the current year’s budget last June, then vetoed out by Christie.

Advocates say the current starting salary of $10.50 an hour should be raised by $5 over four years — $1.25 per hour for each of the next four years. This year, that would cost the state $36 million, matched by the federal government in $36 million in added Medicaid funds.

At least theoretically, said Assemblyman Gary Schaer, D-Passaic.

“Are we so sure that anything is being matched by the federal government anymore?” said Schaer.

Advocacy groups share that concern, conceded Daniel Keating, executive director of the Alliance for the Betterment of Citizens with Disabilities.

“I would say I would not make a prediction that that could be assured,” Keating said.

The proposal made by House Speaker Paul Ryan, developed in conjunction with President Donald Trump, to replace the Affordable Care Act would reduce spending nationally on Medicaid by $880 billion over 10 years. It cuts enhanced funding to states that expanded Medicaid eligibility and for home and community-based personal attendant services for children and adults with severe disabilities.

Any cutbacks or a potential switch to block grants present a serious danger, said Kevin Casey, executive director of the New Jersey Council on Developmental Disabilities.

“People with developmental disabilities and their families are living through very frightening, very difficult times for them, trying to figure out where this system is going and what its future is going to be,” said Casey, who acknowledged that the $36 million require is “a very heavy lift.”

Casey said the developmental disability system in New Jersey and all states is more than 90 percent funded by Medicaid.

Casey said the system could be made more stable by raising the starting salary for direct-care workers, which haven’t budged in eight years. Mark Michelson, president and chief executive officer of Spectrum for the Living, said new workers leave for direct-care jobs in New York that pay more or at retail stores.

“A crisis situation has now degenerated to catastrophic staffing conditions, to the point where we’re hemorrhaging,” Michelson said.

“It is not a job that anyone necessarily chooses to do,” Michelson said. “It takes a unique person to do this work. And the bottom line is they’re leaving. They’re leaving left and right.”

The Arc of New Jersey says community providers face a 44 percent staff turnover rate and a 20 percent vacancy rate.

“These services are not frills. Our children’s very existence, their health and well-being, are totally dependent on direct care workers,” said Paul Blaustein, president of the Family Support Coalition of New Jersey.

When Christie proposed the coming year’s budget nearly three weeks ago, state Treasurer Ford Scudder touted the big benefits realized in New Jersey’s budget by reducing the numbers of uninsured through expanding Medicaid under the Affordable Care Act – a cumulative $2 billion in savings over four years.

State and federal funds to New Jersey hospitals for charity care for the uninsured have gone from $665 million in Christie’s first budget seven years ago to $252 million in the upcoming year, as 487,000 people enrolled in the state’s FamilyCare program and 295,000 bought insurance in the federal marketplace.

Senate President Stephen Sweeney, D-Gloucester, said billions of dollars are at stake as Congress considers a health-care law that could lead to many more uninsured – as many as 14 million nationally in the first year, growing later by another 10 million, according to the Congressional Budget Office.

“That will influence the amount of folks we can provide services to,” said Jillian Hudspeth, president of New Jersey Care Association, of the impact of Medicaid changes on federally qualified health centers. “I remain concerned that those folks, if they don’t get care in our centers, will fill our emergency rooms … or they’ll just get sicker. It’s just not a good situation either way.”

“It’s the worst thing they could do,” Sweeney said. “It will set states back. It will create recessions in the states.”

New Jersey has also reduced spending more than 70 percent, over $160 million, on its Pharmaceutical Assistance to the Aged and Disabled program because the so-called “donut hole” for coverage was eliminated, said Raymond Castro, senior policy analyst for New Jersey Policy Perspective.

“The effects are going to be quite considerable, and there’s more than a moment of foreboding in terms of what the future will look like,” Schaer said.

Assemblyman Declan O’Scanlon, R-Monmouth, said he has concerns about the proposed changes.

“I do. That could be substantially impactful here, and it’s going to be some of our most critical middle class and folks that are struggling that could be affected by it,” O’Scanlon said. “We have to pay attention to that and be ready when and if that happens.”

More From WPG Talk Radio 95.5 FM