Issue Background

Affordable Care Act

Value Based Billing Proposed for Medicare

CMS has proposed a value-based modifier on physicians’ Medicare payment rates in its 2013 physician fee rule proposal. This is to implement a provision in the Affordable Care Act which will phase in beginning in 2015. CMS proposes to base the 2015 payment adjustment on physicians’ quality and resource use in 2013 applicable only to physicians in groups of 25 or more. In 2017 the value-based modifier would apply to all physicians. CMS is proposing a 1% payment reduction to groups of 25 or more who do not participate in the PQRS. MSNJ has objected to payment rules that penalize physicians in the future for past quality reporting. We will continue to do so.


Implementing the Affordable Care Act in New Jersey 

Last week's U.S. Supreme Court decision finding the individual mandate to purchase healthcare insurance constitutional, as a tax, will result in the implementation of the Affordable Care Act (ACA), but whether New Jersey expands Medicaid eligibility and establishes its own state run health insurance exchange (HIX) is still in question. The Court decision makes clear that states may forego the ACA expansion of Medicaid eligibility criteria without jeopardizing current federal funding to their programs. However, the Medicaid expansion is federally funded at 100% in the first two years and 90% thereafter, creating a strong incentive for states to expand.

Governor Christie has stated that the New Jersey’s Medicaid program is already inclusive, so it is not yet clear what direction his administration will take on the expansion. The ACA also requires the creation of a HIX, which the federal government will establish if the state does not. Governor Christie previously vetoed the New Jersey Legislature's bill on a state run HIX to consider the ramifications of the Court decision. Now, the administration must decide. MSNJ supported the HIX legislation and will continue our efforts to ensure a state-run HIX. Read Governor Christie's statement.


MSNJ's Statement Regarding the Affordable Care Act (ACA) Supreme Court Decision 

The Supreme Court decision finding the Affordable Care Act (ACA) constitutional will have a significant impact on healthcare delivery in the United States.

While the Medical Society of New Jersey (MSNJ) did not support the passage of national healthcare reform legislation, largely because it did not address the sustainability of the Medicare and Medicaid programs and tort reform, MSNJ has a long history of supporting access to both affordable healthcare and affordable healthcare insurance.

Earlier this year, MSNJ supported the creation of a Health Insurance Exchange (Exchange) in New Jersey. This could increase competition and remove barriers in the healthcare insurance market so that more uninsured New Jersey residents may purchase affordable healthcare insurance with transparent terms. We stand ready to work with the Governor and the New Jersey Legislature to establish a robust Exchange. MSNJ fully supports expanding the availability of affordable healthcare insurance to our residents.

We are pleased for our patients that key provisions of the ACA, supported by MSNJ, were upheld by the Court including:

  • The elimination of pre-existing conditions as a barrier to coverage;
  • The right of parents to insure their children on their existing policies up to age 26; and
  • The elimination of maximum life-time caps on benefits.

MSNJ continues to have concerns about whether New Jersey has the physician capacity to treat all patients who will become eligible for Medicaid with expanded eligibility requirements. Because New Jersey has among the lowest payment rates for Medicaid in the nation, together with the highest practice costs, there is already a shortage of physicians who treat Medicaid patients. Expansion of the insured population through the Exchange and Medicaid will worsen the physician shortage. We will further analyze the Court’s opinion and work with the Governor and the Legislature to address the needs of our state’s neediest population.

MSNJ is a tireless advocate for a sustainable Medicare program. We have advocated for a repeal of the broken funding and payment formula. We know that the cost of caring for our seniors must be reduced and we intend to be part of the solution by providing quality, cost-effective, coordinated care. MSNJ supports physician-led integrated care models to provide cost efficient, quality care.