Protecting every NJ child: A Q&A with Sen. Joseph Vitale – NJ.com

There are 80,000 kids in New Jersey who lack health insurance, and nearly three quarters of them are children of color. This doesn’t rank among our state’s proudest boasts.

It is also plainly illogical, Sen. Joe Vitale often points out: The cost of insuring kids is relatively low, and the benefits are enormous when it comes to avoiding future health and social expenses, so it’s one of the best investments we can make.

So Vitale, the Senate Health Committee chairman who helped create NJ FamilyCare – the landmark program that provides affordable coverage for low-income families and their children – fixed the problem by delivering the Cover All Kids bill that received Gov. Murphy’s signature Tuesday.

This measure, which eliminates premiums and waiting periods for kids without coverage to enroll in FamilyCare, is another capstone in a stellar career for the Middlesex County lawmaker who has helped guide state health care policy for decades. Vitale spoke with Dave D’Alessandro of the Star-Ledger Editorial Board about this critical expansion and other issues earlier this week.

Q. Getting health care for 80,000 uninsured kids is something Joe Biden would call a big freakin’ deal, given that you’ve been chasing universal coverage for kids for more than a decade.

A. Back in 2008, I wrote the bill that mandated all kids have coverage. That law included a buy-in program. So any kid or family who was ineligible for CHIP or Medicaid could buy in at full cost. A couple of hundred people signed up right away, then (Gov.) Christie let it die and 1,549 kids lost coverage in 2012. But it’s still the law; we still have FamilyCare Advantage, which is basically what this will morph into.

Three things happened with the bill Gov. Murphy just signed: One, we eliminated premiums for FamilyCare. Until now, if your family was 200% to 355% above the poverty level, you paid a premium ($44.50 to $151.50 a month), which is higher than what people currently pay on the State based exchange. Second, we eliminated the 90-day waiting period that had been put in place to prevent employers from dropping dependent coverage, but really only served to punish vulnerable populations.

The bill also restores an annual $20 million allocation to target people that are eligible but not enrolled. NJ Policy Perspective did a study two years ago showing that most of the 80,000 uninsured eligible kids are rural and urban and don’t know coverage exists. So we need robust outreach.

Q. We had managed to close the coverage gap under the ACA, but what are the effects of leaving kids out of our health care system?

A. The research is pretty clear, especially in communities that have poverty, high crime, low coverage rates, a lack of transportation and food options. It shows that these children have a greater likelihood of having significantly poor health outcomes at an older age, and that access to affordable care can reduce those adverse health outcomes.

The good news is, we already have a lot of partners including hospitals, FQHCs (Federally Qualified Health Centers) and clinics as well as school districts engaged in helping to enroll children. I want to see a renewed energy in all of these partners and I want to see churches and community organizations get more involved.

Also, kids are generally healthy, and making sure they are enrolled helps to balance out the cost to cover people who are aged and have spent down their resources and become Medicaid eligible.

Q. Is there an enrollment period? If people want to get their kids signed up, what do they need to do?

A. You can just go to the FamilyCare website and enroll. It’s fairly simple, and the electronic gatekeeper will tell you whether you’re eligible for Medicaid or FamilyCare after you enter your income.

The beauty of this is, if you’re stuck in employer-sponsored coverage or COBRA and it’s super expensive, or it doesn’t cover providers in NJ, you can call FamilyCare (1-800-701-0710) and talk to a Health Benefits Coordinator. They can tell you if you can drop your current coverage entirely, or at least drop dependent coverage and enroll in FamilyCare, which is a really robust program – it’s not just medical, it’s dental, vision, mental health, everything.

And now the waiting period is eliminated, so if you’re stuck in a lousy plan and you’re eligible for FamilyCare, make the call. Families can do the math and decide what works best for them. They no longer have to bear that 90-day “crowd-out” period, which was a disincentive to drop your insurance.

Q. Lightning round time: We only have seven syringe access programs, and the facility in Atlantic City is in danger of closing. What is the future of needle exchanges in NJ?

A. I’m moving a bill now that allows the Department of Health and the entity that wants to provide the service to locate it, without local governing body interference. Obviously, a program would not be able to open next to a school and would have to abide by zoning rules. The current law says – and it was written this way to get passed – that local approval is required to locate one, no matter where, even if it’s in an industrial park at the end of a road.

Q. It will never cease being a Nimby issue.

A. That’s why we only have seven: The law says that if the town turns you down, you have no recourse. So if a group like Hyacinth wanted to open up a needle exchange in a community of need, they’d have to get approval from the local governing body just to have one at all. So this bill eliminates that step and still upholds zoning approval, but adds that you can’t unilaterally say, “You can’t come here.” I expect to get it done in the fall.

Q. NJ is losing 3,000 lives annually to overdoses, the top killer of Americans under 50. You’ve led the fight to increase Naloxone access, but you’re trying to convince New Jerseyans to accept OD prevention centers, a.k.a. supervised injection sites. How are you going to win that argument?

A. That’s the needle exchange debate on steroids. It took us over a decade and a half to pass syringe access, and it took an evolution in thinking; it needed time for legislators to see the evidence and get past the stigma of needle exchange programs – which were proven through studies under a Republican administration that they are effective in limiting blood-borne pathogens, while increasing the number of people going into treatment.

So the moral of the story is, it’s evolutionary thinking. I don’t know if injection sites will happen in my lifetime, but the evidence shows that these facilities not only mitigate overdoses and prevent death, they also facilitate the transition into treatment.

Q. You have shepherded a pile of bills in response to the tragedy of our nursing homes during the pandemic, but only the media examined the circumstances surrounding the deaths of our 8,000-plus seniors so far. Do you still plan hearings, and what kind of folks are at the top of your list to testify?

A. Absolutely, there will be hearings, and I’d like to speak with experts in the field, starting with advocates for better quality care and organizations that represent the workers. One of the issues is, we don’t have a robust system to examine the quality of care in these facilities. For hospitals, we have Leapfrog, the non-profit that culls through infection rates, morbidity rates, C-section rates, and so on. It’s the kind of information consumers should have, but it’s also an incentive for the industry to say, “all this information is being publicly reported.” We need that from nursing homes.

For now, I have a bill that would require financial reporting of for-profit nursing homes – the same information that non-profit nursing homes are required to provide. We need to know that the facilities we fund are high quality. We give them tens of millions for staff and PPE and infrastructural improvements like HVAC improvements. But can we see the ROI? Is it going for the best care? There isn’t that kind of oversight that we need to have.

Q. Will state Health Department officials be compelled to testify?

A. Yes. I just introduced a bill that would require every Department to review their COVID-19 preparedness, response, and recovery and make recommendations. I am not interested in politicizing this or playing a blame game. I want us to take the time to conduct a practical self-assessment. Hindsight is 20/20, and we all know we could improve on every single thing we have done in our past if given the opportunity to relive each moment — each critical decision.

What could we have done different that would have prevented loss of life? How do we need to adapt and modify the playbook for the future? While our aged population suffered the most with COVID19, another population might suffer worse next time. What can we do be prepared in general? Why was the PPE stockpile allowed to be stored past their usefulness? Are their positions and responsibilities in Departments that cannot be left vacant under any circumstance?

Q. Rep. Bonnie Watson Coleman authored a bill calling for decriminalization of all drugs and a shift of all matters pertaining to “individual” narcotics use from the purview of law enforcement to the health care realm. Your thoughts?

A. It is a proposal worthy of debate. If we can rationalize decrim of cannabis, we can rationalize the decriminalization of other drugs. This is not about dealers or distribution, it’s about personal use, and for the most part these people are in a death spiral – injecting heroin and fentanyl, doing harm to themselves and others. So they’re addicted, it’s a health care crisis, and it should be treated as such. But if someone is arrested for possession, there ought to be an opportunity for them to go into treatment and have access to drug court. Obviously, you have to factor of unequal rates of arrests among races.

Q. Is this the year you finally get your menthol cigarette ban? The two remaining obstacles – opposition from the NAACP and tax revenue – are no longer in play.

A. The Feds have announced they want to do the same thing. I think we should beat them to it, because it’s going to take them years to do it — for all the reasons you know. So that’s something I’ll push for in the fall. It always struck me as strange that this was regarded as a revenue issue. That’s a weird way to look at the poison we sell, mostly to kids and in communities of color.

Speaking of smoking, I would love to see our casinos stay smoke-free. Every casino in our region – even tribal-owned casinos – went smoke-free during the pandemic. From Maryland to Massachusetts, casinos are all 100% smoke-free by law. New Jersey and Pennsylvania casinos have been smoke-free during the pandemic. My hope is that NJ and PA will move together to stay smoke-free, and stop using the other as the reason not to act. Casino workers deserve the same protections as the rest of us.