We, in the state of New Jersey under the leadership of Governor Christie, continue to implement provisions of health reform law as deemed appropriate to improving the health of the people of New Jersey. One such provision is creating a health insurance exchange, which is a marketplace for individuals and small businesses to buy state-approved insurance policies. The goal is for these exchanges to provide individuals and small businesses with a “one-stop shop” to find and compare affordable, quality private health insurance options. Currently the federal law requires that each state have an exchange, offering the opportunity for states to create their own, providing subsidized insurance options for individuals up to a FPL of 400%. We estimate a minimum of 500,000 New Jerseyans buying insurance through the exchange, with a potential of 150,000 people transitioning from the employer sponsored health plan coverage to the insurance exchange. The administration has been evaluating this, seeking input from community and industry stakeholders, and last month was awarded $7.67 million in Level One exchange grants from HHS. In addition, last week the legislature passed a bill that would create a health insurance exchange in the Garden State in anticipation of full implementation of the Patient Protection and Affordable Care Act with key components that include an active exchange, a governance structure and a basic health plan or “optional Medicaid expansion”.

As we decipher our current environment, it is important for us to recognize that there are some factors affecting our position and decision in the state. Firstly, our state already has two “mini-exchanges”- the Individual Health Coverage Program Board and the Small Employer Health Benefits Program Board. Both are “in but not of” the Department of Banking and Insurance. We will have to develop rules that will help the integration and interaction of these exchanges with the state-wide exchange. Secondly, creating a new system to administer the federal requirement will be costly and time-consuming, so we will have to identify ways to make the process effective and efficient. Although the federal government will pay for exchange start up, state exchanges will have to fund their own administrative costs starting in 2015. Our state is still working with actuaries to estimate the cost, but Rhode Island received the first Level Two Exchange Establishment grant in November 2011, of $58.5 million to fund the development, design, and technology procurement of the Exchange through December 2014. Another aspect to consider is whether the state should set up a ‘passive’ exchange, which simply acts as a clearinghouse, or an ‘active’ one that would allow the exchange to be the purchaser and negotiate its rates. While we assess this, it is important to recognize that the active approach will require significant resource allocation, and the possibility of duplication and redundancy of governmental and regulatory functions. Finally, The United States Supreme Court will later this month, consider a lawsuit challenging the federal law that requires the mandate with a decision widely expected to be issued by the end of June.

The clock on that deadline is not as close to midnight as initially interpreted to avoid a federally operated health insurance exchange in our state. With all these confounding variables in this current environment, the Governor should approach the next steps in creating the state health exchange carefully. Most importantly, waiting to see the U.S. Supreme Court ruling in June, before seeking the additional grants that New Jersey will continue to be eligible for until the end of 2014. If the lawsuit to overturn the PPACA is successful, then the governor’s administration would have wasted valuable resources building a program that will not be put into place.

As a physician, previous health insurance executive and the former commissioner of health, I know that our collective goal remains to ensure access to high quality healthcare to all New Jerseyans. The state including the policy makers, legislators and the Governor should carefully assess and evaluate all these factors before intuitively reacting and embarking on an effort that may be futile. While waiting for the Supreme Court decision, we should continue our due diligence on creating the best state operated health insurance exchange for our state, which is void of bureaucracy, administrative duplication and red tape. Having worked personally with many of the stakeholders in this domain, I am confident that we will continue to have these healthy debates, while finally reaching consensus on the best approach for our collective New Jerseyan community.

More than 1.2 million lives in New Jersey rely on the safety net provided by Medicaid. However, the viability of that safety net will be put at risk if we do not understand and prepare for the potential repercussions of the Patient Protection and Affordable Care Act (PPACA). The federal health care reform law can add more than $36 billion to the state budget when thousands of residents enroll in the system for the first time. Legislators must begin the work now to reduce costs, and save a system without jeopardizing the already delicate balance inherent within a budget during these difficult economic times.

Medicaid provides health care to our neediest residents, and is funded jointly by the state and federal governments. Under the PPACA, income limits for eligibility were increased, and the federal government will fully fund newly-eligible enrollees through 2016, and a minimum of 93% of their cost through 2019. For this population, taxpayers should take some comfort in knowing these added costs will be paid for by their federal tax dollars instead of state tax dollars, the federal funding does lessen the effect on a state that is constitutionally-required to balance its budget each year. However, many New Jerseyans are eligible for Medicaid under the pre-PPACA income standards, but have not enrolled for one reason or another. The coming requirement that all Americans demonstrate they have some form of insurance will encourage many of these residents to sign up for Medicaid, and they will do so without the federal government paying more than its standard reimbursement rate of 50%. This combination will leave New Jersey and its residents in a precarious position in terms of access to care, and the cost of the program.

Medicaid spends about $8,000 per New Jersey patient, with about $4,000 of that paid for via the state’s general fund. The effect of the PPACA on the fund is frightening. A model developed by the Cato Institute for a Common Sense Institute of New Jersey health care forum detailed growth of New Jersey’s Medicaid budget both with and without the PPACA. In 2014, The Affordable Care Act can add $1.6 billion to New Jersey’s Medicaid costs; the number continues to increase eventually costing New Jersey taxpayers an additional $36 billion between 2014 and 2023.

This will result in some unacceptable choices for policy makers and legislators. As Medicaid crowds out other budget priorities, we face difficult decisions. These choices can include steeply higher taxes, deep cuts in Medicaid and other safety net programs, and further neglecting the need to rebuild infrastructure and pay down debt. Worst of all, we would be doing this to pay for a program where access to physicians is inadequate, and the health care outcomes are poor. All of which contributes to the increasing cost of health insurance and health care.

New Jersey needs a vision for its Medicaid system that results in providing care for the neediest residents cost effectively. States as politically diverse as Florida, Texas, Rhode Island, and Washington are demonstrating that a bipartisan consensus exists to address the problem and those solutions to improve medical outcomes and save money are not mutually exclusive.

Some of these programs include competition amongst the insurance companies in a marketplace for Medicaid patients, tailoring plans to specific markets and financial rewards for healthy behaviors. In addition, care coordination programs especially for comorbid mental and medical conditions, accountable care organizations, integrating health information technology, rebalancing long-term care, and payment reform initiatives should be explored and implemented. There are other examples from across the country that New Jersey can look to adopt, but we must build on the progress already made here more quickly if we are to protect Medicaid patients, and our state.

As a physician, health insurance executive and the former Commissioner of Health and Senior Services, I know first-hand the difficulties faced by Medicaid patients seeking care, and doctors who lose money with every patient who walks through the door. We must do better, and we can if we collectively pursue organic grass roots and market-based reforms in advance of the coming changes.

This commentary was published by The Asbury Park Press, and the Times of Trenton

CSI-NJ President Jerry Cantrell debated the budget on My9′s New Jersey Now on Sunday, February 26. The full video is available below, and the governor’s Fiscal Year 2013 Budget Summary is available at this link.

New Jersey Now: February 26, 2012: My9TV.com

The charts below identify the breakdown of state aid to every school district in the state. The districts are in alphabetical order by their county. Districts in Atlantic-Monmouth Counties are in the first table, while those in Morris – Warren Counties are in the second.

Proposed 2013 State Aid: Atlantic - Monmouth Counties

Proposed 2013 State Aid: Morris - Warren Counties

Click here to read "In Need of Healing

New researched released by Dr. Poonam Alaigh, a member of CSI-NJ’s Board of Directors, demonstrates the cost the Patient Protection and Affordable Care Act (PPACA) will add onto New Jersey’s Medicaid budget, and offers solutions to preserve Medicaid’s safety net while protecting taxpayers from an expected $36 billion cost increase that will occur when an additional one million New Jerseyans enroll in the program by 2023. The research was unveiled as part of a CSI-NJ report, In Need of Healing: Medicaid and the New Jersey Budget.

Federal health care reform expands Medicaid in two ways: it increases eligibility levels, and the individual mandate will cause many New Jersey residents who are eligible for Medicaid, but not enrolled, to sign up for the program. New Jersey will receive no funding above the federal government’s standard 50% reimbursement rate for these patients, creating the higher cost.

CSI-NJ proposes several solutions that were developed during a series of meetings with policy makers, providers, stake holders and health care policy experts. These changes focus on creating choice for patients, innovative approaches to increase access to care, and reforms related to care coordination, long-term care, and the use of health information technology.

To read the report in its entirety, click this link.

About the Author

Dr. Poonam Alaigh, M.D., MSHCPM, FACP, is President of Alaigh Care Associates, and a Member of the Board of Directors at the Common Sense Institute of New Jersey. Prior to joining CSI-NJ, Dr. Alaigh was Commissioner of Health and Senior Services for the State of New Jersey. She has a mufti-faceted background in health care administration and delivery, including practical hospital practice, hospital administration, managed care, pharmaceutical medicine and health care policy.

In December, Anthony Kim of Education Elements addressed an education forum co-hosted by the Monmouth University School of Education, and the Common Sense Institute of New Jersey. In the address, Mr. Kim discussed the advantages and obstacles of blending online and traditional learning systems in public schools.

The entire address is available in the video below. To learn more about the partnership between Monmouth University, and CSI-NJ, e-mail info@csinj.org.

The tool not only allows taxpayers to compare public pensions to private savings, but also to compare New Jersey public pensions to other states. For example, a male police officer hired in 2000 with 25 years of service and earning $90,000 when he retired at age 55 would collect an annual pension benefit of $58,500. To yield the same income, a private sector retiree would need to have saved $1,279,943 by the same age. If that police officer worked in New York instead of New Jersey, his pension would be $32,850. These estimates do not include the cost of health benefits.

“New Jersey taxpayers now have even greater insight into the good deal public employment has been and continues to be for government workers,” said CSI-NJ President Jerry Cantrell.

To see what your pension would be if you were a public worker in New Jersey, visit http://www.calculateyourpublicpension.com/NJ/

In this new position in the organizational structure, the Development Director will have the opportunity to build the development capability. The most important output of the Development Department is revenue raised. To accomplish that, the Director of Development must raise a significant portion of the Institute’s annual revenue through personal recruitment and ongoing relationships with major donors.

The Director of Development will:

• Develop and implement a cohesive fundraising strategy for the Common Sense Institute, including strategies for high dollar donors; foundations, and corporate donors;

• Work closely with the President to implement the fundraising strategy, including making recommendations on how the President’s time can be most effectively utilized in a fundraising capacity;

• Identify and develop relationships with key individual prospects and record key information about these individuals;

• Solicit current and prospective donors for financial support for the Institute;

• Interact with donors through telephone calls, one-on-one visits, and written correspondence to keep them informed of our work;

• Manage an aggressive, high dollar direct mail program;

• Oversee the planning and implementation of special events;

• Gather and analyze data related to the effectiveness of various aspects of the fundraising strategy;

• Maintain the fundraising database to ensure current data on donors, gifts, and prospects;

• Begin the development of a planned giving program;

• Maintain relationships with charitable foundations that currently support the Common Sense Institute and regularly seek funding from new foundations; and

• Maintain relationships with private corporations that currently support the Common Sense Institute and seek funding from prospect corporations through meetings and written proposals.

The ideal candidate will have the following attributes:

Demonstrated ability to raise funds for organizations;
Entrepreneurial spirit and ability to be a self-starter;
A minimum of five years of experience in fundraising;
Experience with individual donors, foundations, and corporate donors;
Notable relationship building skills, and an outgoing, friendly personality;
Solid writing skills, including proficiency in proposal writing;
Ability to multi-task, organize numerous moving parts of a project, and meet deadlines;
Understanding of and commitment to the principles of limited government, free enterprise, and personal responsibility;
Experience with databases and basic Microsoft Office products, including Word, Excel, PowerPoint, and Outlook;
Excellent communication skills;
Ability to travel on a regular basis;
Bachelor’s degree

The Director of Development can reside anywhere in New Jersey and will work from a virtual office.

This position will require travel throughout the state of New Jersey, as well as occasional travel to other locations around the country. Expected travel: 25%.

Application Process

To apply, please email the following materials to Claire Kittle, Executive Director of Talent Market, who is assisting with the search: Claire@talentmarket.org:

• Résumé

• Cover letter, which must include your philosophical interest in the mission of the organization and your desired salary range

While we thank all applicants in advance for their interest in this position, we are only able to contact those to whom we can offer an interview. No phone calls please.

About The Common Sense Institute of New Jersey

The Common Sense Institute of New Jersey is a nonprofit research and education organization that conducts scholarly research and analysis of New Jersey public policy. The Institute’s mission is to explore and advance public policy alternatives that foster individual liberty, personal responsibility and economic opportunity. Institute staff will pursue this mission by conducting timely research on important issues and then marketing the findings to elected leaders, the media, business leaders, community organizations, and individual citizens.

The Common Sense Institute of New Jersey is governed by an independent Board of Directors and is a nonpartisan, tax-exempt organization. The Institute relies solely on voluntary support from individuals, private foundations and businesses, and as such neither accepts government funding nor conducts contract research.

When New Jersey first authorized charter public schools in the 1990’s, the public was told the charters would operate at 90% of the cost of the host district, saving taxpayer dollars with each family that freely chose this newly-available public education option. Nearly 20 years into this grand experiment, it is clear that the advertised figure is bogus, but not in a way charter critics can use.

In 2010, there were 66 charter schools operating in New Jersey, with many of them operating more than three years. Although the press has covered various aspects of charter school facts, the research comparing charter-per-pupil-expenditure in relation to their host district(s) is lacking.

By statute, charter schools receive funding at 90% of the foundation aid of their host district(s), a percent level that has long been disputed by charter school operators as insufficient and unfair. Recently, the New Jersey Department of Education has been including charter school expenditures in their Taxpayer Guide to Education Spending (formerly Comparative Spending Guide), which forms the financial basis for this simple analysis.

Below is a simple analysis of charter school ‘Total Spending’ and comparative ‘Budget Cost’ data. The ‘Total Spending’ variable, as computed by the New Jersey Department of Education, for the first time includes all expenditures paid by both the school district and the state, including costly pension and health care contributions. Meanwhile, the Budget Cost’ variable includes only those expenditures common to all districts, excluding items such as debt, transportation and other non-comparative expenditures.

At question is whether the charter schools ‘Total Spending’ is much less than their host regular public school districts? Taxpayers and policy makers should consider this analysis as the charter experiment expands. The program is expected to add an additional 15+ schools already approved but not opened, and many more in the review pipeline.

From the 2011Taxpayers Guide to Education Spending, utilizing the 2010 actual numbers for Total Spending and Budgetary Cost, the chart below compares individual charter schools spending levels to their host district. Some charter schools receive a majority of their funding from multiple districts, making a direct comparison impossible.

Key Findings

This analysis is not intended to be comprehensive, but it raises serious questions regarding the range of charter school spending, and the reasons they almost universally receive less than the statute-guaranteed funding levels. The key findings of the analysis are:

• For the former Abbott districts, charter schools receive approximately 65% ‘Total Spending’ funding level compared to their host district, much less than the 90% ‘foundation aid’ level;

• For non-Abbott districts, the funding level range is 56% to 89%, a significant difference in funding level, which reflects large expenditure differences due to student weighting factors and local contribution variation;

• The range of charter per-pupil expenditures for the former Abbott districts range from $10.244 (Camden Institute of Excellence) to $22,222(Camden Promise), requiring further investigation into reasons for large variation across former-Abbott districts;

• The variation of charter school funding within a host district can be significant, requiring further investigation into reasons for large variation;

The analysis for the selected districts is intended to identify basic funding levels, and does not identify productivity, performance or even reasons for funding variation in- and between- districts.

Camden

Camden had eight charter schools in 2010, with Total Spending ranging from $10,244 to $22,222, a difference of $11,978 per pupil. In comparison, the Camden Public School District had a Total Spending of $23,770, with a charter school funding level range of 43% to 93%. The large variation in Camden’s charter school spending is significant, and requires further investigation.

Jersey City

Jersey City identified nine charter schools in operation in 2010, with a Total Spending range of $11,525 to $18,818, a difference of $7,293 per pupil. In comparison, the Jersey City School District had a Total Spending of $21,824, with a charter school funding level range of 53% to 86%. The large variation in Jersey City’s charter school spending is significant, and requires further investigation

Newark

Newark had 13 charter schools operating in 2010,with a Total Spending range of $12,423 to $17,915, a difference of $5,492 per pupil. In comparison, the Newark Public Schools had a Total Spending of $22,992, with a charter school funding level range of 54%to 78%. Although Newark’s variation was less than other former-Abbott districts, it still is significant to require further investigation.

Paterson

Paterson’s two charter schools in 2010 had a Total Spending range of $12,606 to $13,031, a difference of only $425 per pupil. In comparison, the Paterson School District had a Total Spending of $20,229, with a charter school funding level range of 62% to 64%. Paterson funds their charter schools at similar levels.

Plainfield

Plainfield’s three charter schools in 2010 had a Total Spending range of $13,039 to $13,620, a difference of only $581 per pupil. In comparison, the Plainfield School District had a Total Spending of $19,572, with a charter school funding level range of 67% to70%. Plainfield funds their charter schools at similar levels.

Trenton

There were six charter schools operating in Trenton in 2010, which had a Total Spending range of $13,559 to $18,674, a difference of $5,115 per pupil. In comparison, the Trenton Public School District had a Total Spending of $21,038, with a charter school funding level range of 64% to 89%. The large variation in Trenton’s charter school spending is significant, and requires further investigation

Conclusion

There is still much more we need to learn about charter schools, and this quick analysis highlights the large range of funding levels between charter schools and their host districts. Although all charter schools have a Total Spending less than their host districts, there are still many questions on whether this constitutes actual taxpayer savings (since former-Abbott districts receive a SFRA-language 2% annual increase in funding) and whether the addition of 100 new charter schools on an already large fragmented system will have long term consequences.

But on the surface, many charter schools spend only 65% of what it costs for the public schools, making this education option taxpayer-friendly.

Comparing Charter Schools Per-Pupil Costs

This article was first published by InTheLobby.net. To download a copy, click here.

New Jersey Now: January 29, 2012: My9TV.com