All New Jersey residents deserve affordable, quality health care, regardless of immigration status, race or ethnicity, gender, age, education, or employment status. However, access to coverage, which helps mitigate individuals’ rising health care costs, remains plagued by significant gaps and challenges.
With a rising rate of residents who lack insurance, New Jersey’s leaders urgently need to address gaps in coverage. Extending existing programs that connect residents with affordable coverage regardless of immigration status and expanding coverage options for all residents would ensure that everyone can access the health coverage they need.
Coverage Gaps Re-appeared with the End of Pandemic-Era Protections
2023 marked the end of COVID-19 pandemic-era protections that kept many people covered by affordable health insurance, resulting in the first increase in uninsured residents since the pandemic began. The end of the main coverage protections was called the Medicaid “unwinding” — the reevaluation of every enrollee’s eligibility for the program after the pandemic-era pause on disenrollments ended.[i] The huge losses in coverage resulted in many families unexpectedly losing or having to change insurance.
In 2023 alone, over 660,000 New Jerseyans were uninsured, a nearly 6% increase from 2022, according to recently released data from the U.S. Census Bureau’s American Community Survey. This significant increase in state residents living without health insurance raises alarms about the recent reopening of pre-pandemic gaps in coverage and potential threats to the gains made since the introduction of the Affordable Care Act.
Racial and Economic Disparities Continue to Plague the Goal of Universal Coverage
In addition to an increase in uninsured rates, the data shows persistent racial and economic disparities in coverage rates. In particular, residents with incomes between 138 and 399 percent of the federal poverty level (between about $34,300 and $99,400 for a family of three, such as a single mother with two children) were more likely to lose coverage in 2023 than other income groups.[ii] These residents, ineligible for Medicaid and less likely to have employer coverage, faced increased uncertainty as their previous coverage options ended.
Gaps in coverage for low-wage workers and families struggling to make ends meet are closely tied to a history of racism and xenophobia; restrictions in programs like Medicaid, variations in the quality of employer-sponsored insurance, and even limitations on the state health insurance marketplaces have been structured to limit coverage for specific groups.[iii] Unfortunately, residents of color and immigrants still do not have equitable access to affordable coverage. Black residents remain twice as likely to be uninsured than white residents, while Hispanic/Latinx residents are over six times more likely to be uninsured than non-Hispanic/Latinx New Jerseyans. Immigrants, too, are far more likely to lack coverage, with non-citizens remaining over six times more likely to be uninsured than naturalized citizens and nearly 10 times more likely to be uninsured than citizens born in the United States.
Disparities continue at the county level, as counties with larger immigrant populations experience higher uninsured rates. Because of gaps in coverage, residents in counties with the largest communities of non-citizens are twice as likely to be uninsured than residents in counties with similar income levels but smaller communities of non-citizen residents.[iv]
State Leaders Need to Expand Affordable Coverage Options for All Residents
To provide affordable coverage for all, New Jersey leaders need to open the NJ FamilyCare program to older age groups and the state marketplace, GetCoveredNJ, to all residents regardless of immigration status. Additionally, the state should explore the opportunity to establish a state public option that would be available to all residents, covering adults and children who still lack affordable options due to income and immigration status.[v] Leaders must improve outreach and connections between programs so that no one loses coverage unnecessarily.
While state leaders have begun initiatives, such as the highly successful Cover All Kids program, to address gaps, persistent holes in the patchwork of coverage options will prevent the state from achieving significant improvement for all of New Jersey’s residents.[vi] As long as gaps continue for residents based on age, immigration status, and employment, universal coverage will stay out of reach.
With stronger stitching, our patchwork system of coverage can better provide accessible, affordable health coverage for all.
End Notes
[i] Stay Covered NJ, Eligibility Unwinding, 2023. https://nj.gov/humanservices/dmahs/staycoverednj/unwinding/
[ii] NJPP Analysis of U.S. Census Bureau American Community Survey, 2023, Table S2701 and 2023 Federal Poverty Levels at: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
[iii] Health Affairs, Structural Racism In Historical And Modern US Health Care Policy, 2022. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01466; Center on Budget and Policy Priorities, Health Coverage Rates Vary Widely Across — and Within — Racial and Ethnic Groups, 2024. https://www.cbpp.org/research/health/health-coverage-rates-vary-widely-across-and-within-racial-and-ethnic-groups
[iv] The average percent of the population across counties made up of non-citizens is 8.6%, based on NJPP Analysis of U.S. Census Bureau American Community Survey, 2023 Table DP02.
[v] See footnote below on the Cover All Kids program. This program was broken into three phases of insurance enrollment goals for: (1) kids who were already eligible for NJ FamilyCare but not enrolled, (2) kids who were income-eligible but previously ineligible for NJ FamilyCare due to immigration status, and (3) kids who are both income-ineligible for NJ FamilyCare but don’t have access to other affordable options such as GetCoveredNJ due to immigration status. As of September 2024, the first two phases have been implemented, but the third phase still remains unaddressed. The law, P.L.2021, c.132., allows for the state to explore public options to fill this gap. https://www.njleg.state.nj.us/bill-search/2020/S3798
[vi] NJ Spotlight News, Big enrollment of undocumented kids in NJ health insurance program, 2023. https://www.njspotlightnews.org/2023/08/large-number-undocumented-children-enrolled-for-nj-health-insurance-program/; New Jersey Department of Human Services, Cover All Kids, 2024. https://nj.gov/coverallkids/
