Exploring Policy Pathways for a New Jersey Public Health Insurance Option: Stakeholder Perspectives & Design Considerations for an NJ FamilyCare Buy-In Program
Lud Milca Ceus, Abigail Asante-Amoah, Olivia Matts, Trevor Jedwabnik, Alexander Koskoski, & Monica Santora
Policy Research Practicum Prepared for New Jersey Citizen Action
Faculty Advisor: Dr. Joel Cantor
New Jersey faces a serious threat to health insurance coverage. Changes in federal policies, particularly under House Resolution 1 of 2025 (H.R. 1; also known as the “One Big Beautiful Bill” Act of 2025), along with the end of enhanced subsidies within Affordable Care Act (ACA) Marketplaces, will limit access to Medicaid, Children’s Health Insurance Program (CHIP), and premium tax credits (PTCs), which will affect many immigrants and low-income residents who already struggle to find affordable coverage. As a result, more people in the state are expected to become uninsured, especially those who depend on public programs and financial support.
To address this issue, this report examines three policy options New Jersey could consider to expand coverage for individuals who are left out of federal programs due to their immigration status or because they cannot afford coverage. The options are a Basic Health Program (BHP), a Medicaid Buy-In, and a state-run Public Option. The analysis is based on a review of federal and state policies, case studies from other states with similar models, and interviews with policymakers, advocates, and health policy experts. The information in this report is intended to provide an understanding of the practicality, trade-offs, and challenges of each option.
The report’s findings highlight some key issues affecting coverage expansion in New Jersey. The main barrier to coverage is affordability; many residents cannot pay Marketplace premiums and out-of-pocket costs even when they qualify for financial aid. Additionally, the state must maintain a balanced budget and relies heavily on federal funding, which is being substantially reduced. Because of these financial limits, New Jersey cannot fully replace lost federal support and must be deliberate about how it allocates resources across different policy goals.
For all three models, decisions about program design, especially regarding management, provider payments, and cost control, are crucial for long-term success. Stakeholders noted that healthcare costs are largely driven by provider prices, suggesting that expanding coverage without addressing these costs may limit the effectiveness of any policy solution. Experiences from other states show that each model has its own strengths and weaknesses. BHPs offer greater affordability and continuity of coverage, especially for low-income residents and certain immigrant groups, but they rely heavily on federal funding. Medicaid Buy-In programs can leverage existing systems to improve access, but they require significant state investment and careful planning. State-run Public Options can lower premiums through set plans and regulated provider payments, but depend on federal subsidy levels and require strong enforcement mechanisms to ensure provider participation.
In summary, New Jersey has several options to reduce coverage losses and lessen health inequalities. However, each choice involves trade-offs regarding cost, complexity, and political support. As federal policy changes, this puts greater pressure on the state’s coverage system; prompt, strategic actions from the state are crucial. Without intervention, New Jersey risks a rise in the number of uninsured individuals, additional strain on the healthcare system, and greater disparities in access to care. By drawing on lessons from other states and aligning policies with its financial and management capacities, this report informs how New Jersey can create a sustainable approach to maintaining coverage and ensuring fair access to healthcare.