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Healthcare issues at the state level [PODCAST]

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The Hospital Finance Podcast

In this episode, Assemblymen Jon Bramnick and John DiMaio of the New Jersey State Legislature join the program to discuss healthcare issues at the state level including Medicaid expansion, interstate sale of insurance, and the opioid epidemic.

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The following interviews were recorded live at the Winning Strategies Washington/Princeton Public Affairs Group annual post-election luncheon on November 9, 2017.

A live episode of “On the Record”, featuring Michael Aron, was taped at this event.

photo of BESLER team at WSW luncheon
Photo taken at the WSW/PPG Post-Election Luncheon.
Seated L-R: NJ Senate President Steve Sweeney, Bill Pascrell III, Michael Aron, Chris Russell, Assemblyman Jon Bramnick
Standing L-R: Michael Passanante, Jon Besler, Scott Besler

Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, I’m joined by Assemblyman Jon Bramnick of New Jersey’s 21st district who is the Republican leader in our assembly. Welcome to the podcast!

Jon Bramnick:  Great to be with you.

Mike: So, let’s start out with a few questions. According to the New Jersey Hospital Association, there are now over 811,000 New Jerseyans that have insurance coverage due to Medicaid expansion and through the ACA marketplace. What is the impact to a state like New Jersey should the current formula for Medicaid matching funds change or if subsidies to insurers in the marketplace were to be eliminated?

Jon Bramnick: Very difficult. The hospitals need as much support as possible. They have difficulty now balancing their budgets. So consequently, you would think the state, to try to increase charity care, they would try to make up for it.

So I think, at least the members of Congress that I know, want to make sure that we continue to have federal funds so we can support our hospitals. It would be devastating if we lost more funding to the hospitals.

Mike: A question for you. It’s a national issue, but it comes down to the states in a lot of ways, interstate sale of health insurance. That’s a concept that gets discussed with some regularity.

My question for you… is that a viable idea for New Jersey? Is that something that could or might result in lower insurance rates and more choice?

Jon Bramnick: Well, there’s a few questions built into that. The first is: “Would it result in lower rates?” No question about it. “Do you want more choice?” Yes. But the product of insurance—and I’m a trial lawyer—is very complicated. Most people cannot read their insurance policy or understand it.

So, if you had a system, a national system, where you could sell whatever type of insurance you want, then you’d have to be very careful that those policies at least had some minimum basics within that.

So, my position, absolutely, I would like a broader market. I want competition. But you have to make sure that if someone is buying a catastrophic policy that it’s really a catastrophic policy. So if it has a deductible of $100,000 where it pays 30% of fair market value back to a hospital reimbursement, it’s not insurance.

So yes, I think we should broaden the market. But even at the national level, there would have to be some basics that every policy would have to have. Otherwise, it would be very difficult for consumers to really read and understand what their policy is.

Mike: Now, something that’s a national issue but close to home is the opioid addiction crisis. Earlier this year, you co-sponsored a bill that Gov. Christie subsequently signed designed to reduce access to opioids while increasing treatment options. Can you tell us about that initiative?

Jon Bramnick: Sure! We know that there’s a national and state health crisis with respect to addiction. Much of that has come from prescription drugs, someone can no longer get the prescription drugs, and then they go to the street to buy dangerous drugs with incredible problems and deaths.

So, what we did is we limited the ability of the doctors to prescribe opioids for a significant period of time.

However, we’re going to have to fine-tune this thing. We surely didn’t want a dentist to give a 30-day prescription of opioids for a root canal. And certain doctors, we wanted to limit in terms of prescriptions.

But once again, that’s our first time out of the box. We’re on the right path, but it’s going to need some fine-tuning. So if someone has major surgery, they end up in a hospital, they leave the hospital and they’re home on a Sunday, and they can’t get a new prescription, as I’ve said, there are some tinkering we have to do. But generally, I think we’re on the right path.

And also, by putting in a piece of legislation, it opens a discussion as to the problem that exists. But some people, for a long period of time, didn’t recognize it as a crisis.

Mike:  Well, assemblyman there are a myriad of issues to deal with. We wish you much luck in the coming New Year. And thank you for your service to New Jersey.

Jon Bramnick:   Thanks! Great to be here.

Mike:  Hi, I’m joined today by Assemblyman John DiMaio of New Jersey’s 23rd district.

John DiMaio:  Good to be here!

Mike:  So it’s great talking state issues and of course federal issues touch on us here in the state as we were talking about offline a second ago. One of the things we were just touching on was the idea of Medicaid expansion through the ACA marketplace and some of the subsidies that come in.

How a reduction in those subsidies might affect a state like New Jersey? As we mentioned, that money comes in from the Fed. And if it disappears, and it becomes part of your yearly budget planning process, how do you start to fill that gap?

John DiMaio: Well, since Gov. Christie opted into the program, the money came in. And it’s available for use for healthcare issues.

But there’s always concern with the federal government with any program that when they lead with money, and then they start to take the money away, or change the amount of money, reduce it or eliminate it, then that would fall back on our budget at the state level. And that’s part of a bigger program obviously.

We’re dealing with many, many departments. So, if you have people that are used to receiving services, and suddenly, the rug gets pulled out, that’s concerning. Certainly, the impacts could be broader than that one department.

If we had finite revenue, and we tried to do other programs and, costs rise, we’re trying to maintain programs, something hit, or depending on who the governor may be and majority party in the legislature, they may decide to raise taxes to do it which has an impact on all New Jerseyans.

So, it’s a concern. It’s a concern. Because once you get used to it. And that’s why people are not very happy about losing services. But then, at the same time, how do we cover the costs?

Mike: Clearly. And then, offline, a few minutes ago, you and I were talking about the opioid addiction crisis. And of course, New Jersey has touched on that as well. We know earlier in the year, there was some legislation that the governor signed to help limit access to opioids. How do you think this is playing out in New Jersey?

John DiMaio: Well, it’s been problematic. Listen, people are dying every day. I think the number in 2016 was somewhere around 1700 people died in only 12,000 Narcan deployments. Some for the same person twice in a day. The addiction is unbelievable! It’s frightening. It’s frightening. And no one is immune from it.

As we’ve talked about earlier, there are so many different ways that people enter into this. One of them is opioid prescription drugs. And we’ve talked a little bit about someone who’s in high school athletics, for example. They go to the doctor’s, they have some sort of surgery or something that’s painful. And the doctor prescribes them three pills a day for 30 days. That’s 90 pills. And then, they don’t know how to manage that.

And one thing I say to parents is, “Listen, even if your child is prescribed an opioid, you manage the dosage. They don’t need every pill.” And I’ve had surgery myself—spine surgery, painful nerve damage. And I’ve had them, but I could never take them because I’m frightened. I’m absolutely frightened.

And then, we have the other side of this picture where we have young people that go out, they’re hanging out with her friends, they’re getting into alcohol or have marijuana. They get weakened, then somebody comes along, “Hey, you have to try this…” And it’s so small and easy now and cheap and accessible. And actually, once somebody does this, in one time, they could be hooked on heroine.

And I’ve talked to the young people. I say, “You see your friends dying. Doesn’t it scare you?”

How does it keep happening? It is awful, just awful.

In fact, if I had my way in New Jersey, we don’t have the death penalty, but for major traffickers, I think we may want to start thinking about that as an option—stiffer penalties. You want to play in the high stakes game, make money off the death of our children, we may have something to offer you back if you want to be in that game.

Mike: It’s insidious!

John DiMaio: Ugh! Thank God my children are grown.. But who knows? I mean, they might make one bad choice one night…

I think we need to educate. Parents have to know that if your child went out with friends, know who their friends are. Is there anything you don’t like about the friend? Well, maybe it’s the wrong friend.

And so, parenting is critical. Prevention, we can work with if you have a prescription. Manage that especially for your child or for yourself. You don’t have to take the amount that’s prescribed.

Mike: And dispose of it the right way.

John DiMaio: Exactly, exactly.

Mike:   …if you’re not going to use it.

John DiMaio:  The Police Departments have drug disposal methods. You don’t want it hanging around the cabinets. Kids raid the cabinets.

Mike: No, it’s a terrible problem. And it’s certainly gratifying to see New Jersey took some steps this year to try to alleviate it as much as perhaps a government can in these situations.

John DiMaio: Well, the government could only do things like limiting. It really starts with great parenting and leadership at home. Be a good role model yourself. Not talking off the cuff about painkillers. It’s got to be explained because these could be very difficult and very damaging to a person.

Mike: Assemblyman,  it’s been a pleasure having you on the podcast today. Thanks for all of your insights around these critical issues.

John DiMaio: Thanks, Mike!

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