Obamacare's greatest challenge? Cost

• Obamacare is supported by 45 percent of New Jerseyans%2C opposed by 46 percent.
• An upcoming Supreme Court decision on Obamacare subsidies could cripple the law.

WEST LONG BRANCH – Obamacare in its fifth anniversary has insured thousands of New Jerseyans. It's forced hospitals and doctors to cut out unnecessary care. And it's changed Americans' focus from treating their illnesses to preventing them, health care experts said Wednesday.

But it hasn't solved its biggest obstacle: how to make health care affordable, they said.

"The greatest challenge (before Obamacare) and the greatest continuing challenge is cost," said Wardell Sanders, president of the New Jersey Association of Health Plans, an insurance industry trade group.

Sanders was part of a panel that spoke to about 150 people at a forum sponsored by Monmouth University titled "The Affordable Care Act: Is It Working in New Jersey?" He was joined by former New Jersey Gov. James Florio; John Lloyd, president and chief executive officer of Meridian Health based in Tinton Falls; and Frank Vozos, president and chief executive officer of Monmouth Medical Center in Long Branch.

The law, enacted in 2010, has drawn its share of cheers and jeers. It has provided health insurance to consumers who previously went without coverage, helped slow down what was the skyrocketing cost of health care, and focused on the importance of prevention. But it also has irritated both consumers who are faced with higher out-of-pocket costs and voters who don't think they should be required to buy insurance.

The result: In New Jersey, 45 percent support the law and 46 percent oppose it, said Patrick Murray, director of the Monmouth University Polling Institute.

Four things we've learned about Obamacare?

• It's not set in stone. The U.S. Surpreme Court can put a wrench into the law in New Jersey. It recently heard a case in which opponents argued that consumers in New Jersey and more than 30 other states that use an exchange operated by the federal government shouldn't be eligible for subsidies that make the plans affordable.

If the court rules in favor of the opponents, about 200,000 New Jerseyans would lose their subsidies. A decision is expected in June.

"If they win that case, it will be disastrous for New Jersey," Vozos said.

• Simply having insurance doesn't necessarily provide access to care. (Or does it?) The Affordable Care Act expanded Medicaid to consumers who make as much as four times the poverty rate. As of March, 1.7 million New Jerseyans were covered by the state's Medicaid program, NJ FamilyCare.

But Medicaid's reimbursement rate often doesn't cover what health officials say it costs to deliver the care. And few doctors accept the insurance plan.

"Until that reimbursement structure changes, I don't know that it will succeed the way it should," Vozos said.

Insurers don't agree. Sanders noted that consumers covered through New Jersey's Medicaid expansion program received more than $500 million in care in the first half of 2014. It's a sign they do have access.

• The impact on hospitals is anyone's guess. Hospitals are in no-man's land. Executives said they saw reimbursement from Medicare chopped. But they have more patients who have insurance. They face steep penalties when patients return within a month of being discharged. But many patients are delinquent on their bills because their deductibles are so high, the executives said.

Meantime, they are treating patients not in the hospital, but in smaller offices, off-site.

"At the end if you can figure out if we're better off, God bless you all," Lloyd said with a laugh.

• The debate is likely to continue. Florio said he worried that consumers will continue to pick up more of the cost. It could reach the point that voters begin to call for a single-payer system in which the government sets rates and provides insurance.

It drew shudders from the other panelists. Sanders' members would essentially be replaced by the government. Lloyd and Vozos' hospitals would see less revenue because of lower reimbursement rates.

But it might be the Affordable Care Act's lifeline.

"If we don't see substantial improvement in the next three to four years, I think single payer will be back on the table," Lloyd. "It's up to all of us to make this system work."

Michael L. Diamond; 732-643-4038; mdiamond@app.com