Christie's drug-crisis fight: How is New Jersey paying for it?

Christie Budget Address
Gov. Christie's $35.5 billion budget proposal for the fiscal year beginning July 1 includes $430 million for addiction services, up from $283 million when he took office in 2010.

As he pursues a wide-ranging agenda to carry out his promise to battle the addiction crisis during his final year in office, Gov. Christie is looking beyond the state budget to bankroll the effort.

While the Republican governor’s attention to the issue has won praise, parts of his approach — including his call to tap the reserves of the state’s largest insurer — have drawn objections. And some lawmakers and advocates worry federal funding bolstering the state’s programs is in jeopardy as Congress considers a rollback of the Affordable Care Act.

Christie’s $35.5 billion budget plan for the fiscal year starting July 1 includes $430 million to target addiction, up from $283 million when he took office in 2010.

The spending boost "has already happened. Quietly, but it's happened," said Assemblyman Declan O'Scanlon (R., Monmouth), the Republican budget officer.

Federal money has paid for the bulk of the increase, in part due to the expansion of the Medicaid program. But from 2010 to the current budget year, state spending grew by nearly $60 million, according to the state treasurer's office.

Christie emphasized the spending increase in his budget address last month, pointing to plans to spend an additional $12 million on residential services for 18- and 19-year-olds and $5 million to expand a program that screens children for behavioral and substance-use issues, among other initiatives.

Expanding those programs "does not impact" other services provided by the state Department of Children and Families, said spokesman Ernest Landante.

But "no one's hiding behind a claim that there's no cost to these initiatives. There is," O'Scanlon said of the anti-addiction efforts.

Christie got blowback for his proposal to tap the reserves of Horizon Blue Cross Blue Shield of New Jersey, calling on the nonprofit insurer during his budget address to establish a fund that would help pay for addiction services for “our most vulnerable population who access Charity Care and Medicaid.”

In addition to Horizon — which said raiding its reserves “will only make insurance more expensive and less secure” — the business lobby and groups on both ends of the political spectrum opposed Christie’s proposal. A leader of the national Tea Party Patriots group called it "the very essence of government overreach."

Sen. Joseph Vitale (D., Middlesex), who has been a lead sponsor of legislation combating addiction, said the proposal was “not sustainable.”

Asked Friday about the status of the proposal, Christie spokesman Brian Murray said: “We’ll say more when we have more information we need to share.”

O'Scanlon, whose brother died of alcohol addiction, supports Christie's efforts, including a new law requiring insurers to cover drug treatment. "It will cost something," he said, referring to the prospect of premium increases stemming from the law, which applies to about 30 percent of insurance plans in the state. But "it sends a message that we're taking this seriously."

As he signed the insurance law, which also limits opioid prescriptions by doctors, Christie said last month that "whatever the cost is of this, it's certainly less than 1,600 lives a year" — the number of overdose deaths in New Jersey in 2015.

Among the most significant areas of increased spending, Christie has raised reimbursement rates for substance-abuse treatment, allocating an additional $128 million in the current budget. New Jersey previously had one of the lowest reimbursement rates in the country, according to providers.

The rate increase "made things more viable financially," said Alan Oberman, director of the John Brooks Recovery Center in Atlantic City.

Christie has also put more money into the state's drug court program, with spending increasing from $43 million in 2010 to $64 million this year. On a smaller scale, he has devoted $2.8 million to a recovery coach program, which connects overdose victims with people in recovery to encourage them to seek counseling and treatment.

"Can we spend more? Yes. Should we? Absolutely," Vitale said. But "there's limited resources."

Christie has been "very helpful" by making addiction a public priority, Vitale said.

The state has spent $2.6 million so far on advertising featuring Christie and publicizing the state's REACHNJ hotline — an effort to connect people to substance-abuse services that the governor announced in his January State of the State address.

Under a new contract, the state is prepared to spend up to $15 million, Murray said. The effort differs from other state public health campaigns, given Christie’s executive order in January declaring the opioid epidemic a public health crisis, Murray said.

Acknowledging that the Philadelphia and New York media markets are expensive, Vitale said he would prefer more money was spent on treatment. "I’d rather see some sort of balance as opposed to spending all of that much money."

Other concerns involve the fate of the federal Medicaid program as the Republican-led Congress pushes a repeal of the Affordable Care Act. New Jersey expanded Medicaid under the federal health-care law in 2014.

If there are federal cuts, "we can likely forget about covering anyone in Medicaid who needs inpatient treatment" for substance abuse, Vitale said. "The money just won't be there."

While describing Christie as a "tremendous asset to the treatment field," Oberman, of the John Brooks Recovery Center, said he was "very disappointed that [Christie] hasn't spoken out" against proposed Medicaid changes.

Christie has described the GOP bill as "the beginning of negotiations."

Privately, Christie has acknowledged the impact of a Medicaid rollback on New Jersey, according to Rep. Tom MacArthur (R., N.J.). "He gave me pretty dire predictions about what happens," MacArthur said at a town-hall meeting this month.

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