Now, those two worthy goals appear to be at war with one another.
The ever-increasing cost of medical care has meant ever-rising insurance premiums. Those increases, say state officials, are causing more and more
families and small businesses to abandon their insurance. And that in itself has forced up premiums even more and triggered an explosion in the cost of caring for the uninsured.
This week, an 11-member commission newly appointed by Florio will take up this complex and controversial dilemma as it attempts to fashion a new system that would, in Florio's words, provide "access to quality health care at a reasonable cost."
"One of the key questions we're facing," said Brenda Bacon, Gov. Florio's top health expert and the chief of his office of management and planning, "is how we can preserve the safety net for the uninsured while keeping health insurance costs affordable."
While many of the problems require technocratic fixes - streamlining or rewriting regulations, for instance, and finding new money to pay for health care for the uninsured - they may also provoke a more fundamental debate about who should get health care and at what cost.
Just such a debate is now under way in Oregon, which recently became the first state to propose limiting medical services for people whose health care is paid for by the government.
And in New Jersey, which has one of the nation's highest incidences of AIDS and a growing elderly population, some health care experts believe it is time for a similar debate - especially given a system that encourages the best possible care, no matter what the cost or prognosis.
Vincent Maressa, the executive director of the Medical Society of New Jersey, said last week that while "technology can do all sorts of wonderful things, the question really comes down to, is there a cost-benefit relationship to some of what we're doing. The question of whether we can afford to give everything to everybody has to be studied."
Bacon, for her part, said that "I'm not sure people in New Jersey are interested in denying care to anyone, but clearly, it is something that is going to come up for discussion."
Although the issue of rising health care costs is not new, several looming problems have combined to give a sense of urgency to the commission's work and to prompt Florio to call for recommendations by October, just six months away.
Most immediately, Blue Cross and Blue Shield has indicated that, on top of its recent 24 percent average increase for individual subscribers, it will seek another rate increase of between 40 percent and 60 percent in November. Such an increase no doubt would force even more people into the ranks of the uninsured.
Those numbers are already intimidatingly large, even for a state with the second highest per capita income in the country. State officials estimate that nearly 1 million New Jerseyans - one out of every seven - have no health insurance, even though two-thirds of those uninsured people hold jobs.
"It's the affordability issue," said Fred Hillman, a spokesman for Blue Cross and Blue Shield. "And certainly, this will probably continue unless something is done about the cost of health insurance."
Complicating the problem, the fund created to pay for the hospital costs of the uninsured is set to expire at the end of the year. The fund has grown more than 100-fold since 1985, consuming dollars Pac-man-style, and is expected to cost more than $600 million this year.
As it now works, the fund is paid for by those with insurance through a surcharge on hospital bills of up to 13 percent that can add nearly $450 to an average hospital bill. Many business leaders question the fairness of putting the entire burden of paying for the uninsured on those paying for insurance.
As a result, a new, more broadly based way to pay for this fund is seen by the Florio administration as a top priority and could lead to recommendations for higher taxes, as well as tax incentives to encourage employers to provide insurance and penalties against those who do not.
Commission members will also be looking at ways to make health insurance more available and possibly expanding the eligibility requirements for Medicaid, a state-federal program that pays for health care for the poor.
This would also mean an added burden on the taxpayer. Medicaid costs soared 70 percent in New Jersey in the last five years - one of the fastest-growing costs of state government - with New Jersey taxpayers spending $904 million this year and the federal government picking up a roughly equal amount.
Hospitals, meanwhile, are complaining about the state's unwieldy and inefficient system of reimbursing them according to a formula that pays a fixed amount for each patient with the same diagnosis - no matter how much the treatment actually costs.
The New Jersey Hospital Association says that while this pioneering system, implemented 10 years ago, has helped to contain hospital costs by holding them to an average increase of 8 percent in each of the last five years, it left 37 of the state's 89 acute-care hospitals operating in the red last year.
"Hospitals must be adequately paid for all of the costs of doing business," Louis Scibetta, the association's president, asserted last week, ''not just those that the government feels are enough."
Doctors, for their part, are likely to call for a greater reimbursement
from Medicaid for their services. The fees the state pays to doctors for treating the poor have increased only once since 1973 and remain so low that most doctors in New Jersey won't accept Medicaid patients.
One of the consequences has been that many poor people either delay needed care or seek help at hospital emergency rooms, which can cost the state up to six times more than a visit to a doctor's office.
These issues and others are likely to be aired this week, when Florio's
commission starts taking testimony from the varying and competing interest groups that make up New Jersey's medical community.
Some of those groups - the doctors, in particular - are already wary of Florio's intentions, since the governor excluded representatives from the medical society, hospital association and other interested groups from his panel.
But the hospital association's Scibetta gives Florio credit for taking on the issue at all and is hopeful some good will come of the commission's efforts.
"We're really pleased this governor has taken the initiative to put some very tough stuff on the table and allow a prestigious group of people to reflect on them," he said.
