Imagine that you are a 50 year old waitress with no children working in a restaurant that does not provide health insurance. You are struggling to make ends meet on $14,000 a year, and you certainly can’t afford to purchase your own health care plan. Thanks to the Supreme Court’s decision to uphold President Obama's health care law, this waitress, and millions like her across the country, will be able enroll in Medicaid, the federal-state partnership program that provides health insurance to the poorest Americans. All in all, the Kaiser Family Foundation estimates that over 550,000 New Jerseyans who can’t afford health insurance could gain coverage through the expansion of this critical program.

These reforms are much needed and long overdue. That’s why I was so disappointed when I heard Governor Christie's comments indicating he is considering joining other Republican governors across the country in refusing to expand access to Medicaid for the state’s uninsured poor. Now that the Supreme Court has unequivocally ruled the Affordable Care Act the law of the land, New Jersey should immediately begin implementing the Medicaid expansion, as well as move to create our state health care exchange.

You may be surprised to learn that New Jersey has already taken the commendable step of being one of only five states, and the only one with a Republican Governor, to request a Medicaid waiver through the Affordable Care Act. This waiver increases Medicaid coverage for uninsured, childless adults. New Jersey’s waiver became effective in April 2011, and allows enrollment for childless adults who have incomes up to 23% of the federal poverty line in Medicaid. So far, 50,490 eligible residents have taken advantage of this opportunity. It would be a mistake for our state to back away from our proactive efforts to expand Medicaid access. Another half million New Jerseyans will benefit if we fully implement this provision.

But this expansion is about more than just ensuring people have access to quality health insurance. It’s about reducing costs for everyone in the system. When uninsured individuals use emergency services, everyone else has to pay in the form of increased insurance premiums and taxpayer reimbursements to hospitals. This is not small potatoes; New Jersey hospitals spent approximately $1.35 billion on charity care last year alone, and New Jersey taxpayers reimbursed hospitals $337.5 million of that.

While some are troubled with the effect an expansion of Medicaid could have on our state’s budget, we wrote the law precisely to assuage such concerns. The federal government will pay for the entire cost of the Medicaid expansion for the first three years of the program. After that, federal funding is gradually reduced to 90 percent, where it will remain. All in all, the federal government could send over $11 billion to New Jersey by 2019 to pay for this expansion. Considering New Jersey only gets 61 cents back for every dollar we send down to Washington, it would be a disservice to New Jersey taxpayers not to take full advantage of these federal funds.

But the Affordable Care Act is about more than just this one program. New Jersey should also move ahead with approving a state health exchange. This exchange will provide New Jerseyans with a comprehensive way to find affordable and quality health plans while encouraging competition and bringing down costs. Our state could potentially be eligible for hundreds of millions of dollars in additional federal grants to set up this exchange if legislation implementing one is signed.

My colleague, Congressman Scott Garrett, recently wrote to all 50 governors, urging them not to create their state health care exchanges. Governor Christie should reject this extremism. When he vetoed a bill earlier this year to create a state exchange, he said he wanted to wait for the Supreme Court to rule. The Supreme Court has decided. Now New Jersey needs to move forward with implementing this historic legislation.

While refusing to implement the exchanges or Medicaid expansion might score the Governor points with the most extreme elements of his party, it will be at the expense of the best interests of the people of New Jersey. The Affordable Care Act will provide health insurance to the most vulnerable among us, reduce costs for all New Jerseysans, and bring needed federal funding for our state. To do anything less than fully implement this law would be the height of irresponsibility.

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