When federal lawmakers planned the massive expansion of Medicaid as part of the Affordable Care Act, they included a big enticement to physicians — a significant, but temporary, pay increase.

Although the pay increase was not tied to Medicaid expansion, New Jersey accepted the deal. Some 300,000 additional state residents have enrolled in Medicaid in the last year.

Even though the number of patients continues to increase, come Jan. 1, the pay increase will be gone, adding even more stress to overburdened health care providers in the state.

The provision of the health law that boosted Medicaid reimbursement rates to make them equal to Medicare rates expires at the end of the year.

Medicaid reimbursements to New Jersey providers will decline by 53 percent, according to an Urban Institute report. Only four other states — New York, Michigan, California and Rhode Island — will see greater decreases, the report found.

Because the state has had a low reimbursement rate, only about 40 percent of New Jersey physicians accept Medicaid patients — a nationwide low, according to a 2012 Health Affairs study.

In addition, because many feared the boosted payments would end without an extension, few of the state's doctors who hadn't been accepting Medicaid patients joined the program, she said.

"Many doctors in New Jersey didn't trust that it would be a long-lasting parity situation," said Campagnolo, a past president of the Medical Society of New Jersey.

Medical society CEO Lawrence Downs speculated in a Nov. 18 letter to Human Services Commissioner Jennifer Velez that the return to 2012 reimbursement levels could drive physicians out of Medicaid.

"Our concern is that we could have 5,000 less physicians accepting Medicaid in 2015, when payments go back down to one of the lowest in the nation," he wrote. "Thus, continuation of this payment level is crucial for the proper access to care for Medicaid patients."

Rex Ryan talked about going to the White House when he took over as Jets coach nearly six years ago.

Instead, his tenure with them ended unceremoniously today with a pink slip.

Ryan was fired by owner Woody Johnson as part of a major shakeup that also included the dismissal of second-year general manager John Idzik.

"After extensive thought and reflection about the current state of our football team, this morning I informed Rex Ryan and John Idzik that they will not be returning for the 2015 season," Johnson said in a statement. "Both Rex and John made significant contributions to the team, and they have my appreciation and gratitude for their efforts and commitment. Over the years, Rex brought the Jets a bold confidence and a couple of great post-season runs, which all of us will remember."

"Getting the Jets back on track is my top priority," Johnson said, "and today's decisions are important steps towards achieving our goals."

Johnson has hired former Houston Texans and Washington Redskins general manager Charley Casserly as a consultant to help with the search for a new general manager and coach.

"I am beginning our search for new football leadership, effective immediately, with guidance and support from respected football experts, including Charley Casserly and Ron Wolf, two Super Bowl winners with decades of valuable experience," Johnson said.

The U.S. economy roared into overdrive in the third quarter as consumer and business spending fueled the biggest expansion in more than a decade.

Gross domestic product grew at a 5 percent annual rate from July through September, the biggest advance since the third quarter of 2003 and up from a previously estimated 3.9 percent, revised figures from the Commerce Department showed today in Washington. The median forecast of 75 economists surveyed by Bloomberg projected a 4.3 percent increase in GDP.

Back in June, when we were looking at the final Q1 GDP print, we discovered something very surprising: after the BEA had first reported that absent for Obamacare, Q1 GDP would have been negative in its first Q1 GDP report, subsequent GDP prints imploded as a result of what is now believed to be the polar vortex. But the real surprise was that the Obamacare boost was, in the final print, revised massively lower to actually reduce GDP!

Vermont Gov. Peter Shumlin is canceling his dream plan to create a single-payer health system in the state, he announced Wednesday.

"I am not going to undermine the hope of achieving critically important health care reforms for this state by pushing prematurely for single payer when it is not the right time for Vermont," Shumlin said in a statement Wednesday. "In my judgment, now is not the right time to ask our legislature to take the step of passing a financing plan for Green Mountain Care."

The problem is, of course, how to pay for it. Even while plans were moving forward for a 2017 launch of the single-payer system, to be called Green Mountain Care, Shumlin had held off on releasing a plan for how to pay for the system, waiting until his announcement Wednesday.

Tax hikes required to pay for the system would include a 11.5 percent payroll tax as well as an additional income tax ranging all the way up to 9.5 percent. Shumlin admitted that in the current climate, such a precipitous hike would be disastrous for Vermont's economy.

Eggs are about to get more expensive, as California moves to make sure hen houses are roomy enough to allow the birds to lay down, stand up, extend their wings and dance around.

Farmers nationwide who want to continue selling to the most populous U.S. state are moving to comply with a new law, taking effect next month, that requires the larger cages. They either must build more hen houses, or house fewer birds in the ones they have, raising their costs.

Wholesale egg prices already average a record $2.27 a dozen nationally, up 34 percent from a year earlier. With the new law, the price Californians pay may jump as much as 20 percent for shell eggs in three to six months, according to Dermot J. Hayes, an agribusiness professor at Iowa State University in Ames. The rest of the country will probably follow suit, he said.

"You're going to see some really large spikes in the price of eggs in January," said Scott Ramsdell, who owns Dakota Layers LLP in Flandreau, South Dakota.

California imports more than 30 percent of its eggs from other states. A California Department of Food and Agriculture rule says that an enclosure containing nine or more hens that produce eggs sold in the state needs at least 116 square inches (748 square centimeters) of floor space for each bird, a 73 percent boost over the current standard.

Voters in California approved Proposition 2 in 2008 calling for egg-laying hens to have space to move. Subsequently, Assembly Bill 1437 was signed into law, applying to all eggs sold in the shell in the state. These rules all go into effect Jan. 1.

President Obama misspoke when he said that immigrants living illegally in the U.S. would have to "pay any back taxes" in order to qualify for work papers under the plan he initiated via executive action. They would not.

The immigration plan announced by Obama on Nov. 20 provides a temporary relief of three years from the threat of deportation to parents who are in the country illegally but who have children who are U.S. citizens or lawful permanent residents. The parents must have lived in the United States for at least five years, and they must register, and pass background checks in order to obtain the reprieve. The White House estimates that 5 million people are eligible for "provisional unlawful presence waivers." If they meet certain requirements, those immigrants also would be given work authorization for three years.

For immigrants who step forward, the procedure is to make sure that they "start paying their fair share of taxes" so they can "temporarily stay in the U.S. without fear of deportation for three years at a time," says a White House fact sheet. The key word in there is "start." There is no mechanism to require immigrants in the country illegally to pay any back taxes in order to obtain a three-year work authorization.

An Obama administration official told us the president misspoke when he said that immigrants would have to "pay any back taxes."

President Obama's unilateral executive action on immigration will make hundreds of thousands, perhaps more than a million, illegal immigrants eligible for federal transfer payments. That will be done primarily through two widely used programs — the Earned Income Tax Credit, or EITC, and the Additional Child Tax Credit, or ACTC.

The two programs, intended for low-income workers, are what is known as refundable tax credits. That means they give workers a tax refund that is larger than their tax liability. So a family with a tax bill of $1,000 might receive an EITC "refund" of $5,000, meaning the family doesn't write a check to the government but rather receives a check from the government. The ACTC works similarly for low-income workers with children.

As it turns out, those two programs are already among the most corrupt and fraud-ridden in the entire federal government. A newly-released report from the inspector general of the Internal Revenue Service confirms that the EITC is plagued by fraud (which was already well known) and also reveals for the first time that the ACTC is even worse.

According to the inspector general, the IRS paid out $63 billion in EITC benefits in 2013. Of that, 24 percent, or about $15 billion, was given improperly to people not qualified to receive it. That improper payment rate has been enough to qualify the EITC as a "high risk" program for years.

The IRS paid out $26.6 billion in ACTC credits in 2013. The inspector general reports the child credit improper payment rate for that year was somewhere between 25.2 percent and 30.5 percent — worse than the EITC.

Considering that federal law defines a program as having "significant improper payments" when such payments exceed 2.5 percent of all the money the program sends out, those are pretty terrible numbers.

In a survey taken in the fall, The Commonwealth Fund, a private, independent health care research organization, found that about 40 percent of adults nationwide who had high-deductible private insurance plans reported delaying care because of the cost.

In another, the Gallup Poll, which annually asks about health care cost and use every November, reported that the percentage of Americans who had insurance and chose not to go to a health care professional for a routine visit or a need because of cost hit an all-time high of 34 percent.

"Last year, many hoped that the opening of the government health care exchanges and the resulting increase in the number of Americans with health insurance would enable more people to seek medical treatment," Gallup said. "But, despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure."

The problem is easy to identify but difficult to solve. Health care is extremely expensive in the U.S., and to keep from busting their budgets, companies that provide coverage to their employees and families increasingly are turning to plans that keep monthly premiums lower by increasing deductibles and charging more for out-of-pocket costs, said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute.

"More and more of [the cost] is being put on the employee, and because of that, they're reluctant to get the care they need because they're concerned about the cost," she said.

Housing giants Fannie Mae and Freddie Mac on Monday released the final guidelines for low down payment mortgage loans, reviving a practice that critics say could eventually lead to defaults and another financial crisis.

Fannie and Freddie announced that eligible first-time homebuyers could now obtain mortgage loans with down payments as low as 3 percent. Both entities still purchase a majority of loans in the housing market and remain under government conservatorship after the 2008 crisis.

Fannie and Freddie, known as government-sponsored enterprises (GSEs), said that borrowers would have to clear several hurdles before they could take out the loan. Those include obtaining private mortgage insurance, providing income documentation and verification, and seeking homebuyer education and counseling.

Peter Wallison, fellow at the American Enterprise Institute (AEI) and former general counsel to the U.S. Treasury Department under President Ronald Reagan, said in an interview that the new loans could eventually inject more risk into the housing market.

Required premiums for mortgage insurance will raise the cost of homes, he argued, making them unaffordable for many buyers. Pressure will then mount to make the mortgages more accessible, and risky.

"When those loans do not really result in any significant numbers in increased low-income loans, they will reduce the underwriting standards further," he said.

"Eventually we'll be back in a situation a year from now in which many of these loans will look like the loans before the financial crisis," he added.

The low down payment loans could also be a political move to placate Democrats who have long pushed for looser lending standards to aid low-income borrowers, Wallison said.

Wallison noted that taxpayers will again foot the bill if Fannie and Freddie's mortgage loans default in large numbers. Treasury provided $188 billion to the GSEs in 2008 to keep them afloat.

"The only reason banks will make these loans is that they can sell them to Fannie and Freddie," he said. "Taxpayers are going to take the risk."

As the WSJ reports, far from paying for the privilege of holding other people's cash (and why would they with nearly $3 trillion in positive carry excess reserves sloshing around) US banks - primarily of the TBTF variety - "are urging some of their largest customers in the U.S. to take their cash elsewhere or be slapped with fees, citing new regulations that make it onerous for them to hold certain deposits."

The change upends one of the cornerstones of banking, in which deposits have been seen as one of the industry's most attractive forms of funding, said more than a dozen corporate officials, consultants and bank executives interviewed by The Wall Street Journal.

U.S. banking rules set to go into effect Jan. 1 compound the issue, especially for deposits that are viewed as less likely to stay at the bank through difficult times.

The new U.S. rules, designed to make bank balance sheets more resistant to the types of shocks that contributed to the 2008 financial crisis, will likely have little effect on retail deposits, insured up to $250,000 by federal deposit insurance. But the rules do affect larger deposits that often come from big corporations, smaller banks and big financial firms such as hedge funds. Hundreds of companies and other bank customers with deposits that exceed the insurance limits could be affected by the banks' actions.

Overall, about $4 trillion in deposits at banks in the U.S. were uninsured, covering more than 3.5 million accounts, according to Federal Deposit Insurance Corp. data

The rule primarily responsible involves the liquidity coverage ratio, overseen by the Federal Reserve and other banking regulators. The new measure, finalized in September, as well as some other recent global regulations, are designed to make banks safer by helping them manage sudden outflows of deposits in a crisis. The banks are required to maintain enough high-quality assets that could be converted into cash during a crisis to cover a projected flight of deposits over 30 days.

Because large, uninsured deposits would be expected to leave most quickly, the rule will now require that banks maintain reserves that they cannot use for profitable activities like making loans. That makes it much less efficient or profitable for banks to hold these deposits.

Some argue that while it is a good policy on its face, the rule potentially magnifies problems in a recession by encouraging banks to hoard high-quality assets, potentially paralyzing markets for these assets such as Treasury securities and some corporate bonds.

"This proposal, which is supposed to promote financial stability, actually does the opposite," said Thomas Quaadman, a vice president at the U.S. Chamber of Commerce.

A report summarizing a yearlong investigation by the legislative panel examining the George Washington Bridge lane closures found no evidence of Governor Christie's involvement but concluded that two of his allies acted "with perceived impunity" when they gridlocked Fort Lee's streets apparently for political reasons.

The committee's 136-page report, drawing off sworn testimony, private interviews and thousands of subpoenaed documents, also highlights the unsuccessful efforts by a now-shuttered arm of Christie's office to court the Fort Lee mayor's endorsement, finding that the closures were "motivated in part by political considerations."

The report states there is "no conclusive evidence" as to whether the governor "was or was not" aware of the lane closures or involved in directing them.

The governor's office released a statement late Thursday in response to the report from the attorney it hired to conduct its own investigation.

"The committee has finally acknowledged what we reported nine months ago — namely, that there is not a shred of evidence Governor Christie knew anything about the GWB lane realignment beforehand or that any current member of his staff was involved in that decision," attorney Randy Mastro said. "Thus, the committee's work has simply corroborated our comprehensive investigation. And with this inquiry behind it, the governor and his office can now focus on doing what they do best — serving the public interest."

We're no longer No. 1. Today we're No. 2. Yes, it's official. The Chinese economy just overtook the United States economy to become the largest in the world. For the first time since Ulysses S. Grant was president, America is no longer the leading economic power on the planet.

The International Monetary Fund recently released the latest numbers for the world economy. And when you measure national economic output in "real" terms of goods and services, China will this year produce $17.6 trillion — compared to $17.4 trillion for the U.S.A.

As recently as 2000, we produced nearly three times as much as the Chinese.

To put the numbers slightly differently, China now accounts for 16.5% of the global economy when measured in real purchasing power terms, compared to 16.3% for the U.S.

This latest economic earthquake follows the development last year when China surpassed the U.S. for the first time in terms of global trade.

These calculations are based on a well-established and widely used economic measure known as "purchasing power parity" (or PPP), which measures the actual output as opposed to fluctuations in foreign exchange rates. So a Starbucks Venti Frappucino served in Beijing counts the same as a Venti Frappucino served in Minneapolis, regardless of what happens to be going on among foreign exchange traders.

PPP is the real way of comparing economies. It is one reported by the IMF and was, for example, the one used by McKinsey & Co. consultants back in the 1990s when they undertook a study of economic productivity on behalf of the British government.

Make no mistake. This is a geopolitical earthquake with a high reading on the Richter scale. Throughout history, political and military power have always depended on economic power. Britain was the workshop of the world before she ruled the waves. And it was Britain's relative economic decline that preceded the collapse of her power.

And it was a similar story with previous hegemonic powers such as France and Spain.

Burwell acknowledged that affordability is still a high hurdle for many, however. Affordability, whether in the cost of the premium, the deductible, co-payments or co-insurance "is one of the fundamental issues" keeping people from getting health insurance, she said.

"We need to work on putting downward pressure on those costs," Burwell said.

Payroll records show the number of city school district employees making at least $125,000 has doubled over the past five years, an increase that comes as test scores for Paterson students remain among the lowest in the state.

At present, 66 Paterson Public Schools employees make at least $125,000, the records show. During the 2010-11 school year, the district had 33 employees above the $125,000 mark.

Most of the increase has occurred among central office administrators. In 2010-11, the district had 18 principals earning more than $125,000 and 15 non-principals, the records show. This year, there are 28 principals and 38 non-principals at or above the $125,000 mark.

In some instances, the increase stems from people who already were on the payroll and simply got raises or promotions, the records show. In other cases, the district created new high-salaried jobs.