There are about 1.3 million people in NJ without health insurance - people who forgo needed doctor visits, can not afford medicines, avoid surgery, receive short term help in emergency rooms, and die earlier than those insured. One would think that such a large group would have a significant voice in NJ's approach to the Affordable Care Act (ACA). Alas!... no way. There is the Republican approach which is to "repeal and replace Obamacare" and the Democratic approach which is to implement a NJ health exchange with consumer friendly rules and participate in Medicaid expansion.