Thanks to Republican administrations in Trenton and in Washington, the New Jersey administration that will replace Chris Christie will be facing giant problems in the provision of healthcare to the state’s low- and middle-income residents.

A full fifth of the state’s residents, including 800,000 of its children and half a million adults who qualified under the Affordable Care Act, rely on Medicaid, the government-funded health program, for their medical coverage.

But problems with healthcare delivery in the state, and the GOP-dominated Congress’s planned repeal of the ACA, threaten their access to care.

The New Jersey Health Care Quality Institute recently released a report recommending changes to Medicaid delivery that it said would both cut unneeded costs to the program, which comprises a full 20 percent of the state’s budget, while improving services. These include, for example, consolidating a patient’s mental and physical health care and using telecare services.

Another recommendation, however, points out the complexity of trying to cut costs and improve care under the onus of GOP control: The report noted that pregnancy and childbirth care accounts for $1 billion of the Medicaid budget each year, accounting for 42 percent of all births in the state and including a large number of C-sections and extended NICU stays that could be reduced with better prenatal care.

The GOP’s new national legislation, however, cuts funds from Planned Parenthood and other clinics where the low-income women most at risk seek prenatal care if those clinics also provide safe, legal abortions, and in fact denies funds to any insurance plan that includes safe, legal abortions, greatly reducing their access to care.

Additionally, the GOP Congress wants to provide funding for Medicaid to the states in block grants, leaving New Jersey to make up the (sure to be considerable) shortfall itself, and to make it harder for people who are not continually on Medicaid (for example, those who get a decent paying job to get off welfare but then lose that job) to get back into the program.

New Jersey pays more into the federal government than it gets back, and it has an affluent enough resident base to mitigate some of the worst effects of punitive federal legislation, but it will take a progressive, Democratic administration with the population’s health as a priority to ensure that happens.