Lawmakers Grill Horizon Execs on Insurance Plan

Joe Vitale

Joe Vitale

Lawmakers today expressed misgivings about Horizon New Jersey’s proposed insurance plan, applauding efforts by the carrier to reduce costs in a state with the second most expensive healthcare in the country, but finally unconvinced that the plan’s implementation would uniformly positively impact all New Jersey hospitals.

Horizon’s OMNIA Alliance consists in part of 14 hospitals designated as “tier one,” facilities that agreed to accept lower reimbursement in exchange for higher patient volume. But 36 other hospitals around the state worry about being relegated to second class citizen status, to paraphrase state Senator Diane Allen (R-7).

“I continue to have the concern about winners and losers,” Allen said. “Call them blue and green instead of one and two.

“I need to have a tier one hospital in Burlington County,” she added.

Marino

Marino

Horzion fought back.

“We don’t believe any of our network hospitals and ‎doctors are second class; all provide quality care for our 3.8 million members and all remain in our networks, whether a member has our standard  or new OMNIA health plans,” spokesman Thomas Vincz said in an emailed statement.

In the hearing, Allen told Robert Marino of Horizon that the insurance provider needs to correct the impression that tier two hospitals would be at a disadvantage.

“I have some very serious concerns,” state Senator Ray Lesniak (D-20) added. “It’s pretty apparent your definition of value is pretty discriminatory.”

State Senator Bob Gordon (D-38) said, “I’m very concerned about the way this process unfolded and the lack of transparency. A lot of us are hearing from hospitals that did not meet tier 1.” The senator noted what he feared was “reputational damage done to hospitals that did not meet tier one lists.”

Conlin

Conlin

Kevin Conlin of Horizon told lawmakers that 40,000 New Jerseyans who today do not have coverage will be able to afford coverage through the exchange as a result of the proposed changes. “We believe that this is a significant step forward in addressing affordability for working families,” Conlin said.

While joining his colleagues with concerns, state Senator Jim Whelan (D-2) was generally positive about the plan.  “We shouldn’t gloss over the fact that there are cost savings. If you can save them 15%, it’s certainly something that should be part of the discussion,” Whelan said.

Midway into the hearing, Sister Patrica Codey President of Catholic HealthCare Partnership of New Jersey, slammed Horizon’s plan in a statement.

“The statements made at today’s hearing further prove that Horizon’s OMNIA plan will severely burden Tier 2 hospitals and by extension New Jersey taxpayers by unfairly labeling them as second-rate facilities,” Codey said. “Despite repeated requests from the Legislature, Horizon has yet to disclose the criteria for its new network or any justification for excluding nearly 90% of Catholic hospitals, not to mention so many others.”

Worried about the lack of access to tier one hospitals by urban residents, state Senator Ronald Rice (D-28) doubled down during his time at the microphone.

“There’s no tier one in Trenton,” said Rice. “I’m starting to get pissed and angry.”

Marino shot back demographics he said proved the presence of tier one coverage to urban residents. “We are being responsive to the consumer segment,” he told Rice.

 

Lawmakers Grill Horizon Execs on Insurance Plan