TRENTON — Senate President Steve Sweeney (D-3) will testify in favor of Horizon OMNIA’s tiered health insurance plans Monday at the Senate Commerce Committee. The plans, which Horizon rolled out last fall, designate hospitals and individual practices as ‘Tier One’ or ‘Tier Two,’ a cost-cutting measure that has lead to some patients having to switch providers to avoid higher premiums and co-pays.
Following questions about the criteria for inclusion in the first tier from the legislature, Senators Nia Gill (D-34) and Joe Vitale (D-19) called on the Attorney General to establish “a permanent oversight mechanism for the process for tiering and rating health care providers in New Jersey” and sought to halt the rollout of the new plans. The Attorney General found that Horizon had not violated any state laws in the structuring of the new plans.
Arguing against a patient volume-based standard, Sweeney is expected to argue for transparency between Horizon and the state on those criteria, thorough reporting of hospital profitability and clear communication of the cost of care for patients.
“I support requiring insurance companies to disclose the criteria they use in developing tiered products,” Sweeney wrote in the remarks he is expected to deliver this afternoon. “I also support requiring insurance companies to fully educate consumers about their cost share obligations. I don’t believe this type of transparency will hurt any current products, increase cost, or threaten consumer choice.
“[We] can no longer afford a health care system that rewards the number of patients who enter a hospital or doctors’ office — almost like a sports team is rewarded for bringing fans into the stadium. The idea is to keep patients out of the hospital, not to bring them in.
The hearing addressing the controversial new plans from New Jersey’s largest insurer will be at 1:00PM today at the state house, in Committee Room 6. Sweeney’s full remarks are here.
Calling the Sweeney’s testimony “a test for certain groups to practice what they preach,” Horizon issued a statement praising the Senate president for his emphasis on transparency.
“Horizon has been more transparent than any insurer about the criteria we used to establish our tiered network and support his call for transparency in the criteria insurers use when creating tiers,” read the statement. “We also support his call for legislation to require that insurance companies fully educate consumers about their cost share obligations.”