NJ State Senate to Hold Hearing Examining Horizon Blue Cross Blue Shield

Steve Sweeney. Kevin B. Sanders for Observer

Two New Jersey state Senate committees –the Senate Health, Human Services and Senior Citizens Committee and the Senate Commerce Committee– will hold a joint hearing in early 2018 to examine insurance products offered by Horizon Blue Cross Blue Shield of New Jersey, the health insurer that was at the center of the 2017 budget standoff that shut New Jersey government down over Fourth of July weekend.

The hearing will specifically examine Horizon’s OMNIA tiered network plan and recent changes to the insurance company’s Medicare Advantage plan, programs that critics say limit access to care for consumers by forcing them to visit doctors and facilities classified as “Tier 1” or pay more to visit other health providers. OMNIA was introduced to consumers by Horizon –New Jersey’s largest health insurer– in 2015. At the time, many hospitals protested the move, claiming that Horizon would drive services away from facilities classified as “Tier 2″ where premiums and deductibles would be higher. But Horizon said that the plan would lower out-of-pocket costs for many consumers.

Saint Peter’s University Hospital filed a motion against Horizon earlier this month, part of an ongoing legal battle relating to OMNIA. The new motion claims that the health insurer excluded the hospital from the new Medicare Blue Advantage Plan in 2018, something the hospital claims is a breach of contract.

In a Friday announcement, Senate President Steve Sweeney (D-Gloucester) said that the upcoming hearing would determine how OMNIA impacted the health insurance marketplace in New Jersey. He said that Horizon’s leadership is invited to testify during the hearing on the plan. The last hearing on the issue was held about two years ago, before the plan was made available to the public.

“Members of the Senate continue to receive frequent inquiries from constituents and health care providers concerning these products,” Sweeney said in a statement. “New Jersey residents are continuing to have their choice of health-care provider limited. Our health care providers are continuing to be reimbursed less for the outstanding care they give, yet the premiums that insurance companies impose and the profits they make both continue to rise. To be clear, these issues are complex, which is why a public hearing is necessary and appropriate.”

Tom Wilson, Horizon’s director of public affairs, said that the health insurer is “confident” that the goals of the Legislature align with Horizon’s goals.

“As Washington continues to dismantle the Affordable Care Act increasing uncertainty and raising the cost of insurance, Horizon is confident that the legislature shares our priority of putting the needs of consumers, particularly seniors, first,” Wilson said in a statement.

No official date for the hearing has been announced but it will be held after the next legislative session starts on Jan. 9, 2018.

The OMNIA and Medicare Advantage plans are unrelated to Gov. Chris Christie’s summer initiative to raid Horizon’s reserve in order to fund his efforts to combat the opioid epidemic in New Jersey.

NJ State Senate to Hold Hearing Examining Horizon Blue Cross Blue Shield