Following a meeting with Department of Banking and Insurance (DOBI) officials, 15th district legislators - Assemblyman Reed Gusciora, Assemblywoman Liz Muoio and Senator Shirley K. Turner - on Friday called on Gov. Christie to intervene to ensure that Horizon Blue Cross Blue Shield's new OMNIA Health Alliance plan does not do irreparable harm to capital city residents and its two hospitals.
Horizon recently announced that it was forging a "tier one" partnership with only 22 hospitals throughout the state to offer lower out-of-pocket costs, which will essentially increase costs for patients who visit more than half of New Jersey's hospitals that have been excluded from the plan, including both Trenton hospitals - Capital Health and St. Francis.
The lawmakers (all D-Mercer/Hunterdon) met with DOBI Commissioner Richard Badolato and other administration officials earlier this week to discuss their concerns over the impact the new plan will have on Trenton area residents.
They noted that under state regulations, the commissioner of DOBI is given authority to license and regulate a Health Service Corporation and that in doing so "the issuance of the certificate of authority would not be contrary to the public interest." State regulations also stipulate that an insurance carrier "shall maintain an adequate network."
During the meeting, administration officials claimed the plan is fine under the state's "adequacy rule." However, the lawmakers pointed out that the rule is vague and doesn't define what adequacy is, thereby granting DOBI wide discretion to determine if it's both adequate and in the public's interest, two major clauses that they believe are not being met by Horizon's new plan.
"The state shouldn't stand idly by while an insurance company dictates public policy in New Jersey," said Gusciora. "This plan clearly favors an elite group of hospitals while threatening to run others out of business. If I were in charge of this administration I would not want to be responsible for presiding over the closure of the capital city's hospitals."
"State intervention to review all aspects of the new plan is needed," said Muoio. "Let's be clear, Horizon has made some calculated decisions that will disproportionally affect urban areas. If there was ever a circumstance for the state to use its full authority to review the impact of a multi-billion dollar insurer, this is it."
"DOBI took a narrow interpretation of what their role is and it's disappointing that they're going to sit on their hands when they have the ability to act to protect what's in the public's best interests," said Turner. "While this plan may benefit certain parts of the state, it will do irreparable harm to capital city residents and many others."
The lawmakers are now calling on Gov. Christie to intervene to protect Trenton area residents and ensure that both capital city hospitals don't teeter towards insolvency because of this plan. Additionally, the lawmakers are meeting with Horizon officials next week to request that they yield the plan until further review of the criteria used to select participating hospitals.