HEALTH

Horizon Absent as Omnia Health Plan Goes Before Joint Assembly Committees

By Michael Aron
Chief Political Correspondent

The signs were up and the lobbyists were out as the opponents of Horizon Blue Cross Blue Shield’s Omnia Health Alliance made their case before two combined Assembly committees.

The Omnia plan provides discounts at 36 hospitals designated tier one, and excludes 33 hospitals designated tier two. The state Department of Banking and Insurance on Monday upheld the plan for a second time.

Attorney Steven Goldman, a former commissioner of banking and insurance under Governor Corzine, is taking that decision to an appeals court on behalf of 17 excluded, or tier two hospitals.

“The goal of having lower cost health care is the appropriate goal. The issue here is not a quarrel over the goal. The issue here is the fairness in the mechanics that were used to attempt to implement the goal,” Goldman said.

The opponents say the process lacked transparency. Horizon, they say, made “secret deals” with mainly large suburban hospital groups, excluding inner city, rural and all but one of the state’s Catholic hospitals. They say patients at those hospitals will either have to travel to tier one facilities or stay close to home, but pay more in premiums and co-pays.

“I often wonder with everything going on in this country today about discrimination, why is this not an issue of discrimination when a group of people who clearly don’t look like the residents they serve get to decide who’s the tier one and tier two hospital,” Elizabeth Mayor Chris Bollwage said.

“Nobody wants to sign up for tier two. We all want to be tier one, because the psychology consequence is if I go to a tier two hospital, I’m going get tier two care,” said Trenton Mayor Eric Jackson.

Horizon executives defended their plan at a Senate hearing in October, but stayed away today, as did the Department of Banking and Insurance, known as DOBI.

“The disappointment I’m expressing is that both DOBI and Horizon Blue Cross Blue Shied have declined our invitation to come,” said Assemblyman Reed Gusciora.

Horizon did not respond to repeated requests for comment, but it was pointed out at the hearing that the issue is in litigation. Legislators of both parties have serious concerns about the plan.

“I think it needs to be redone. I think the process for determining the tiering needs to be open, it needs to be transparent,” said Herb Conaway, chair of the Health and Senior Services Committee.

“Now they’ve said hospital A is tier one and hospital B is not. It creates a caste system within health care,” said Assemblywoman Nancy Munoz.

The Legislature has no authority to block the Omnia Health plan. It’s scheduled to go into effect Jan. 1. It’s in the hands of an appeals court now. Experts say tiered health networks are here to stay because they lower costs, so New Jersey better get used to them.