Democratic State Assembly members are calling on the state Department of Banking and Insurance Commission to place a hold on the new venture
TRENTON -- Democratic State Assembly members are calling on the state Department of Banking and Insurance Commission to place a hold on a new venture by the state's largest insurer that excludes the capital city's two hospitals from premier insurance coverage.
Exterior of the Bristol-Myers Squibb Regional Trauma Center at Capital Health Regional Medical Center in Trenton, New Jersey. Horizon Blue Cross Blue Shield of New Jersey announced last week that it plans to offer new lower-priced insurance policies that offer discounts for care provided at 34 selected hospitals.
"This is where an insurance company has decided who are the winners and the losers and who will survive and who will die," Assemblyman Reed Gusciora. "I think this is too critical of a step in health care not to have a public airing."
Gusciora and Assemblywoman Elizabeth Muoio (both D-Mercer) were joined by Trenton Mayor Eric Jackson, Mercer County Executive Brian Hughes and hospital executives Thursday to express their concerns about the process and possible repercussions that the plan might have on residents.
MORE: Hospitals excluded from Horizon's proposal worry about future
A Horizon spokesman said the OMNIA Health Alliance was created to meet demands for more choices and more affordable health plans with access to quality care.
"Our customers have made it clear that the status quo, fee-for-service system of rising health care costs is unsustainable," spokesman Thomas Rubino said.
Customers with the new health plans will be able to get care at any of Horizon's network hospitals and doctors, but those who go to tier-one providers will pay lower out-of-pocket costs than those who go to tier-two providers like Capital Health and St. Francis Medical Center.
The lawmakers said that the residents who rely on the city's two hospitals will be left to pay higher premiums or deductibles.
It also leaves them without a tier-one hospital that provides critical maternity and cardiac care.
"The result will be the opposite of what appears to be the intention of this new plan, which is to try to encourage preventative, quality, low-cost health care," Muoio said. "By putting up barriers that make it less accessible, you'll discourage people from actually seeking out preventative care in the front end."
Muoio said many city residents depend on mass transit, but the closest tier-one hospitals will be Robert Wood Johnson University Hospital Hamilton, University Medical Center of Princeton at Plainsboro or Hunterdon Medical Center.
"Our most vulnerable residents will be unable to access the more affordable network of care that OMNIA promises unless they can travel to the hospitals and doctors in the suburbs," state Sen. Shirley Turner (D-Mercer) said in a statement. "Those without transportation or the funds to pay higher co-pays, deductibles, premiums and out-of-pocket expenses are more likely to forgo care, even when they need it."
Vince Costantino, St. Francis' chief administrative officer, said residents will be faced with a dilemma: travel longer distances or pay more out-of-pocket costs.
"All Horizon members, no matter where they live, deserve the right to choose where they receive care and by whom," he said. "Instead, Horizon has inconvenienced its members and left them with no choice."
Costantino said Horizon's decision left hospital staff members scratching their heads. Earlier this year, St. Francis was recognized by Horizon as a high-performing hospital only to be shut out months later from the alliance and tier-one group.
"St. Francis is more than a hospital," he said. "We're a safety net for our community."
The officials also took issue with the lack of transparency and the process by which the hospitals were chosen.
"The question is now what criteria was used to pick these hospitals," said Al Maghazehe, CEO and president of Capital Health. "If you're worried about patients and not anything else, access is your number one priority."
Hughes said there are too many unanswered questions.
"Let's figure out why these alliances have been put together, how these levels and tiers have been placed together and come up with a reasonable way to have the city of Trenton represented in the tier-one hospitals as they certainly should be," he said.
The letter being sent to DOBI's Acting Commissioner Richard Badolato asks for a review to see whether the process was equitable to all stakeholders; thoroughly evaluated the impact of implementing a narrow network of tiered providers; considered the effect on access to affordable, quality care; and analyzed the short- and long-term consequences of the excluded hospitals.
Officials worry that Horizon's decision could threaten the financial stability of the city's hospitals.
"The direction of health care reform that restricts care and services to a limited number of hospitals and doctors makes it impossible for the field to remain competitive," Turner said. "Hospitals like Capital Health and St. Francis Medical Center will be forced to close, further restricting access to care and putting thousands of employees out of work."
Editor's Note: This story was updated to include comments from Horizon.
Cristina Rojas may be reached at crojas@njadvancemedia.com. Follow her on Twitter @CristinaRojasTT. Find The Times of Trenton on Facebook.
