Wednesday, September 16, 2015

Dixie Chicken, Cheap Gas & Horizon's Exclusionary Health Care Alliance

Current lineup of Little Feat - still rockin' after 46 years
After I posted my last blog about newly-famous NYPD cop James Frascatore last Friday afternoon, I jumped in the shower and drove straight into Princeton for a Mexican-themed BBQ at my friend Geoff's house that turned out to be a rather festive gathering of old friends from high school (and three of their kids).

The next morning was a working Saturday for me so I was up early to get to the office before leaving at 1pm to drive up to Port Chester, New York to see Little Feat in concert at the Capitol Theater at 8pm with some friends.

Great venue, really intimate and a super relaxed place to see live music.

Oh, get this. After my complaining about feeling "Trumped Out" on this blog two weeks ago after seeing "The Donald's" face on The Hollywood Reporter, when I arrived home earlier than expected on Sunday the day after the concert and found my latest issue of Rolling Stone in the mailbox - guess whose scowling face was on the cover?

My frown quickly turned to a smile when I saw that a brief letter I wrote to the editor last week about a Q&A interview with Wilco lead singer Jeff Tweedy had been published in Rolling Stone's "Correspondence" section. (My name is Mark and I'm from Hamilton, NJ should you wish to check it out)

Writing letters to various editors has been a hobby of mine for years, I've had letters published in The New York Times, The New York Post and many other papers and magazines - Rolling Stone was on my personal bucket list so that really helped my hangover on Sunday.

Anyway, the mileage I racked up on my Honda SUV during my travels last week is made less painful by the fact that the price for regular unleaded at my local gas station is now about $2 a gallon; which is just about as low as it gets for gas in the United States according to the latest figures from the AAA Daily Fuel Gauge Report.

What is it with New Jersey? We have some of the cheapest gas in the nation, but we also have some of the highest property taxes and state taxes - and few states pay higher health care costs than we do in the Garden State. 

Horizon Blue Cross Blue Shield CEO Robert Marino
Now on the surface, one might think the September 10th announcement that the state's largest health care insurance provider, Horizon Blue Cross Blue Shield of New Jersey had formed the "OMNIA Health Alliance" in an effort to lower out-of-pocket costs for consumers would be a positive thing for average folks, right?

Horizon CEO Robert Marino (pictured left) certainly thinks so.

The Alliance is a partnership with 34 of the state's largest hospitals (and physicians affiliated with those hospitals) that seeks to channel higher patient volume to the selected hospitals in return for their agreeing to lower reduced levels of reimbursement for procedures and other patient services from Horizon.

According to Horizon, the hospitals in this new alliance would also have an incentive to provide better patient care because Horizon would then pay higher reimbursement costs to those hospitals and physicians. As's Kathleen O'Brien reported last week:  

"Under this new alliance, participating hospitals and physicians will be rewarded for quality care that results in speedy recovery. OMNIA will also emphasize preventive care that heads off health problems before they snowball into crises."

But according to an article by reporter Susan Livio posted on on Saturday, the only problem is that this alliance of 34 hospitals has excluded the largest inner city hospitals in Trenton and Camden.

The largest hospitals included in the alliance were given a "tier one" rating by Horizon, while the 38 hospitals left out of the alliance were designated "tier two" hospitals.

With the State House, NJ Motor Vehicle Commission's main office, Social Security Administration, New Jersey utility provider PSE&G and US Postal Service all located in Trenton, the state (and the federal government) are now the largest employers in the Trenton area.

This new alliance potentially sets up a scenario where large numbers of patients concentrated in urban areas with high populations of poor and working class African-Americans, Hispanics and other ethnic minorities would face significantly higher costs for out-of-pocket health care expenses.

For example an insured state employee in the Trenton area enrolled in the new Horizon alliance would pay a $1,500 deductible is they visited any of the "tier two" hospitals in Trenton; but they would pay no deductible if they went to a "tier one" hospital.

But since there are no "tier one" hospitals in Trenton, state employees face a choice of higher health care costs, or increased costs in time, money and convenience to travel to a "tier one" hospital.

So why did Horizon leave hospitals in Trenton, Camden and Burlington County off the list?

St. Francis Hospital in Trenton, NJ
The hospitals designated "tier two" in Trenton might not be the largest hospitals in the state, but they are not slouch hospitals by any means.

Right now there is a rapidly growing number of people wondering why the state capital does not have at least one "tier one" hospital to serve the city's needs.

As people in this area know, both Trinity Health and St. Francis Hospital in Trenton (pictured left) have excellent reputations for quality of service and customer satisfaction.

As does Our Lady of Lourdes Hospital in Camden.

But even though Horizon CEO Robert Marino has been actively lobbying the state legislature to change out-of-network regulations since at least last March, the political backlash to the unveiling of Horizon's alliance has been swift.  

The Burlington County Times' David Levinsky reports that Assemblyman Herb Conaway has expressed concern that none of the three major hospitals in Burlington County made the list of "tier one" hospitals. According to Conaway, the only practicing doctor in the NJ state legislature:

"The No. 1 reason people miss (doctors' appointments) is because they can't get to them," he said. "You're now saying to people already economically marginalized that they need to pony up cab or bus fare to get to a more distant health care facility. It could mean remarkably reduced care."

Trenton Mayor Eric Jackson
Trenton Mayor Eric Jackson (pictured left) has requested meetings with state officials to determine how all Trenton hospitals were excluded from the "tier one" ranking by Horizon.

Democratic Assembly members Reed Gusciora and Elizabeth Muoio of Mercer County both issued a joint statement stating in part:

"Ultimately, the decision to leave our capital city and its residents without a Tier One provider jeopardizes Trenton's access to quality healthcare at more affordable rates. Horizon's actions threaten to create a gaping void in affordable coverage for those who most need it." 

Affordable and quality health care is also a marker of a civilized and evolving society.

The lengthy national debates and passionate discussions that accompanied the passage of the Affordable Health Care Act during President Obama's first term made one thing clear: the vast and overwhelming majority of Americans support comprehensive health care for all citizens. Period.

"All citizens" doesn't mean a large health care insurance provider should be able to use it's market share and influence over the state legislature and the health care industry to decide which citizens in which parts of any state will have access to health care discounts intended to drive down overall health care costs to hospitals, insurers and consumers.

My guess is that consumer backlash on this issue is going to heat up pretty quickly.

If Horizon CEO Robert Marino says this hospital alliance is an effort to drive down health care costs in the state of New Jersey, I don't disbelieve him - or doubt that his intentions are true.

But regardless, someone who sat at the table when Horizon laid out this list of "tier one" hospitals as part of this new "OMNIA Health Alliance", should have raised their hand and pointed out the fact that there were no "tier one" hospitals located in two of the state's largest urban areas.

Given the challenges Trenton and Camden have faced over the years, at the least you'd think one of the high-powered health insurance executives who drew up this alliance would've recognized that making the alliance accessible to all New Jersey citizens should have been a cornerstone of getting buy-in from the public, consumer advocates, health care experts and politicians.

Instead they've crafted a policy of health care discounts for consumers that are essentially, exclusionary - and they haven't explained why.

Someone in that room should have told Robert Marino the alliance of "tier one" hospitals needed to be expanded to at least 37 - so that Trenton, Camden and Burlington County were not ostensibly labeled "tier two" communities and were not placed at risk at having the existing hospitals they DO have close because Horizon's alliance plan causes a bleed-off of customers.

Horizon's proposal may lower health care costs, they're not actually releasing specific cost details until next month, but one thing is clear; it appears to have created a two-tier health care system in New Jersey with one set of pricing discounts for some and inconvenience and higher costs for others.

There's a lot of folks in New Jersey, myself included, who'd much rather pay a little more for gasoline if it means more equitable quality of health care for all.

And we wonder why we pay some of the highest costs for health care in the nation; Horizon's alliance proposal offers insight and shows those cost aren't restricted to just money.

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