Health care groups eager to make voices heard

By Anjalee Khemlani
Trenton | Jan 11, 2018 at 3:34 pm

Health care groups aiming to get their goals and objectives in front of the incoming gubernatorial administration have been increasingly vocal about initiatives the state should focus on to improve health care cost and access.

Better Care Better Choices New Jersey, a consumer-focused coalition funded by the state’s largest health insurer, laid out 15 points that could help improve health care in the state, according to the November 2017 report.

This includes, even before the repeal of the Affordable Care Act’s individual mandate, encouraging greater participation by the state’s residents in the health insurance pools. The idea follows a basic concept of the insurance industry: the greater participation overall in the risk pool, the lower the cost of premiums.

The group anticipated some action by the federal government.

“Should Congress pass and the president sign a repeal of the ACA and replace it with a law that does not include the individual mandate, or, should the administration continue a policy of not enforcing the mandate, the state of New Jersey should create its own mandate or work on ways to incentivize the business community to fill that void. As noted above, a properly thought out coverage mandate would draw healthy individuals into the health insurance system, thereby driving down costs for all, increasing access to care and improving health outcomes for all New Jerseyans. Before a mandate is implemented, however, an impact study should be conducted to see what such a mandate would do to small businesses. If a negative impact is found, ways to alleviate that impact should be discussed and, based on feasibility, implemented,” the report said.

Another move by the federal government, encouraging association health plans, could see a growth in self-funded plans by small employers looking to find ways to control costs. But that comes without protections.

“State law should be revised to prohibit and eliminate self-funded arrangements in the small employer market. This, in turn, will reduce costs for small business owners and their employees. Reforms, however, should ensure that small employers’ ability to join a MEWA or other alternative health insurance coverage model would not be impeded,” according to the report.

The report also focused on transparency of costs, to end costly surprise billing, and changing the way the medical board oversees disputes of cost.

In response to these and other recommendations by BCBCNJ, which focused on insurance and regulations, another group, Access to Care Coalition, responded with a focus on the health care providers.

Access to Care is comprised of groups representing physicians and other providers.

“Regarding the recommendation requiring insurance network participation, there is … a shallow understanding of the way physicians are paid. They rely on third-party payers to keep their practices open for patients, whether in network or out. In hospitals, physicians treat and heal patients regardless of insurance status. However, they must make decisions based on patient demographics and other criteria, including private practice costs, when deciding which networks to join. There are hundreds of plans, but not all allow physicians to cover their costs. In fact, physicians are getting kicked out of contracts as insurers focus more and more on cost over quality, using narrow and tiered networks. Contract negotiation is only getting harder for physicians, resulting in decreased patient access,” the ATCC report said.  “A government forcing a physician to sign a contract with any insurance company is a restraint of trade. Further, it will jeopardize access to care.”

On the issue of the medical board and how it is regulated, ATCC said: “This issue is sorely misstated, as if regulatory bodies in New Jersey are without oversight or are inherently self-serving. First, the example provided, the Board of Medical Examiners, in fact has three seats for public members. Most boards deliberately include this kind of diversity. The issue with most boards is actually getting seats filled; we need administrations to make appointments.”

With a change in legislative leadership and a new administration in the state, it remains to be seen how long it takes before Trenton refocuses on health care issues.

Anjalee Khemlani | | AnjKhem