There is a controversy brewing in New Jersey over a health insurance plan devised by Horizon Blue Cross/Blue Shield, the state's largest health insurer. Three former governors have come out against the plan, called Omnia; they give a good introduction to the controversy in this open letter to Gov. Christie:
Horizon Blue Cross Blue Shield of New Jersey, the state's largest insurer, has rolled out a new insurance product — the OMNIA Health Alliance — that threatens to erode the bedrock of New Jersey's health care marketplace at the eventual peril, we believe, of dozens of hospitals and tens of thousands of health care consumers in New Jersey, especially the uninsured and the under-insured.We urge you to examine OMNIA more closely and take swift and strong executive action.
The state of New Jersey has always provided oversight of its insurance industries to protect consumers, and there is no more important and universal consumer in this state than the one who seeks health care, because everyone at every stage of life is entitled to quality health care from the provider of their choice.Horizon's plan gives its insured members a monetary incentive to seek care at hospitals it considers more qualified than others based on non-transparent criteria it alone has selected and did not vet in any public forum.Regrettably, patient preference was never considered by Horizon. Nor did its "quality" ratings of hospitals square with the reality that many, if not most, hospitals to which it failed to grant favored status within its network are widely acknowledged as among the best in the state for clinical care.
Everyone get this? Horizon is advantaging hospitals that serve less needy patients, and that's restricting "choice." And it's doing so using a system of rating hospitals that is not transparent.Rather, in one fell swoop, New Jersey hospitals have been divided into "haves" and "have-nots." The "haves" are the state's largest health care systems and a small handful of independent hospitals chosen to fill in voids where those systems do not operate.The "have-nots" are the segregated hospitals, many of which rely on the reimbursement of private insurers like Horizon to offset the costs to treat our neediest patients, the indigent who rely on charity care or Medicaid.As a result, the viability of non-preferred hospitals is threatened and so, too, is consumer choice. [emphasis mine]
Pretty bad, right? In today's editorial, Moran and the SLEB seem to think so:
New Jersey's dominant health insurance company, Horizon, is facing growing opposition to its Omnia plan — and for good reason.The plan presents a threat to some of the state's best hospitals, especially those serving more than their share of poor patients. Catholic hospitals are at special risk.Horizon is doing all this behind closed doors. Worse, there is good reason to believe that the company is picking winners and losers based on its self-interest, rather than the public good it is expected to protect as a non-profit.
Here's the problem: It is closing this network to many of the state's best hospitals.It is scoring them in secret, and refusing to release those findings. The losing hospitals are placed in Tier 2, where patients will not receive the same discounts.It's not hard to see how this will play out: Patients will flock to Tier 1 hospitals, drain huge streams of revenue from Tier 2 hospitals. Some of them will likely close, and most will be forced to scale back on charitable services, according to several hospital executives and legislators.You might think Horizon would pick the best hospitals for its Tier 1 network. But the opposite seems to be true. On average, Tier 2 hospitals are ranked higher than Tier 1 by the Leapfrog Group, which produces the most respected national rankings. [emphasis mine]
The SLEB is shocked -- shocked, I say! -- that Horizon would create incentives to drive customers to favored hospitals that do not have a record of performing any better than others that will likely close when they are denied funding. The SLEB finds it "reckless"* that the system by which Horizon determines a hospital's efficiency is not subject to transparency. They find it completely unfair that hospitals that serve the most disadvantaged patients will suffer because funds will be diverted to preferred hospitals -- again, which have not been shown to do a better job treating patients.
(Regular readers know what's coming next...)
Why, then, don't Tom Moran and the charter-loving Star-Ledger Editorial Board find it "reckless" to promote a system of urban schooling that drives students toward charter schools, which are "held harmless" in funding but have never been shown to perform better on average and are judged by evaluation systems that are not transparent and contradicted by the state's own data?
The SLEB is terribly concerned that hospitals which serve the neediest patients are going to be closed. Why don't they care, then, that New Jersey's charters are not enrolling equivalent populations of special education, Limited English Proficient, and free lunch-eligible students?
The charter schools in Newark and elsewhere have been "held harmless" from funding cuts that have devastated public district schools -- again, even as they enroll less needy students. This year, Christie is going to pitch in more in state aid to those districts, but that aid will flow straight to the charters: public district schools will continue to be grossly underfunded. Where is the SLEB's concern over this if they care so much about unequal incentives for hospitals?
The NJDOE rates schools in a way that punishes schools that serve students with greater needs. Newark (and Camden -- more soon) rated its schools as part of its One Newark plan, but the ratings were clearly biased against schools that enroll more black, special needs, and free lunch-eligible students. Why doesn't the SLEB care about this if they care about hospitals getting biased ratings because of who they treat?
The answer is obvious: Tom Moran and his Editorial Board have made up their minds thanks to a constant stream of propaganda foisted on them by the New Jersey charter industry. They are so enthralled by the easily digestible talking points fed to them that they can't even see the screaming contradictions between their stance on charters and their stance on Omnia.
Once again: I am not against charter schools per se. There is a way to offer "choice" that does not create problems for public district schools. But when chartering is done improperly -- as it is in New Jersey and so many other places -- it fosters segregated schools with redundant systems of governance that promote bad behaviors.
If the Star-Ledger's Editorial Board could get its head out of the sand, it might come to understand this.
"Charter school problems? What are those?"
* In the headline.