New Jersey senators ask FTC to delay health care alliance

Two New Jersey senators are asking the Federal Trade Commission to delay the state's biggest health insurer from rolling out a new tiered health care system.

Democrats Nia Gill and Joseph Vitale, who chairs the state Senate health committee, wrote to FTC chair Edith Ramirez on Friday, seeking the commission's intervention as Horizon Blue Cross Blue Shield sets up its new system, the OMNIA Alliance.

The senators want an oversight mechanism established.

Their letter is their second attempt this week to halt the alliance. Previously, they asked acting Attorney General John Hoffman to investigate the alliance. But Hoffman recused himself because of his father's affiliation with Robert Wood Johnson health system, according to spokesman Leland Moore.

"It is our firm belief that oversight of the OMNIA Alliance and all tiered plans will ensure fairness, transparency and consistency," the senators wrote.

FTC spokeswoman Betsy Lordan said Friday the letter had not yet been received. She had no comment on the senators' request. Horizon spokesman Thomas Vincz said in a statement that the company is committed to complying with regulations and laws and has done so.

"Horizon carefully complied with laws and regulations in structuring the OMNIA Health Alliance and developing its new products and engaged external experts to ensure such compliance," he said.

All the details of Horizon's new plan have not been released. The company says that under the federal Affordable Health Care Act it can't make the specifics public until later this month.

In the system, patients would have low or no copays or deductibles for using preferred hospitals, or they would have higher out-of-pocket expenses for using other ones.

The insurer says the change will save money. Critics worry the plans could hurt some patients and hospitals.

Horizon says the average premium will be about 15 percent lower than current plans it offers and copays and deductibles will also be lower. The company says that factoring in premiums and out-of-pocket costs, patients would at worst have the same health care costs as they do now if they use non-preferred hospitals.

The insurer expects 250,000 people to be enrolled next year through their employers, by buying coverage on their own, or by choosing a plan on the federally run insurance exchange. State government is among the employers offering the Horizon Blue Cross plans; the public school employees benefit system is not.

Horizon says it anticipates 40,000 people who are currently not insured at all to sign up.

Others worry half the state's hospitals could be in bad shape if they lose patients and funding after being designated as "Tier 2" facilities.

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