State: OMNIA health alliance can move forward

TRENTON, N.J. (AP) — The Christie administration denied a hospital group's appeal seeking to halt a new alliance formed by New Jersey's largest health insurer.

The denial means Horizon Blue Cross Blue Shield's OMNIA network will not be shuttered for now, though the roughly dozen hospitals seeking to block the alliance are promising further appeals.

Halting the alliance now, as consumers already have begun to buy plans for 2016, would cause "upheaval and disruption" in the state's health insurance marketplace, according to acting Banking and Insurance Commissioner Richard Badolato.

"While it is unclear what, if any, harm would be experienced by the Hospital Group as they have only advanced speculative scenarios, it is clear that granting a stay and removing the Department's approval of the OMNIA Network would cause significant upheaval and disruption to the New Jersey marketplace and its consumers," Badolato wrote Monday in the 40-page reply.

The hospitals seeking an appeal include Capital Health, Virtua Health and Trinitas Regional Medical Center, among others.

Plans with effective dates of Jan. 1, 2016, within the network are already being sold on the federally facilitated marketplace and directly by Horizon off the marketplace, Badolato said, as well as to small employers.

"Staying the sale and effective date of these plans would immediately trigger chaos," he said.

Steven Goldman, an attorney for the hospitals, said the group will seek a further appeal.

"(The) decision by DOBI is disappointing but not surprising," he said.

At issue is Horizon Blue Cross Blue Shield's OMNIA plan, which uses a tiered network and is touted as a money-saving way to cover health care.

Under the plan, patients will have low or no copays or deductibles for using preferred hospitals and higher expenses for using others.

The appealing hospitals worry the alliance demotes them to Tier 2, and Tier 1 hospitals will likely get more patients because of lower costs.

Horizon 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 uninsured to sign up.

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