Health Benefits Report
Having been involved in the PBA for the entirety of my adult life, one of the most dangerous times of a legislative cycle is the lame-duck period. This is the time at the end of a term when legislators who will not be serving in the next legislature try to push through bills that are part of their agenda. I remember Mr. Laird teaching us about it in high school, but generally the public doesn’t know how crazy that period can be.
This year, while NJSPBA President Pat Colligan, Executive Vice President Marc Kovar and Director of Government Affairs Rob Nixon were working to make sure that we were not harmed by any of this fast-moving legislation, I noticed something. I was prompted to reflect on where we have gone on this health benefits journey since June 28, 2011 and why we just can’t get over the top.
At the very end of the session, Senator Loretta Weinberg, the Senate majority leader, resigned her seat in the Senate and was immediately appointed to the Horizon BCBS board of directors by Senate President Steve Sweeney. As you will read in this article, the Senate president has the authority to appoint one seat on Horizon’s board under state law.
I then reflected upon a bill that Senator Weinberg was vehemently supporting several years ago, making it illegal for workers who waived their benefits to be compensated in any way. Think about that in context now: She wanted to separate health benefits from compensation. If I have conveyed one thing to you over and over, please remember that since the Roosevelt administration, benefits have been part of compensation.
Senator Weinberg’s actions to me are as mysterious as her qualifications to sit on the board of directors for a health insurer that cannot or will not control the costs of insurance. I guess her misunderstanding of benefits as compensation qualified her for an $82,000 job. I would call it no show, but that would be irresponsible, as the job description isn’t posted anywhere. I looked. As a matter of fact, I had to pull the board of directors list from Horizon’s filings with the Division of Banking and Insurance because they don’t post it anywhere.
I wonder if Senator Weinberg will now turn down her benefits with the state of New Jersey, since the director job has free health benefits attached?
When I started researching information about Horizon’s board, I saw that outgoing Senator Kip Bateman was appointed by Governor Murphy to the Horizon Board to replace former Senator Joseph Kyrillos, who was appointed by Governor Christie. Kyrillos was moved to a corporate seat after his term expired. Prior to that, Paul Juliano, the Bergen County Democratic chairman, was appointed by Governor Murphy. That appointment was to replace Michelle Brown, who was also a Christie appointee.
Yes, that is the same Michelle Brown to whom the former governor loaned $46,000 while he was U.S. attorney. And yes, the one who withdrew her name from a judge’s appointment when other issues came to light. Once again, a check into any of their qualifications didn’t yield much on health benefits.
The appointments of both Senator Weinberg and Senator Bateman were also troubling because any state worker who leaves the state’s employ must wait one year before they can work for a state contractor. I know this may seem hard to believe, but the legislators have exempted themselves from this regulation.
Now let’s talk about the qualifications of these appointees in the healthcare arena. I’m done, as they don’t post resumes for these jobs.
In the filings I found, the board of directors for Horizon is comprised of 16 people: the CEO, nine elected positions, four appointees by the governor, one by the Senate president and one by the Assembly speaker.
As a very good friend and a mentor in the healthcare field has said to me, the relationship between Horizon BCBS and the state is incestuous. This is evidenced by the ability of the three most powerful people in New Jersey having the ability to hand out patronage jobs that comprise more than 37 percent of the board of directors. Handing these jobs to unqualified people is not producing lower costs or better outcomes. It is not producing transparency, which is the premium payer’s friend and the insurer’s enemy.
This was patently obvious when Senator Sarlo introduced a bill that would have separated the provider network from the claims administration in the State Health Benefits Plan. It also would have made the carrier a fiduciary. (I can’t believe that the current carrier does not have fiduciary responsibilities either, but that was lobbied right out of the bill.)
Digest that for a minute. Doesn’t separating the billing from the network make sense? Doesn’t requiring the agency in charge of billing and payments of tax dollars to have a fiduciary responsibility make sense? My discussions that day yielded the statement from an employee of the insurer that they could no longer work for the state plan because of their rules. Their own rules. Well, maybe we need another insurer, and maybe we need different rules. That bill did yield a third-party auditor for the SHBP. Full disclosure: that third-party auditor is given a list of claims they can’t audit. It is called a “no-touch” list from the insurer. Imagine that. So theoretically, the fox watches the henhouse and no one else can look inside while the fox is slaughtering the hens.
I can deduce that transparency is important to the legislature only when it comes to a six-day suspension of a cop 20 years ago.
My resolve only grows when I see this happen in front of our eyes. This year I watched the state’s third-party administrator be charged with a contract violation and was told there was a settlement. This settlement has not been provided even after two OPRA requests. This year, I also made data requests for the amount that our members and the taxpayers of New Jersey pay for in-network services through the State Health Benefits Plan, a request that was denied in an answer that came directly from the vendor.
The fact that the state has not been transparent in these matters can only lead a reasonable person to one conclusion. You are all cops. You can figure it out.