Counties and towns weigh withdrawal from health plan Counties, towns weigh withdrawal from state health plan

Counties and towns are considering whether to leave the State Health Benefits Program after a state commission approved rate increases of more than 20% last month, a potential exodus that could further destabilize the public benefits plan.

The size of the increases and the process surrounding their passage have incensed some local officials like Essex County Executive Joe DiVincenzo, who now have to decide whether their workers and taxpayers would be better served by a different plan.

"They did everything in their power in the beginning to get as many counties, as many towns into this to make it easier on everybody else," DiVincenzo said. "But there's no question: If people decide to take it elsewhere, there'll be less people in. It might cost more. Those are things that we've got to weigh."

Counties and some towns move in and out of the state plan on occasion. Middlesex County insures its workers through the Middlesex County Joint Health Insurance Fund and has done so for years.

It's not yet clear how many local and county governments will withdraw from the state plan in response to the rate hikes - increases blamed on inflation and a shift in the way workers used benefits during the pandemic - but a sharp decrease in participants could drive public worker health plan premiums yet higher.

The State Health Benefits Program is a self-insured plan, meaning employee contributions are used to pay for employee health claims. If claim amounts outpace premiums, the rates go up, and if governments withdraw, the pool of workers paying premiums shrinks. All of that could cause problems for Gov. Phil Murphy's administration.

"They have an issue with the local public sector unions. They've got an issue with the local elected officials, and they've got an issue with the State Health Benefits Program moving forward because if you have members - particularly members with good experience ratings - leaving, that's detrimental to the long-term viability of the program," said John Donnadio, executive director of the New Jersey Association of Counties.

Local officials are still researching to see whether the alternatives are preferable, according to Michael Cerra, executive director of the New Jersey League of Municipalities, and that process alone can take months. Open enrollment for the State Health Benefits Program launched at the start of October and is set to end when the month does, leaving a short runway for any decisions.

"It can't be done this year because we have less than two months, and then we have to present our budget. And we have 26 unions, so you have to get everybody on board with the same thing, so it's not going to be as easy as people think," DiVincenzo said, adding there is "no question" Essex would weigh a move to a different insurer.

The timing means Essex will have to find a way to pay for the $21 million in rate hikes it's expecting this year. DiVincenzo said that'll mean service cuts, tax hikes, or - as a last resort - layoffs. Essex, the most populous county in the state, has roughly 3,600 workers and an annual budget of $865 million, according to budget documents.

Though a withdrawal might make sense for counties and larger municipalities, small towns with lean staffs might have trouble finding insurers who can give them a better deal.

"With 35 employees, no one's looking at us. It's not that they don't want to - it's cost prohibitive in a lot of respects," said Clinton Mayor Janice Kovach.

No fix for locals

Though similarly large increases were approved for state workers, a deal between public-sector unions and the Murphy administration will keep those increases locked to just 3%, down from 18%, this year.

It's not clear how that agreement will function or how it's being paid for. The governor's office directed an inquiry on its mechanics to the state Treasury, which directed the inquiry to the governor's office.

There's been no similar relief for local and county workers, and the chances of such aid appear increasingly slim despite calls from local officials to use American Rescue Plan Act funds to defray the rate hikes.

In the absence of aid, the New Jersey Association of Counties has recommended its members pull out from the state plan if possible. The New Jersey League of Municipalities has made no such call, though it has provided its members with information on how to effectuate a withdrawal.

"At the county level, they're certainly exploring their options," Donnadio said.

Assembly Speaker Craig Coughlin (D-Middlesex) previously told Politico New Jersey he was "reluctant, at best" to consider a cash infusion to offset rate increases for local and county government workers over concerns that such an infusion could increase costs in future years without actually addressing rising rates.

There's little chance of direct financial assistance without legislative approval, but other reforms appear to have a better shot at coming to fruition.

Multiple lawmakers from both parties have introduced bills to give county and local players seats on the State Health Benefits Commission and its schools counterpart, the School Employees Health Benefits Commission. County and local governments don't currently have any representation on either body.

"We're not at the table on this one. We're at the door yelling," Cerra said.