Insurance industry assesses the state of health care in New Jersey

What is the state of health care in New Jersey when it comes to insurance coverage? Spirited answers to that question were addressed at the State of the State in Healthcare 2018 Symposium, sponsored by the New Jersey Association of Health Underwriters, in Monroe Township on Friday.What is the state of health care in New Jersey when it comes to insurance coverage?Spirited answers to that question were addressed at the State of the State in Healthcare 2018 Symposium, sponsored by the New Jersey Association of Health Underwriters, in Monroe Township on Friday.

Attendees heard from an array of speakers from the health insurance industry, health systems, government and academia who discussed a wide range of topics ranging from the type of insurance coverage New Jersey residents have, to health care spending and legislation that impacts health care.

Joel Cantor, director of the Center for State Health Policy at Rutgers University, said health insurance in New Jersey is in moderately strong condition.

“We face continued high and rising costs that have very little to do with the dynamics of our health insurance markets or the Affordable Care Act. New Jersey simply has very high costs,” Cantor said.

On the positive side, Cantor said that there are good things going on in private markets such as value-based purchasing. “On the insurance market front, New Jersey has seen relative stability in a tumultuous time compared to other states. Our premium increases are below national trends.”“On the insurance market front, New Jersey has seen relative stability in a tumultuous time compared to other states. Our premium increases are below national trends.” - Joel Cantor, director, Center for State Health Policy at Rutgers UniversityCantor said that in the first quarter of 2017 individual health coverage program enrollment was up about 115 percent over 2013, and that the bottom line coverage numbers are pretty good.

“The percentage of non-elderly uninsured fell from about 14 percent in 2013, pre-ACA to about 8.7 percent in 2017,” he noted. “This can be attributed to Medicaid expansion as well as growth in individual coverage particularly in the subsidized part of the market.”

Linda Schwimmer, president and CEO of the nonprofit organization NJ Health Care Quality Institute, said that in addition to affordability she’s looking at a system redesign.

“I think New Jersey has been a state that has focused on coverage and successfully. We are now at the lowest level of uninsured then we’ve been in three decades. But it’s still not affordable here, we still have pain points in certain populations.”

She cited a drop-off point for people 18 and 19 as they age-out of Medicaid and another drop-off point with people in their late 20s as they age-out of their parent’s coverage.

Schwimmer cited national health care spending data from 2012-2016 indicating that health care spending has gone up 15 percent over the past five years, but utilization in most categories has gone down for multiple reasons, including high deductible plans and cost-shifting.Sean Hopkins, senior vice president of the New Jersey Hospital Association, said that there is an emphasis by governmental payers and commercial payers to squeeze down the amount of money that is being paid for services.

So what are hospitals doing in reaction?

“We’re proactively looking at creative ways such as bundled programs, more judicious use of hospital resources and doing everything we can to shift to the population health model, to keep people healthy as opposed to treating episodic care or being reactionary,” said Hopkins.

He added that the association fought aggressively in Washington to keep the ACA in place."We are now at the lowest level of uninsured then we’ve been in three decades. But it’s still not affordable here, we still have pain points in certain populations.” - Linda Schwimmer, president and CEO, NJ Health Care Quality Institute“There were repeated efforts to repeal the ACA and we felt that would have bad ramifications for hospitals and the residents of New Jersey from an economic and care delivery perspective.”

Looking ahead, Hopkins said that he’s keeping an eye on repeated calls to try and take down the ACA and concerns about block granting the Medicaid program, which he said, would have bad ramifications.

Ward Sanders, president of the New Jersey Association of Health Plans, said that under the current system the richer the coverage, the lower the cost-sharing and the less managed it is the more expensive it’s going to be. Under a bare bones plan the premium comes down, but it may not be the coverage and services people need.

“Insurance carriers are looking for something in the middle where you balance coverage with affordability,” said Sanders. “They’re trying to find that sweet spot.” Copyright 2018 BridgeTower Media. All Rights Reserved.

CREDIT: Anthony Vecchione