Oscar plan comes back to NJ Obamacare for 2018

June 21--Oscar Health will return to New Jersey's Obamacare market next year, the insurer said Wednesday in a sign that the Garden State's health insurance market, rather than being in a death spiral, has stabilized.

The company, which left the market last year, said it will begin selling policies to individuals and small businesses when open enrollment begins in November.

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"The market in New Jersey is stable and growing," said Mario Schlosser, Oscar's chief executive officer and founder. "We wouldn't have filed for approval (with state regulators) to serve New Jerseyans in 2018 if we weren't confident that we could offer seamless, guided health insurance plans for both small businesses and individuals."

Oscar will join AmeriHealth New Jersey and Horizon Blue Cross Blue Shield of New Jersey in the Obamacare marketplace, an exchange created by the Patient Protection and Affordable Care Act for consumers who aren't covered by Medicare, Medicaid or their employer. That's about 250,000 New Jerseyans.

Oscar announced its return as the nation's $3 trillion health care industry faces uncertainty. President Donald Trump and Congressional Republicans have been working to repeal and replace the law, calling it a disaster.

Among their complaints: it mandates consumers buy insurance or face a penalty; it expanded federally funded Medicaid; and it has left some individual markets with soaring premiums, or, in some cases no carriers at all.

Their efforts are being led in part by U.S. Rep. Tom MacArthur, whose district includes part of Ocean County. The Senate could unveil its bill as soon as Thursday.

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New Jersey consumer advocates on Wednesday once again took aim on the House version, called the American Health Care Act, chiefly for its proposed changes to Obamacare's Medicaid expansion.

Once designed for residents living below the poverty line, Obamacare opened Medicaid programs such as New Jersey Family Care to consumers making up to 138 percent of the poverty line -- $33,600 for a family of four, for example.

The federal government pays for 90 percent of the expansion. It helped to cover an additional 562,000 New Jersey adults.

The AHCA proposed reining in the Medicaid expansion after 2020, leaving states to decide whether to pay for the program themselves or let lower-income residents search for other options.

"Medicaid funding is not simply a line item in the federal budget -- it is a lifeline to hundreds of thousands of New Jersey's most vulnerable populations," said Maura Collinsgru, the health care program director for New Jersey Citizen Action, a consumer group. "These proposed cuts would have dire consequences for New Jerseyans."

New Jersey appears to be beating back at least one of the GOP's critiques: that the individual marketplace is in a death spiral.

Insurers had a deadline of Wednesday to file proposals with state regulators. Horizon Blue Cross Blue Shield of New Jersey said it also will serve the state's Obamacare market, but it declined to disclose its proposed rates.

An AmeriHealth New Jersey spokesperson said it will participate as long as the marketplace is viable enough that it does not negatively impact its members or business.

Neither company indicated how much their plans would cost next year.

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Christine Stearns, a health policy expert with Better Choices, Better Care NJ, said she expects sizable increases in premiums.

The reasons: Health care costs continue to grow faster than overall inflation; the Trump administration might not enforce penalties on consumers who choose not to buy insurance; Congress might not reimburse insurers for providing consumer subsidies; and New Jersey has expanded a program to treat opioid abuse.

"I would say we have moderate competition, but we're neither a health care desert on one extreme, nor do we have robust consumer choices on the other extreme," said John Sarno, president of the Employers Association of New Jersey, a business group based in Livingston. "I would sort of describe us as moderately competitive."

Still, New Jersey's insurance market is stable enough to attract Oscar, a New York-based insurer that sold policies in the state in 2015 and 2016. Its calling card is a slick digital strategy designed to appeal to young consumers.

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Oscar, whose early investors included Jared Kushner's brother, Josh, said it would sell policies in 14 New Jersey counties in Central and Northern New Jersey.

Schlosser said the uncertainty of health care policy in Washington, D.C. didn't dissuade him from returning to New Jersey.

"We're confident that when the dust settles, the market for health insurance will stabilize in time for 2018," Schlosser said. "For all of the political noise, there are simply too many lives at stake for representatives in Washington, D.C., not to do what's right for the people."

Michael L. Diamond; 732-643-4038; [email protected]

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