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Horizon And CarePoint Health Fight Back

NJ.com — November 28, 2016

By The Auditor | NJ Advance Media for NJ.com

CarePoint Health is a for-profit hospital chain in Hudson County that has earned wide criticism for charging the highest prices in the nation for some of its out-of-network procedures.

Horizon Blue Cross Blue Shield of New Jersey is the state's largest health insurance company and has spent the past year fending off lawsuits from community hospitals, claiming Horizon's latest line of low-cost health plans would ultimately force them to close.

The Auditor took note how both CarePoint and Horizon separately fought back last week to challenge these unflattering images by throwing money at their problems.

Last Tuesday, the Rand Corporation released a report which concluded that pending legislation (A1952) aimed at controlling out-of-network costs would result in operating losses from 48 to 70 percent at some hospitals. CarePoint, which opposes the legislation, disclosed it had paid for the study.

Last Monday, employers, business and union leaders announced they had formed a new organization that will serve as the voice of consumers who struggle to select and pay for health coverage. Horizon will pay for Better Choices Better Care New Jersey's work.

"You ignore the fact that there is a (consumer) coalition in NJ that has prioritized affordable health insurance...and one of your members told the media consumers have been absent from policy advocacy to make health insurance affordable," Dena Mottola Jaborska, associate director for New Jersey Citizen Action, wrote in an email Monday to the new organization's executive director Christine Stearns, a Horizon lobbyist. "How is that true or fair to say?"

Stearns told The Auditor the group's steering committee is largely labor and business leaders because "they understand that the high cost of health care in this state is financially draining to New Jersey's families and employers and hampering the state's ability to grow economically."

Through a spokesman, CarePoint called Rand's examination of the out-of-network bill "an unbiased study by an highly regarded independent third party in order to examine the issue of out-of-network legislation and its impact on the well being of community healthcare in New Jersey."

Linda Schwimmer, president and CEO of New Jersey Health Care Quality Institute, a research and consumer-focused nonprofit, said she saw nothing wrong with CarePoint paying for the report because it was transparent about it.

But Schwimmer, who is still reviewing the report, questioned its focus. "What's missing...is the impact is on consumers - the person who gets that out-of-network bill."

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