Listen to this article

To find out what insurers are saying about health care premiums, NJBIZ conducted an email interview with Michael Considine, vice president for consumer, small group, and mid-sized markets at Horizon Blue Cross Blue Shield of New Jersey.

NJBIZ: Why do you think so many people, even those with employer-sponsored insurance — find health care insurance premium costs to be a burden?

Michael Considine: Nearly 90 cents of every Horizon premium dollar goes directly to hospitals, doctors, pharmacies, and others to pay for health services or products for our members. There’s no question that health care costs, which ultimately drive premiums, are rising and being driven by a variety of factors, from breakthrough medicines and technologies that carry high price tags, to the higher prices being charged by those who provide health care services or products. Together, these factors have been driving premium costs for private insurance, including employer-sponsored plans, to rise faster than wages for years.

Everyone who pays for health care – through an insurance premium or out-of-pocket expense – is feeling the impact of the higher costs. New Jersey’s Health Care Affordability, Responsibility, and Transparency Program, launched in 2021 by Gov. Phil Murphy, recognizes that New Jerseyans are facing a health care affordability crisis.

Their most recent reports recognize the complexity of the challenge, but call out provider price increases, not higher utilization or increased illness, as the primary driver of rising costs.

Q: What can businesses do to try to reduce their premiums and by extension, the premiums they pass on to employees?

A: Horizon works closely with our customers to help them find the right coverage solutions, and we’re constantly developing new products and options that help them offer their employees quality coverage that is more affordable. At the same time, we’re working with doctors and hospitals that share our commitment to lowering costs by improving quality, and more closely tying how we pay for care to the quality of the results that the care produces for our members. These pay-for-performance models are effective partnerships that deliver improved outcomes and lower the total cost of care. Beyond working with their carrier to take steps to lower costs, New Jersey’s employers should use their voice to support the goals of New Jersey’s HART program. Lowering costs is a responsibility everyone in health care shares.

Q: Can we talk about what you, as an insurer, are doing to try to contain or reduce premiums?

A: Our members and customers have been sounding the affordability alarm for years. Horizon has been aggressive about doing our part to make health care more affordable, but controlling premiums requires everyone in health care to do their part. From partnering with providers who share our affordability goals and improving our operational efficiency, to helping bring less expensive drugs to market and giving our members tools that can help them get the care they need at the lowest possible cost, Horizon is pursuing improved affordability from every angle.

With 90% of premiums and 100% of out-of-pocket costs going directly to pay hospitals, doctors, pharmacies and others who provide health care services or products to our members, more affordable care requires everyone in health care to do their part.

Q: Any thoughts about how the incoming U.S. presidential administration (and Congress) may impact health care insurance costs?

A: Every family should be able to afford health coverage, regardless of their ZIP code or income. One issue that is sure to rise to the top of the agenda is extending the advance premium tax credit for people who buy their own health coverage. Unless Congress acts, millions of people with pre-existing conditions like cancer and diabetes who purchase coverage for treatments, prescriptions, and drugs on their own will receive a premium increase that will make quality care too expensive to afford. Five million Americans will lose their coverage completely — and that will raise premium prices for everyone. Millions more could see their premiums increase by more than 50%. With middle class families already struggling, preserving the tax credit is just common sense.