Latest news with #StateHealthBenefitsProgram
Politico
22-07-2025
- Business
- Politico
An SHBP show
Good Tuesday morning! Still no update on who our U.S. attorney will be come Wednesday as of the time this newsletter was filed last night. More on that from POLITICO's Ry Rivard below. But since I am the interim Playbooker this morning, let me take a minute to talk about an issue that will take up a lot of Gov. Phil Murphy's time during his final days in Trenton: fixing the state's beleaguered health insurance program for government workers. The State Health Benefits Program is facing massive proposed rate hikes for the upcoming plan year. Its coverage for local governments is in a 'death spiral.' And the current state budget requires state workers to find $100 million in recurring savings in a six-month period. Amid this backdrop, Assembly Speaker Craig Coughlin is supporting a labor-backed bill that revamps the SHBP and is set for a rare summer committee hearing. That bill overhauls the governance and makeup of the board that oversees the SHBP — giving unions more leverage than they currently have — and changes how local government employees pay for their health care contributions that could insulate them from future rate hikes. But that effort may be dead right out of the gate: One executive branch official told Playbook that the bill is an 'unserious proposal' and a 'complete non-starter.' A key concern from other administration officials is that they are skeptical the proposal would achieve meaningful savings to make the SHBP solvent in the long run. They also said that the governance structure would prevent the commission from being nimble. (The bill does allow for an independent arbitrator to make decisions in the event of a prolonged stalemate, although it could take weeks, if not months, to get to that point.) Amid all this, Senate President Nick Scutari has proposed a time-honored Trenton tradition: create a task force for recommendations on SHBP fixes, as per an op-ed. A spokesperson for Senate Democrats said that setting up the task force 'doesn't rule any idea in or out.' Murphy declined to comment on the bill when asked about it in Trenton yesterday, but said the situation on the health benefits was 'complicated.' 'It's probably six or seven bank shots that would all have to come together,' he said of a potential long-term fix. 'Folks are gonna have to revisit what the state's putting in, on the other side what the workers are putting in. It depends on the plan, but the fact of the matter is the math is not working and we need to find ways to make the math work.' More on this below. FEEDBACK? Reach me at Dhan@ WHERE'S MURPHY — In Trenton with first lady Tammy Murphy for a groundbreaking ceremony for the Maternal and Infant Health Innovation Center QUOTE OF THE DAY: 'Kim, it'll be nice to have you hanging here. Not literally.' — Gov. Phil Murphy, during the unveiling of former Lt. Gov. Kim Guadagno's portrait HAPPY BIRTHDAY — Alexis Degan, Marelyn Rivera, former Rep. Mike Ferguson and former Hoboken Mayor Peter Cammarano WHAT TRENTON MADE Labor-backed public worker health insurance bill has rare summer hearing — and some pushback, by POLITICO's Daniel Han: Assembly Democrats are moving forward with a rare summer committee hearing on a labor-backed bill that overhauls the state's beleaguered health insurance program for state and local government employees. It's already facing hurdles. The legislation, NJ A5903 (24R), has the backing of Assembly Speaker Craig Coughlin. But one executive branch official, granted anonymity to speak candidly on the pending bill, described it as a 'complete non-starter' that would 'accelerate the death spiral and collapse of the [State Health Benefits Program].' Other administration officials have questioned whether the proposal would achieve meaningful savings. THE NOT UNTOUCHABLES — Gov. Phil Murphy did not rule out the possibility of redrawing the state's congressional map as Texas Republicans are trying to overhaul their congressional map in a way that would benefit Republicans. 'No news to make, other than I will quote Sean Connery in 'The Untouchables': 'Never bring a knife to a gunfight,'' Murphy told reporters at an unrelated event. 'So if that's the way we're going, we're from Jersey, baby, and we won't be laying down.' The comments come as House Minority Leader Hakeem Jeffries recently told CNN that national Democrats are considering several states — including New Jersey — to redraw their congressional maps if Texas moves forward with its proposal. But an attempt to overhaul the state's current congressional map mid-decade would almost certainly require a state constitutional amendment. For the uninitiated, that would require a resolution to pass the Legislature in two years with a simple majority or one year with a supermajority — and then it goes to the voters for approval. (The deadline is August to put a constitutional amendment on the ballot this fall.) That's a lot of cooks in the kitchen. Also a relevant throwback: New Jersey lawmakers tried to amend the constitution in a way that would boost Democrats several years ago, but that effort ultimately failed. It's worth noting that the governor has no official role in amending the constitution in New Jersey. Still, Murphy said the issue would likely be discussed among other Democratic governors during an upcoming National Governors Association meeting. 'I suspect as the Democratic governors get together for a drink or a coffee, this will be high on the agenda,' he said. — Daniel Han — 'Assembly nominee accused of abuse faces criminal summons after sharing nude photos,' by New Jersey Globe's Zach Blackburn: 'A New Jersey physician filed a criminal complaint against Democratic Assembly nominee Ron Arnau on Monday, saying the candidate illegally shared nude photographs of him with the New Jersey Globe earlier this month. Physician Cristian Serna-Tamayo alleged Arnau, who is running for Assembly in the 40th legislative district, physically and emotionally abused him during a relationship from 2014 to 2016. Serna-Tamayo, in sworn statements from the time and in an interview with the New Jersey Globe, said Arnau held him at knifepoint for three hours in 2016, leading the pair to receive mutual temporary restraining orders; they later reached an agreement to drop the restraining orders. Arnau was never criminally charged in the matter and is now married to a different man. He has denied the allegations.' BEACH BURN — 'Attorney general blasts 'outrageous' claims lobbed by state senator,' by New Jersey Monitor's Sophie Nieto-Munoz: 'A South Jersey state senator's accusations that Attorney General Matthew Platkin is using his office to pursue political vendettas are 'outrageous, totally ridiculous, and wrong,' Platkin said Monday. 'I think we know his politics and frankly, you know, I wish the folks in Trenton — Democrat and Republican — would spend more time focused on how they improve the lives of people's families and less time attacking people who are trying to help them,' Platkin told the New Jersey Monitor Monday after an unrelated event in Newark. Platkin and the state senator in question, James Beach, are both Democrats, but Beach is an ally of South Jersey Democratic power broker George Norcross, whom Platkin indicted on since-dismissed racketeering charges last year. Beach, who represents Camden County, last week sent a letter to Senate President Nick Scutari asking for legislative hearings in the fall on what Beach called Platkin's 'gross mismanagement and overtly political behavior.'' — New Jersey Monitor: New Statehouse portrait honors former lieutenant governor TRUMP ERA HABBA HUBBUB — Alina Habba, the interim U.S. attorney for New Jersey, is expected to learn today whether she can keep her job. Habba, a former personal attorney to Donald Trump, has drawn scrutiny for prosecuting the mayor of the state's largest city and a member of Congress and investigating the governor. Her 120-day interim appointment expires today and the president has nominated her to a full term, but her fate remains unclear. In an unusual process, district court judges were expected to have met Monday to decide whether she can stay on in the near-term — they could vote to keep her, not keep her or try to pick someone else for the role. Chief Judge Renee Bumb's office said nothing about their work, which is now subject to intense outside scrutiny on social media. In a social media post, House Minority Leader Hakeem Jeffries, a New York Democrat, called Habba the 'so-called U.S. Attorney' and accused her of 'maliciously' charging Rep. LaMonica McIver with felonies following a chaotic May incident outside an immigration detention facility in Newark. A trespassing charge filed that day against Newark Mayor Ras Baraka was dropped. Jeffries said Habba 'must be rejected by the Federal District Court judges who are considering whether to retain her.' Conservative lawyer Mike Davis said he was filing a House ethics complaint against Jeffries for 'strong-arming' the 17 judges, 15 of whom were appointed by Democrats. Davis' move drew praise from Trump allies. On his show, Steve Bannon criticized 'radical neo-Marxist federal judges in New Jersey working with Hakeem Jeffries' for trying to ditch Habba. Todd Blanche, who also represented Trump before joining his administration as a deputy attorney general, said on social media that Habba 'has the full confidence of DOJ leadership.' If the judges do appoint a successor to Habba, it could set up a showdown with the executive branch if Trump moved to fire that person. Trump has asked the Senate to confirm Habba to a full term, but it's clear New Jersey's two Democratic senators don't want the nomination to proceed. — Ry Rivard CONGRESSIONAL GOP OPPOSE SANDY RELIEF AGAIN — 'Shore towns get no federal dollars for beach replenishments for the first time in almost 30 years,' by The Philadelphia Inquirer's Frank Kummer: 'Congress typically allocates between $100 million and $200 million each year for beach replenishment initiatives — projects that dredge sand from the ocean floor or other places and deposit it onto U.S. coastal beaches to combat erosion. This year, however, the federal budget earmarked zero dollars — marking the first complete funding halt for such projects since 1996. And it's possible that zero might carry over into next year as Congress debates spending priorities.' CROSSING BRIDGES — Former Acting U.S. Attorney for the District of New Jersey Vikas Khanna is joining Sills Cummis & Gross P.C. as chair of its White Collar Practice Group. As a prosecutor, Khanna is perhaps best known for prosecuting the Bridgegate trial. — POLITICO: Gottheimer's only challenger ends bid — NJ Globe: 'Anna Lee Williams becomes first Democrat to enter race for NJ-11' — NJ Monitor: 'NJ governor candidates split on housing immigrant detainees at Fort Dix' — The Record: 'A third of new members on US DOT advisory committee have NJ ties" — The Record: 'Medicaid work requirements cut coverage for thousands in other states. Can NJ do better?' LOCAL WHAT'S BLACK, WHITE AND RED BANK ALL OVER — 'A legal complaint to remove an arrest record raises free speech issue in Red Bank,' by the Asbury Park Press' Olivia Liu: 'In an attempt to keep his assault arrest from showing up in internet searches, a Red Bank resident filed a criminal complaint against a local news outlet to get it to remove the original news item. The complaint raises the issue of what the press can print and what restrictions the government may impose on it. Red Bank Green publisher Kenneth Katzgrau and reporter Brian Donohue were named in the complaint that was filed by Kyle Pietila, who had his arrest record expunged about six months after the arrest. The case is being heard in Red Bank Municipal Court.' 'N.J. school district blames state for 'unbearable' 25% tax hike on residents,' By NJ Advance Media's Nyah Marshall: 'A Monmouth County town is blasting New Jersey education officials over deep school aid cuts, saying it was forced to impose a 25% tax hike on its residents. Neptune Township has lost more than $20 million in state aid since New Jersey revised its school funding formula in 2018. For the 2025-26 school year alone, the district saw a $4 million drop in aid, officials said. Struggling to make up the multimillion-dollar budget gap, the district was forced to raise property taxes by $17 million — the largest increase in the township's history, according to Mayor Robert Lane.' EVERYTHING ELSE CHRISTIE SPEAKS — Chris Christie backs Seton Hall president amid clergy abuse investigation, by POLITICO's Dustin Racioppi: Former New Jersey Gov. Chris Christie said Monday he supports Seton Hall University's president amid an investigation into his past handling of clergy abuse allegations. Christie is one of the most prominent graduates of Seton Hall's law school and his wife, Mary Pat, recently left the school's Board of Regents without explanation. BIG DAY FOR 'NY/NJ' — 'NJ and NYC Expect $3.3 Billion Boost From Hosting World Cup,' by Bloomberg's Sri Taylor: 'New York City and New Jersey officials are projecting a $3.3 billion economic boost to the region from hosting the FIFA World Cup in 2026. The region will host eight matches at Metlife Stadium in New Jersey, including the final on July 19, 2026, expecting to bring in over 1.2 million fans and tourists, according to an economic impact summary released Monday by the NYNJ Host Committee, the local body responsible for organizing the games. The tournament will generate $1.3 billion in projected total labor income for the regional economy, and $1.7 billion in projected spending within the regional economy by match and non-match attendees, according to the committee's estimates.'
Yahoo
01-07-2025
- Business
- Yahoo
Fight brewing over New Jersey budget's quest for state health benefit savings
Assembly Speaker Craig Coughlin on the Assembly floor on June 30, 2025 (Dana DiFilippo | New Jersey Monitor) Another fight is brewing over New Jersey's already beleaguered public worker health plans. A provision in the $58.8 billion budget Gov. Phil Murphy signed into law Monday night calls for the state or its unions to identify $100 million of savings within the state part of the State Health Benefits Program for the first half of 2026. It spurred alarm among public-sector unions and a promised fix from Assembly Democrats, all of whom are on the ballot this fall. 'It's clear that there is no immediate need to require state workers to pay more for their health benefits,' said Assembly Majority Leader Lou Greenwald (D-Camden). New Jersey's public health plans are in distress amid rising health care costs, spiking prescription drug utilization, frequent deadlocks in Plan Design Committees that set coverage rules, and soaring premiums spurred by — and spurring — municipal departures. Treasury in May warned local government workers' public plan was at risk of complete collapse as more and more municipalities with larger, healthier workforces leave for cheaper private options. The state workers' plan is shielded from that dynamic because its workers cannot choose private alternatives, but it too faces the threat of more premium increases. In 2024, the state workers' plan lost roughly $113 million, and it is loaning funds to mitigate costs in the local workers' plan, which Treasury has said could not repay its debts without a mid-year rate increase in 2025. Union leaders say hospital pricing is the main driver of growing health benefit costs. 'Until you control the costs, you're not controlling the dollars. When hospitals are getting paid four to five times as [much as] Medicare for service because they allow the state's vendors to negotiate in their interests instead of directly negotiating with them,' said Kevin Lyons, executive director of the New Jersey State Policemen's Benevolent Association. Lyons, a member of the State Health Benefits Program's Plan Design Committee, said New Jersey also could seek to impose caps on the growth of health services. The state's actuary in March reported per-visit costs had increased 7% for outpatient services and 12% for outpatient emergency visits in the 12 months preceding October 2024, with similar increases for behavioral health visits, lab work, and primary care appointments. Per-visit costs for urgent care declined by 8% over that period. Administration officials appear to favor less generous health plans. Plans under the State Health Benefits Program typically cover between 93% and 98% of health care costs. Lowering that number — called an actuarial value — could shave off a significant portion of the state's health benefit spending, which is expected to total roughly $2.9 billion in fiscal 2026. Health benefit committees are due to approve rates for the 2026 plan year later this month. The state's actuaries will make their recommendations public during committee hearings next week. Assembly Speaker Craig Coughlin (D-Middlesex) in a statement following Monday's budget vote said legislators last week had learned of an additional $200 million in revenue that could be used to forestall the $100 million cut to the State Health Benefits Program. 'Although I firmly believe New Jersey's public worker health plans need significant reforms to control costs, the funds allow us the opportunity to find ways to reduce those costs, while treating workers fairly,' Coughlin said, adding his chamber would hold rare hearings July hearings on public worker health benefits. But it's not clear what revenue he's referring to. A spokesperson for Assembly Democrats initially pointed to revenue growth in taxes on energy sales and the state's pass-through business alternative income tax, but those figures were unveiled in mid-May. The spokesperson then deferred to Coughlin and Greenwald's statements, which noted the windfall but made no mention of its source. Overall revenue projections for the state's general fund were $247.9 million higher in the budget signed Monday than they were in the budget Murphy presented in February. The budget's $305 million increase to a $250 million transfer from the state's Debt Defeasance and Prevention Fund Murphy proposed in February more than covers the difference. Lawmakers have limited ability to use gross income tax and other Property Tax Relief Fund revenues to reduce state worker health benefit costs. The state's constitution requires those monies be used 'exclusively for the purpose of reducing or offsetting property taxes.' A Treasury spokesperson did not return a request for comment. Spokespeople for the governor did not address the discrepancy. 'Labor and management can work together over the next five months to find real, sustainable health care savings that ultimately help both workers and taxpayers. With public health benefit plans facing astronomical rate increases, all sides must roll up their sleeves to do the hard work necessary to address this problem,' said Natalie Hamilton, a Murphy spokeswoman. The proposed cut represents about 3.4% the state's expected spending on its employees' health benefits in the current July-to-June fiscal year. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
22-05-2025
- Business
- Yahoo
N.J. public health plans are in distress — how would our governor hopefuls fix the mess?
New Jersey's would-be governors said competition, more oversight, and price transparency could pull the State Health Benefits Program out of a death spiral. (Dana DiFilippo | New Jersey Monitor) Riven by years of municipal departures, soaring premiums, and surging prescription drug use, the local government part of the State Health Benefits Program is on a path to complete collapse, and New Jersey's gubernatorial hopefuls differ on how to fix it. The plan, which in January provided health coverage to 56.2% of the state's local government employers and has repeatedly seen double-digit premium hikes in recent years, faces even sharper increases and will collapse absent wholesale changes to benefits, entry and exit rules, and governance, the Treasury warned in a report released Tuesday. Plans that provide coverage to local government face cumulative premium increases set to exceed 60% over the next four years and will likely collapse as more towns, authorities, and counties flee, the Treasury said. That collapse could leave towns with small or sickly workforces facing high rates in the private market. Because premiums under the local part of the State Health Benefits Program are paid largely by local revenue like property taxes — whether through withholdings from local government workers' salaries or directly from public coffers — spiking premiums stand to raise tax burdens at the local level. There are 11 candidates running in the June 10 gubernatorial primaries (Gov. Phil Murphy, a Democrat, can't run for a third term this fall). They presented disparate paths on how to control escalating costs under the state's public health plans, with some favoring increased competition, new drug pricing rules, or thinner plan requirements. 'We need more competition,' said former radio host Bill Spadea and former Assemblyman Jack Ciattarelli, both Republicans. On top of boosting competition, Republican candidates want to lower the number of public plans' coverage requirements as a method of controlling costs. Murphy in late 2023 signed a law to allow the state's public health plans to have more than one third-party administrator. Aetna has since joined Horizon Blue Cross Blue Shield of New Jersey in administering the state's self-funded public health benefits, but its entry was not expected to generate savings in the current fiscal year, with benefits unclear for out years, according to budget documents. It's not clear any other New Jersey insurers have the capacity to administer health benefits across the breadth of state. Aetna and Horizon were the only two bidders for contracts to administer the public health plans, a Treasury spokesperson said. Spadea and Sen. Jon Bramnick (R-Union) suggested reducing plan coverage requirements, allowing the state to offer cheaper, less fulsome coverage in a bid to lower premiums. 'Right now, we have insurance policies that mandate a whole bunch of different services. I want to bring in companies that have options where you can choose policies that have less mandated requirements than we require in New Jersey,' Bramnick said. In its report, the Treasury listed high-cost health care services among the primary driver of cost increases, alongside surging use of expensive medications, especially new weight loss drugs. It's not clear what services candidates would seek to limit or whether their plans would include a winnowing of existing health care plans. Treasury's report notes that most local government workers remain on older plans with generous benefits and high costs. Most candidates provided answers on how to control escalating costs in public worker health plans before the release of the Tuesday report that warned the plan had entered a death spiral. Newark Mayor Ras Baraka, Rep. Josh Gottheimer, and teachers union chief Sean Spiller — all Democrats — provided responses after its publication. Democrats' proposed solutions were more varied than their Republican counterparts. Some, like Jersey City Mayor Steve Fulop, backed increased competition, though Fulop also wants limits on hospital mergers. 'You have an increase in costs for New Jersey because you have this hospital monopoly as well, which has put a stranglehold on doctors,' Fulop said. 'I think that Trenton needs to be more aggressive in not allowing that consolidation within hospitals or them acquiring medical practices downstream.' Others favored boosting oversight of plan spending, targeting certain insurance middlemen, or broader changes like those the school workers' public health plan saw in 2020. Gottheimer and Rep. Mikie Sherrill (D-11) both suggested increased plan oversight, her through audits of the State Health Benefits Program and him through compliance reviews. The two also said they want greater regulation of pharmacy benefit managers, third-party firms that negotiate prescription prices on behalf of insurance providers and have been blamed for rising prescription drug prices. 'They've driven up pharmaceutical costs up to 10 times,' Sherrill said. Baraka backed reference-based pricing, which would tie prices for some services or drugs to those charged by Medicare. He also supports shifting some regulatory authority over the public plans to the Department of Banking and Insurance. 'We need reference-based pricing to bring costs down and increase transparency in this state and we need to lay the foundation for a true public option — one that prioritizes people, not profit,' the mayor said. Treasury's report partly blames the structure of plan design committees for rising costs within the State Health Benefits Program, saying those bodies, whose membership is split evenly between management and labor, had entrenched the status quo of expensive benefits. Ceding some authority to Treasury could lower costs, the report says. At present, only the committees or the Legislature can change plan designs by, for example, changing copay levels, shifting reimbursement rates, or eliminating specific insurance plans within the program. The State Health Benefits Commission and its schools counterpart set premium levels. Spiller and former state Sen. Steve Sweeney highlighted past reforms to state plans, including the 2020 changes that moved most school workers enrolled in the School Employee Health Benefits Program to cheaper public plans. They also suggested reverse auction rules that see pharmacy benefit managers bid each other down for state contracts. 'When I did the reverse auction on pharmaceuticals, it saved half a billion dollars a year, so that's one of the lower-hanging fruits,' Sweeney said. 'The other one is sitting down with the unions to see where we can negotiate and reduce healthcare costs like we did with the (New Jersey Education Association).' The 2020 changes, which came when Spiller was the teachers union's vice president, succeeded in providing some relief to public school plans, but Treasury's report warns the dynamics that sent the local part of the State Health Benefits Program into a death spiral could do the same for the school workers' plan. Multiple Democrats, including Gottheimer and Baraka, said they want more transparency over hospital pricing, while Spiller blamed hospitals' political heft for public plans' present distress. 'We've seen it where we can make changes to some of the plan's structures. They refuse to do it. Over and over, they refuse,' he said. 'And let me tell you, I am sure it is because the biggest donors in New Jersey politics are the hospitals, the insurance companies, their brokers, all the other folks. We never get the change we need.' Dana DiFilippo and Sophie Nieto-Muñoz contributed. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
20-05-2025
- Health
- Yahoo
Local government workers' health plan enters ‘death spiral'
Sharp premium increases and waning enrollment have put the local government part of the State Health Benefits Program on a path to the grave. (Dana DiFilippo | New Jersey Monitor) New Jersey's health benefits plan for local public workers, harried by years of sharp premium increases and a dwindling subscriber pool, has become 'structurally unstable' and 'financially unsustainable,' the Treasury said in a report released Tuesday. The purely informational report is the latest in a series of dire warnings, now outright alarms, over the future of the public worker health plan, which has faced an exodus of municipalities amid repeated double-digit premium hikes approved in recent years. 'The plan's very high actuarial values, a depleted and now insolvent cash management margin reserve … and a static governance structure have created a self-reinforcing loop of premium increases and employer exits — what actuaries commonly refer to as a 'death spiral,'' the report says. Health insurance plans function by diluting risk, using healthy subscribers' premiums to underwrite medical care for sicker members. But as premiums under the local part of the State Health Benefits Program rose, towns and cities with younger, healthier workers fled to private options. As a result, risk and premiums continued their climb, and municipalities continued their departures. The number of local governments participating in the plan fell from 768 in 2021 to 689 at the end of March. In January, only 56.2% of local governments were participating in the program, and the municipalities that return to the plan after facing higher premiums under private options could push costs up further as higher risk workers return to the public pool, driving up overall risk and costs. Rising prescription drug usage — especially around new and trendy weight-loss drugs — plus the growing use of high-cost services and inflation have contributed to the plan's rising costs, the report said. The state's actuary has said premiums for the local government part of the program would need to rise by 19.5% to stabilize its reserve fund, on top of separate hikes to account for increased prescription and medical benefit usage. A law signed last November to keep local government workers' plan solvent by lending from state workers' plan could bring the floor for premium increases up even higher. The local part of the State Health Benefits Program owes state workers' plan roughly $120 million, and it won't have the money to repay that debt without a mid-year premium hike. By law, those loans must be repaid within 365 days of being taken. 'There could be a 26.5 percent 'floor' to 2026 premium increases … in addition to the 'regular' medical and prescription drug trend rates,' says the report, adding increases to rebuild the plan's reserves could be phased in over multiple years. Cumulative increases from 2026 through 2029 are expected to 'significantly exceed' 60%, according to the report. Those would add to the 59% cumulative increase it saw between 2022 and 2025. 'Without meaningful intervention, current trends in enrollment, utilization, and health care cost inflation will continue to drive unsustainable premium increases,' the report says. 'The situation is not one of temporary imbalance — it reflects deep-seated structural challenges that, if unaddressed, will further destabilize the plan.' The high rates at which the plans cover medical expenses have also contributed to their price. Nearly all, 95%, of local government workers enrolled in the program are on plans with actuarial values of 97%, meaning workers are responsible for paying just 3% of their health care expenses through copays, deductibles, or coinsurance. The School Employees Health Benefits Plan faces similar distress, the report says. That program, which offers health benefits to school board employees, has escaped most of the large premium hikes faced that hit local government workers — between 2022 and 2025, their premiums rose by 44% — and saw some temporary relief from 2020 changes that moved most of its enrollees to more cost-effective plans. But that plan is facing price pressures for the same reasons as the State Health Benefits Program, and the 2020 changes bar the committee tasked with oversight from tweaking benefits or plan rules in response to rising costs until 2028. 'The SEHBP now faces significant financial and actuarial risks and may be on a similar trajectory as SHBP-LG — potentially entering a death spiral in the medium-term or experiencing serious affordability issues for its members,' the report says. Because state workers cannot leave their public health plan, the state part of the State Health Benefits Program remains stable, but it will still require premium increases to meet rising costs, the report says. Plan design changes could partly defray rising costs but 'even the most aggressive plan design changes will likely not be enough to reverse the systemic unraveling now underway' and broader changes are needed to stabilize the public health benefit programs, the report said. Those changes could include a lower actuarial values — meaning enrollees would pay a greater share of their medical costs — as well as waiting periods for municipalities to reenroll in the State Health Benefits Program after leaving and more rule-setting authority for the Treasury. 'Failure to reform will lead to ongoing price increases and employer exits, and eventually a complete and disorderly collapse of the plan,' the report says. Alternatively, the state could unwind the local part of the program and leave local governments to find health coverage through group insurance funds while the plan phases out. 'Phasing out the plan in an orderly, supported, and equitable manner will mitigate further destabilization and align the State's policy approach with prevailing market conditions and local preferences,' the report says. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
25-04-2025
- Politics
- Yahoo
Montclair health benefits matter raises questions about Democrat running for governor
As Sean Spiller campaigns for governor, his record as mayor of Montclair has received scant attention. (Illustration by Alex Cochran for New Jersey Monitor/Spiller photo by Dana DiFilippo) There's a years-old scandal involving one of our candidates for governor and no one's talking about it. Well, almost no one. State Sen. Mike Testa brought it up during a recent budget hearing with Attorney General Matt Platkin. Testa, a Cumberland County Republican, asked Platkin why his office prosecuted the GOP former mayor of Wildwood for fraudulently obtaining town health benefits for his part-time city job — New Jersey law says benefits are meant for full-time workers only — yet has not filed similar charges against a Democratic ex-mayor of Montclair and current gubernatorial candidate accused of the same thing. Testa didn't name names, but he meant Sean Spiller, president of statewide teachers union the New Jersey Education Association. You may know him from the tens of thousands of vote-for-Spiller flyers that have been showering the state since the fall. 'That case never reached a criminal court, while the case in Wildwood was presented to the grand jury not once but twice, and has been pursued aggressively. You've recused yourself from the Montclair investigation, which stopped completely dead in its tracks. Why such a disparity between those two cases?' Testa asked Platkin. Platkin mostly declined to answer questions about the Montclair matter since he's recused from it — Platkin lives in Montclair — and deferred questions about it to the unnamed person in his office who was or is handling that investigation. Platkin said he doesn't know its status. I don't know why Spiller's Democratic rivals — there are six Democrats in the race to succeed Gov. Phil Murphy — have not needled Spiller about this particular matter in advance of their June 10 primary. But the Montclair story is worth examining. Spiller won election as the Montclair mayor in May 2020 after serving on the town's council for two terms. The town had recently joined the State Health Benefits Program, which since 2010 has barred part-time employees from receiving health benefits. Montclair's mayor and council members are part-time employees but were given the green light to receive health benefits because a town official said they worked the requisite 35 hours a week, according to allegations raised in court by Padmaja Rao, the town's CFO. Rao alleged in a 2022 whistleblower lawsuit that an outside auditor told her Montclair's officials could not accept health benefits per state law, and when she told other town officials this, she became the victim of harassment. Spiller did not accept most of Montclair's health benefits, but he did sign up for its dental plan and take about $5,000 annually from Montclair taxpayers in exchange for not taking medical benefits, according to Rao's lawyers. The $5,000 waiver is intended to encourage town employees to save taxpayers money by, say, remaining on their spouse's health plan — not to fatten the wallet of its already well-paid mayor. The New Jersey Education Association's IRS filings show Spiller's 2022 salary was $291,289, plus $106,217 in other compensation. Like Testa, Nancy Erika Smith, Rao's attorney, is curious about why the ex-Wildwood mayor was charged with a crime but no one in Montclair was. 'I don't know what the excuse is,' Smith said. Smith noted that Montclair elected officials, including Spiller, signed certifications swearing under oath they worked 35 hours a week so they could qualify for benefits or the $5,000 waiver. Spiller also worked 40 hours a week for the teachers union, per the union's IRS filings, meaning he was clocking 75-hour work weeks. Busy guy! During Spiller's deposition in the Rao case, Smith asked Spiller how long he worked per week, but Spiller cited his Fifth Amendment right not to incriminate himself — and proceeded to plead the fifth more than 400 more times during that deposition. I asked Spiller's campaign if he would chat with me about this. It sent a statement from Spiller trashing Testa's comments to Platkin as 'yet another MAGA fueled diatribe in Trenton' and said his assertions and those by 'an interested attorney have no bearing on the facts.' (Testa's response: 'Thou doth protest too much.') I also asked if Spiller would move to change the law if elected governor to allow part-time public workers like elected officials to collect health benefits. They are denied benefits under a 2010 law, championed by then-Gov. Chris Christie, who said it would lower costs for taxpayers. 'I have always stood for, and run on, Healthcare as a right for everyone and not a privilege,' Spiller's statement says. 'With countless folks and their town and county legal counsel all over the state — including Essex County — working to interpret current law, we need a Governor who will fight for universal Healthcare for every New Jersey resident. And that's exactly what I'll do.' Awfully slippery. The question was about part-time mayors foisting the cost of their health benefits onto taxpayers even if they have full-time jobs that could provide those benefits, and the answer was a progressive call for universal health care. Spiller would fit in well in Trenton. As for Peter Byron, the former Wildwood mayor, he admitted in September that he defrauded the State Health Benefits Program, among other crimes. Prosecutors with the state Attorney General's Office recommended a three-year prison term. Rao settled her whistleblower lawsuit with Montclair last May for $1.25 million. And Spiller declined last year to seek a second term as Montclair's mayor. 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