Tom Siino, REBC, RHU, is Past President of the NJ Association of Health Underwriters (NJAHU), the leading association of health care benefits professionals and insurance agents in the state. NJAHU Members help employers, employees, and other individuals find comprehensive and affordable health plans in the group market, the individual market, and the Medicare market. NJAHU is a member of the Quality Institute’s Association Council.

Since moving to a state-run exchange in 2020, how has the individual market in NJ fared?

The move from the federal exchange to a state-based exchange in 2020 was extremely positive for consumers in New Jersey. We went from using HealthCare.gov out of Washington to GetCoveredNJ here in NJ. On January 1st of 2020, the enrollment in New Jersey on the marketplace was 250,000 members. Two years later, as of January 1, 2022, enrollment was at 325,000. That’s about a 30% increase. One reason is that the COVID Relief Bill, passed in 2020, increased subsidies on the federal level. New Jersey kicked in some state subsidies of our own on top of the federal subsidies. Purchasing health care in New Jersey, for those who qualify based on income, has become more affordable than ever.

The new system based in New Jersey has been more user-friendly. Now you can pre-qualify your subsidy level right on the website. If you need to call the customer service number, they usually pick up immediately — and you’re talking to someone here in New Jersey! As a broker who sells and services these plans for consumers, the new site makes it much easier to manage my book of business. We encourage any individual in New Jersey looking to purchase coverage through the marketplace to find a licensed, certified agent to help them through this process, hopefully a member of NJAHU.

What are your views on the health of the Small Employer (2-50) market in NJ?

When I first started selling small group plans in 1992, there were about a dozen carriers in New Jersey competing in this market. Now, in 2022, we have about four traditional plans. There’s been a lot of consolidation and it’s more challenging for carriers to compete in this market due to strict regulations. Some of them from the Affordable Care Act in 2014, some within our own state. One regulation with the Affordable Care Act, for instance, is the age rating formula that carriers use that makes it extremely expensive for families to insure their children. A family with three children, especially if some of those children are in their early twenties, are paying $3,000 to $4,000 a month in premiums. Who can afford that?

The regulations make it difficult for carriers to use creativity. They use these strict, metallic tiers. Platinum, Gold, Silver, Bronze plans with no wiggle room outside these tiers. New Jersey also has more mandated benefits than just about any other state in the country. These mandates sound wonderful initially, but they all add to the overall cost of the plan and make it very difficult for carriers to offer competitive plans and for employers to afford them.
Should business owners expect to see significant premium increases for 2023?

I think 2022 has been an especially challenging year for small group plans. Much of it is attributed to all the pent-up demand from COVID when people couldn’t access medical services. That pent-up demand hit the system in 2021 and early 2022.

At the same time, insurance carriers are required to provide 100 percent coverage for COVID testing and treatment. And there’s a recent mandate to provide up to eight free at-home rapid tests per month. Who needs eight rapid tests a month? Carriers are delivering higher increases than usual this year, but we’re hopeful that, once these COVID adjustments have funneled through the system, we can return to more normal renewal levels next year.

How can Quality Institute members, such as providers, pharmacies, etc., support open enrollment efforts?

We just really all need to get the word out that affordable coverage for many individuals is available through GetCoveredNJ. I know this administration is really behind this and there’s going to be a lot of marketing and a lot of advertising as we get closer to open enrollment, which starts November 1. We can all spread the word. People who think they may not be eligible for subsidies may be surprised to learn that they are — and it’s easy to get a quote. There’s a feature on GetCoveredNJ where you can find a licensed agent in your zip code. We encourage people to find a licensed, certified agent to speak with and get a quote. Agents and brokers help people understand their options and guide them to the plan that’s right for them. And when things break down, we can troubleshoot and resolve issues.

We like our readers to get to know you. Where can we find you on a fall weekend?

If it’s a fall weekend, there’s a good chance you will find me at a Rutgers football game. My son just enrolled as a freshman, and I look forward tailgating with him. And, also, you may find me at the Jersey Shore. To me, the fall is the best time to be at the shore.