UPDATE: Brewer v. Middletown: Township Gives Insurance Info To Resident

Last week Middletown released the names of those covered under its self-insured medical plan to resident Lee Brewer. Brewer had requested the names from the township  last July but had to take Middletown to court to have the names of all those covered by the townships medical plan from 2008 through July 2013 released to him.

I reached out to him and asked if there were any names that stood out that he would be comfortable to share with me. He stated that he was still going over the list of names that the township provided but was ready to release anything at the moment. Brewer told me that the lists provided were very basic and were not broken down into years in which an employee participated. The lists only contain the employee names and what type of plan that they are participating in or have participated in (Single, Family, Employee & Spouse...). And there is no reference as to whether or not any of the names provided are current or former employees.  Brewer therefore has some additional work that he needs to do in order to cross reference names to job titles held before he can make any announcements.

I was told one name did standout however and it was Municipal Court Judge Richard Thompson, who has been covered under Middletown's health coverage plan as a "Single" receiver of benefits.

I'm curious what other names will pop up.

Brewer v. Middletown: Township Will Comply and Release Benefits Records

According to this weeks Independent, Middletown has decided to comply with Judge Lawson's ruling in the case of Brewer v. Middletown and release the names of all those who receive health benefits from the township.

Interestingly enough, Middletown's attorney Brian Nelson is somehow blaming Middletown Democrats and former Township Committee Candidate Linda Baum for the township's need to release names of those covered under its self-insured medical plan.  Also Lee Brewer, the man that filed the suit to release the names of those cover will be seeking to recover his legal expenses from the township that are associated from the case. Brian Nelson seems the think that the Township doesn't need to comply with the request however.

Here is what the Independent has to say:

Middletown Township will comply with a court order and release the names of current and former employees who received medical benefits through the township dating back to 2008, according to Township Attorney Brian Nelson.

Nelson confirmed on Monday that Middletown will not appeal an order from state Superior Court Judge Lawrence Lawson mandating that the names be provided to township resident Lee Brewer, who requested a comprehensive list of township benefits records in July.

According to court records, Brewer’s request was part of a quest to seek out “potential fraud” in the township’s health care enrollment system.


While the township provided Brewer with much of the information he requested, the names of the enrollees were redacted. Township officials said divulging that information could allow specific claims information for employees to be made public, which would violate the privacy laws mandated by the Health Insurance Portability and Accountability Act (HIPAA).

Because Middletown is self-insured, the township is a “covered entity” under HIPAA and subject to significant fines and penalties for any violations, Nelson said.

“We have given out — I can’t even count how many — dozens of documents over a period of years in relation to the township’s health benefits plan,” he said on Jan. 23. “The names have been redacted to protect those individuals and their private health information.”

Nelson said other township residents, specifically former Democratic Township Committee candidate Linda Baum, have requested and been provided with a significant amount of benefits records in recent years, only with the enrollee names redacted.

Releasing the names now could allow members of the public to piece those records together and determine claims information for specific employees, he said.

Walter Luers, the attorney who filed the suit on behalf of Brewer, said the township is simply trying to justify blocking the records, and that there is no danger of claims data being made public.

“It’s just something that they are throwing out there,” Luers said on Jan. 24. “If Middletown has released claims data that they shouldn’t have released, they should be making some sort of effort to correct it, to get it back somehow. But they’re not.”

He said the township had verbally argued about the claims data in court, but didn’t reference it in any official briefings.

“It’s like me saying the sky is purple,” Luers added. “Just saying it doesn’t make it true.” In his decision, Lawson wrote that Middletown “failed to identify any concrete example of a past disclosure which could, in conjunction with the present request, bring about such a harm.”

The township had also argued against a state “common law” right of access precedent, which found that certain insurance records must be publicly accessible.

Middletown argued that the federal “privacy rule” under HIPAA and the Employee Retirement Income Security Act (ERISA) trumps state law. Lawson, however, ruled that the township failed to identify just which HIPAA and ERISA regulations prevented the release of the employee names.

While disagreeing with Lawson’s decision, Nelson said the township would now comply with Brewer’s records request. Because the township is only releasing the names under a court order, it should be protected from any potential litigation that arises as a result of the disclosure, he added.

“The township believes that — given that there is a judge’s order — it will be protected from any type of [legal] claims,” he said.

The records would have to be released within 20 days of Lawson’s final order, but Nelson said they would likely be provided sooner.

On Jan. 24, Luers said Brewer may also seek to recoup his legal expenses from the township, to the tune of approximately $5,000.

Nelson said Brewer would not be entitled to such a reimbursement because the records in question are not protected under the state’s Open Public Records Act.

“We will fight that, and we will win that,” he said.

Middletown’s health insurance program has been a subject of scrutiny for years, as Democrats have accused the all-Republican Township Committee of intentionally obscuring the identities of its beneficiaries.

Baum: Open the books on insurance; Middletown's health-care strategy must be examined

The following Op-Ed was written by Middletown Democratic Candidate for Township Committee Linda Baum. The Op-Ed addresses the high cost of Middletown's "double-platinum" self-insured health care plan that has an average cost of $31,000 per beneficiary (under a family plan) enrolled.

The Op-Ed appeared in Wednesday's printed edition of the Asbury Park Press and online HERE:


Middletown’s $9.3-million tab for health benefits has drawn attention recently, following a decision by the township to reduce hours for 25 employees who otherwise would have qualified for future health benefits under the Affordable Care Act (ACA).

Linda Baum

My research shows that Middletown’s cost for medical benefits has risen 50 percent in the last decade. Prescription payouts have risen 100 percent during that time. Steady increases long pre-date the ACA, to which officials are pointing as a cause.

Failure to address this issue falls squarely on the shoulders of our local government. Township Committeeman and current Mayor Gerry Scharfenberger, a Republican, has been in office since January 2005 and has had ample time to do something about this.

Former Committeeman Sean Byrnes, a Democrat, had proposed forming a task force of medical and insurance professionals to review and make recommendations with respect to the township’s health coverage, but the administration’s Republican majority rejected the idea.

Further, the township will not say who’s enrolled for benefits, another thing that needs review in order to get costs under control.

Knowing the names is not just a matter of weeding out people who should not be covered. We should be able to determine, for example, if retirees are properly categorized as retired vs. actively employed to ensure proper coordination of coverage. The information recently released by the township — minus the names — shows at least one person listed as “active” who is living across the country.

In July, a lawsuit was filed in state Superior Court to obtain the names of those enrolled for health benefits with Middletown Township, which claims that as a self-insured entity it is not required to release the information. Other local governments disagree. Earlier this year, Wall Township and the Wall Board of Education, both self-insured for health benefits, released the names of enrollees. And just recently, Monmouth County, which also is self-insured, did the same.

Middletown officials claim that they save money by self-insuring for health coverage, but it’s not clear how that was determined. A health insurance cost comparison prepared by the township compares Middletown’s cost of medical and pharmacy claims — self insureds pay claims rather than premiums — to the premium for a comparable plan through the State Health Benefits Program.

The comparison is faulty in that township enrollees who have other than single or family coverage — the two middle tiers are “employee and children” and “employee and spouse” — are dumped into the higher-premium family coverage bucket in determining the SHBP premium.

This improper distribution of enrollee counts inflates the estimated SHBP premium.

In addition, the analysis doesn’t reflect that one third of enrollees are retirees, for whom premiums are lower if Medicare is primary. Again, the effect is to inflate the estimated premium for the comparable coverage. The township’s self-insured cost would look better in comparison.

The poor math could easily result in an inaccurate conclusion about which insurance option is less costly for taxpayers.

Also, it is important to recognize that comparison of plans and plan costs should be done separately for medical vs. prescription coverage. The best insurance option for one may not be the best option for the other, so we should shop for these coverages separately. Wall, for example, self insures for medical benefits but has private insurance coverage with Medco for prescription benefits.

Because substantially similar benefits can vary widely in cost, it’s possible to achieve significant savings for taxpayers while still providing excellent benefits to township employees, including the 25 who would have qualified under the ACA.

Certainly, given the magnitude of the expenses we’re talking about, this is an area that deserves thorough review.

APP: Middletown health plan tops most in cost, coverage

In following up last week's article "Middletown reduces workers hours to avoid Obamacare", the Asbury Park Press (and others) found it incredulous that the Township was cutting back the hours of  25 part-time employees due to the $31,000 per employee price tag that it would cost the Township to provide health  coverage to them under the terms of the soon to be implemented Affordable Care Act (Obamacare). For many  (myself included, you can read about it  HERE)  the $31,000 price tag stated seemed absurdly high and not at all possible, but it is. In its follow-up article from Saturday, "Middletown health plan tops most in cost, coverage" the APP's reporter Susanne Cervenka spoke to the town's insurance broker who stated that Middletown Township’s health benefits are so good " the coverage would fall under a nonexistent “Double Diamond” rating on the Affordable Care Act’s four-tier ranking."  Insurance rankings for plans proposed under the Affordable Care Act actually includes Bronze, Silver, Gold and Platinum level coverage.

The article goes on to state that Middletown expects to pays about $9.3 million this year for employee and retiree health bills or about 14 percent of this year's overall $67.9 million budget which represent about 18 percent of the municipal tax levy. Employee offset the costs by contributing only $520,000 towards their benefits. And on average,health care costs taxpayers who own an average Middletown home worth $375,500 about $337 a year.

That's outragous especially when you consider that according to the Kaiser Family Foundation, a nonprofit and nonpartisan organization focusing on the major health care issues, the  average health care costs in the Northeast is $17,441 for family coverage and $6,117 for single coverage which would make Middletown's health care costs nearly double the national average.

At that cost, Middletown could afford to insure all it's employees while cutting its overall cost of coverage in half!

Place Blame On Middletown For $31,000 Per Employee Cost Of Township's Self-Insured Health Care Plan, Not Obamacare

Middletown's former mayor and current Township Committeeman Tony Fiore, never let's his ego get in the way of the truth, he has a  hedonistic desire that he can't often control. He needs to let people know exactly how much they don't know by showing them exactly how much he doesn't. Whether it is from the dais, rolling his eyes, sighing with contempt and talking down to people when confronted with facts or a difference of opinion other than his own or using social media to disparage others who he disagrees with, the arrogant, ignorant bulldog in his personality always seems to come out.

Case in point. Last week when the Asbury Park Press announced that Middletown  reduced the hours of 25 part-time employees in an attempt to avoid having to provide health coverage for them under the terms of the Affordable Care Act (Obamacare) when the employer mandate kicks in sometime in 2015, Fiore felt compelled to leave a comment on the APP's website. In defending the reduction in hours and the extremely high $31,000 per employee cost of the Township's self-insured health care plan, Fiore has placed blame on President Obama for the Township's own mismanagement of its health care plan.

After reading Tony Fiore's comment left on the APP, Township Committee candidate Linda Baum sent me a note wanting to refute his statement and asked me to post:

Fiore's statement is totally inaccurate. Per research, Middletown's cost for medical benefits has risen 50% in the last decade, and its cost for prescription benefits has risen 100% in that time. Rising costs long pre-date the Affordable Care Act and have risen steadily during Fiore's term in office. Failure to address this issue falls squarely on the shoulders' of our local government. Our current mayor, Gerry Scharfenberger has been in office since Jan. 2005 and has had ample time to address this issue. Former Committeeman Sean Byrnes (D) had suggested forming a task force of medical and insurance professionals to review the Township's rising health care costs, but the administration's majority would have none of it. On top of that, they aren't telling us who is enrolled for coverage, one of the many things that needs review to get costs under control.

Oh and BTW, Middletown doesn't pay premiums, as Fiore says in his comment. The Township is self insured for health coverage -- it pays claims, not premiums. If Fiore doesn't understand the difference, how great a handle can he have on any of this?

Middletown Cuts The Hours of Part-Timers To Avoid Obamacare: Joins The Likes Of Greedy Corporate CEO's From Papa John's, Applebees and Red Lobster

We can now add the name of Middletown Township NJ to the likes of Papa John's, Applebees, Deny's,  Red Lobster and the many other similar corporate institutions that have decided that it is better to cut employee hours (and livelihoods) than give its hard working, part-time employees health care coverage under the guidelines of the Affordable Care Act, aka Obamacare.

According to the Asbury Park Press at this past Monday night's Middletown Township Committee meeting (I'll post the video when it becomes available), the township administration announced that rather that provide health benefits to 25 part-time employees under the guidelines of the Affordable Care Act, they have instead cut the hours of those employees to avoid paying the extra premiums. 

For the companies named above the additional costs of providing health care coverage to their employees equates as little as 10 cents or less per menu item, to their bottom line. Those costs can easily be added onto a customer's bill with very little notice or trouble from the clientele, as a matter of fact, according to many polls conducted in the past year, customers would be more than happy to pay the few cents more added on to their bill knowing that the additional costs were going to provided health coverage to those that prepare and serve their meals.

In the case of Middletown, providing health care coverage to those 25 part-timers, who live in Middletown and just might be some of our friends and neighbors, would equate to little more than $6 per tax paying township property owner per year. To some of you out there that may sound outrageous but keep in mind, these people are our hardworking friends and neighbors who just might need those extra few hours of pay each week to make ends meet at the end of the month.

Middletown's reasoning for not wanting to provide health coverage to its part-time help is somewhat understandable if you believe that the cost of providing coverage to those employees is indeed $31,000 per individual or family as the township states. That's outrageous! How can it be so much? It doesn't make sense.

I know how much it cost my employer to provide me with an HMO family plan through Cigna Health Care and it is nowhere near $31,000 a year. I think it's about time Middletown starts fessing up as to what real costs are available to them and not try to make excuses.

Whenever the cost of township health insurance premiums are brought up at a public meeting or in the media those on the dais and the administration point to the fact that Middletown is self-insured and as a result of being self-insured, the overall costs of health care coverage is less as compared to enrolling current and retired employees in the state's various coverage plans.  It's obvious to me and many others that this just isn't so.

I've stated it before and I'll state it again, there has been a great many current and former Middletown employees who have told me in the past that they are/were afraid to speak out against their employer (the Township) because Middletown was self-insured. It seemed to them that whenever they would complain to much or too loudly about different work related conditions or insurance benefits, they would notice a slowdown in how their claims or benefits were processed or distributed.

Of course they and I know that that sort of behavior by an employer  is illegal. You can't intimidate or knowingly go out of your way to harass a current or former employee because you are unhappy with them. However those that have talked to me about it feel just that, and believe the only reason why the township is still self-insured is so that Middletown controlled them and demand their loyalty and silence