Insurance commissioners want everyone to remember that when it comes to Obamacare enrollment, states matter.
President Obama met Thursday with state representatives from the National Association of Insurance Commissioners to discuss what's coming up in 2015 for the health care law. While much of the focus on enrollment is at a national level, who is enrolling in each state will determine insurance risk pools and premium prices — and thus the law's continued success.
Insurance commissioners are government officials who regulate insurance companies within their state or territory.
"[We appreciate] the continued flexibility that [the administration] promised with working with us, and the recognition that we do have different marketplaces and concerns," said Sharon P. Clark, who is NAIC secretary-treasurer and Kentucky's insurance commissioner.
The meeting addressed five main issues for the states: the transition to new leadership at the Health and Human Services Department following the resignation of Secretary Kathleen Sebelius; the upcoming 2015 open-enrollment period; unique challenges U.S. territories face with the Affordable Care Act; issues with "navigators," who assist enrollees; and 2015 rates for insurance plans.
A major question moving into 2015 is whether premiums will rise following the law's first open-enrollment period. State commissioners said the rates for insurance plans are still unknown, but they emphasized that their process for rate approval will remain the same.
"I don't have specific information for you, I would be speculating; we'll see the rate-increase requests when they come into our office," said Adam Hamm, NAIC president and North Dakota insurance commissioner, regarding 2015 rates. "All of us will do the same job on those rate-increase requests as we've done historically — [which is] only approve those that are justified."
Those rates need to be a balance between what consumers are able to pay and what is necessary to keep insurance companies solvent, Hamm said. Some factors, such as unknown risk pools or transitioning grandfathered plans, might lead to higher rates; in some cases plans might see decreased rates. Hamm emphasized that any requests for rate changes next year will face the same level of scrutiny as any other time.
"You can't play politics with rates, and that's not something we're going to do," he said.
The administration told the commissioners that 35 percent of enrollees are under age 35, and later said 28 percent are in the coveted 18-to-35 age bracket. However, Hamm emphasized, the health status of those individuals is still unknown.
Concerns over HHS changes are linked to the emphasis on local differences. Insurance commissioners are losing an administration ally with the departure of Sebelius, who is a former Kansas insurance commissioner and NAIC president.
"We also expressed our concern that there has been some turnover within HHS," said Monica J. Lindeen, NAIC president-elect and Montana's commissioner of securities and insurance. "There's been a loss of some folks who have been state regulators in the past, who have brought helpful knowledge. We impressed [to the administration] that we want them to continue to lean on us in the future and to take advantage of our regulatory expertise."
Commissioners say the meeting lasted well over an hour and included President Obama, Vice President Joe Biden, Sebelius, CMS Administrator Marilyn Tavenner, White House Chief of Staff Denis McDonough, senior Obama adviser Valerie Jarrett, other senior administration health care staff, and 44 insurance commissioners. Obama met with executives from insurance companies later the same day.
The White House announced Thursday that enrollment in private plans on the exchanges has reached 8 million nationally.