What State Insurance Chiefs Want From Obamacare

President Obama met with state insurance commissioners Thursday to discuss the health care law and premium rates in 2015.

WASHINGTON, DC - APRIL 17: U.S. Vice President Joe Biden, President Barack Obama, Health and Human Services Secretary Kathleen Sebelius, and other administration officials meet with health insurance executives in the Roosevelt Room at the White House April 17, 2014 in Washington, DC. Obama and Biden met earlier with representatives from the National Association of Insurance Commissioners. (Photo by Chip Somodevilla/Getty Images)
National Journal
Sophie Novack
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Sophie Novack
April 17, 2014, 1:48 p.m.

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.

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