Ben Nelson Works to Build Consensus Around ACA

Middle man: Nelson believes NAIC should serve as an intermediary between state-based regulators and the Obama administration.
National Journal
Dec. 16, 2013, 4:09 p.m.

The man who cast the 60th and de­cis­ive vote for the Af­ford­able Care Act in the Sen­ate is now deal­ing with the re­per­cus­sions of the health care law’s troubled rol­lout.

Former Sen. Ben Nel­son, who has been CEO of the Na­tion­al As­so­ci­ation of In­sur­ance Com­mis­sion­ers since Janu­ary, is charged with the seem­ingly im­possible task of build­ing con­sensus among state-based reg­u­lat­ors fol­low­ing Pres­id­ent Obama’s pro­pos­al last month to delay en­force­ment of cer­tain pro­vi­sions of the Af­ford­able Care Act. The re­quest has split NA­IC’s mem­ber­ship down the middle, with half of them say­ing they will move for­ward with im­ple­ment­a­tion des­pite the White House re­quest. “It’s pretty evenly di­vided,” Nel­son said.

A former Neb­raska state in­sur­ance dir­ect­or, Nel­son is flu­ent in the finer points of the ac­tu­ar­ial pro­fes­sion. The pres­id­ent’s re­com­mend­a­tion, which would al­low con­sumers to keep non-ACA-com­pli­ant in­sur­ance policies for an­oth­er year, could raise premi­ums for the risk pool cre­ated un­der the law, he said. Fur­ther­more, many states have already passed le­gis­la­tion that re­quires the can­cel­la­tion of policies not com­pli­ant with ACA stand­ards.

Some of NA­IC’s mem­bers have pub­licly ques­tioned the or­gan­iz­a­tion’s de­cision not to re­com­mend a single course of ac­tion to its con­stitu­ents. Last month, six reg­u­lat­ors boy­cot­ted a meet­ing between Obama and NA­IC of­fi­cials.

“We made this dif­fi­cult de­cision not to at­tend due to the fact that we were either not in­vited to do so, or were in­vited but have de­clined, but in all cases we have ser­i­ous re­ser­va­tions,” wrote Adam Hamm, North Dakota’s in­sur­ance com­mis­sion­er and NA­IC’s pres­id­ent-elect, in a let­ter to fel­low mem­bers. “This meet­ing has not been dis­cussed in any mean­ing­ful way with the en­tire mem­ber­ship of the NA­IC, nor have we worked to build con­sensus among the mem­bers on what our po­s­i­tions will be in the meet­ing.”

Asked about these as­ser­tions, Nel­son is dip­lo­mat­ic but un­apo­lo­get­ic. “I don’t know that I ex­pec­ted [Hamm to boy­cott the meet­ing], but noth­ing sur­prises me,” said the ami­able 72-year-old. “The com­mis­sion­ers come from a vari­ety of dif­fer­ent back­grounds, so it’s not un­usu­al that they would end up with dif­fer­ent ideas about what they should or shouldn’t do in terms of meet­ing with the pres­id­ent”¦. The com­mis­sion­ers are [act­ing] in the best in­terests of their folks back home.”

Rather than dic­tate policy, Nel­son be­lieves that the pur­pose of the NA­IC is to serve as an in­ter­me­di­ary between state-based reg­u­lat­ors and the Obama ad­min­is­tra­tion. “The NA­IC as an or­gan­iz­a­tion takes no po­s­i­tion with re­spect to policy, but we are very di­li­gent in try­ing to as­sist the states with their loc­al im­ple­ment­a­tion,” he said. Nel­son holds at least one con­fer­ence call with his mem­ber­ship each day and has traveled to Ger­many, Switzer­land, and Taiwan in re­cent months to weigh the ef­fic­acy of in­ter­na­tion­al reg­u­lat­ory schemes.

Born in Omaha, Nel­son re­ceived a bach­el­or’s de­gree, mas­ter’s de­gree, and bach­el­or of laws from the Uni­versity of Neb­raska. A former two-term gov­ernor of Neb­raska, he was elec­ted to the Sen­ate in 2000 and promptly emerged as one of the up­per cham­ber’s most con­ser­vat­ive Demo­crats. Nel­son sup­por­ted the Bush ad­min­is­tra­tion’s tax cuts in 2001 and 2003 and broke with his party in 2007 to op­pose a plan to be­gin with­draw­ing troops from Ir­aq. In 2004, it was re­por­ted that White House strategist Karl Rove, per­haps with the in­ten­tion of con­sol­id­at­ing the Re­pub­lic­an ad­vant­age in the Sen­ate, offered to make Nel­son Ag­ri­cul­ture sec­ret­ary. Nel­son con­sidered the of­fer for five days be­fore turn­ing it down.

As law­makers draf­ted the Af­ford­able Care Act in 2009, Nel­son seemed to ex­ploit his stand­ing as the fi­nal vote needed to pass the le­gis­la­tion by adding a pro­vi­sion that brought some $100 mil­lion in bo­nus Medi­caid fund­ing to Neb­raska. The deal was ex­cised from the fi­nal ver­sion of the bill, but Nel­son was roundly cri­ti­cized for what came to be known as the “Cornhusk­er Kick­back.”

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