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.”