State health insurance commissioners caught in the middle
Ten months after the Affordable Care Act became a law and almost three months after a mid-term election produced a historic number of new Republican lawmakers, state health insurance commissioners find themselves in a precarious position.
"Our role should be how to give good unbiased policy information," said Susan Voss, commissioner of Iowa's Insurance Division and president-elect of the National Association of Insurance Commissioners, at the National Congress on Health Reform held Jan. 19-21 in Washington, D.C. "We aren't politicians; we are regulators. We have to follow the law right now."
Voss was appointed by then-Iowa Gov. Chet Culter, a Democrat who was defeated by Republican Terry Branstad in November's mid-term elections. Under Branstad, Iowa plans to join the lawsuits challenging the constitutionality of the ACA, she said.
Despite the tone coming from a governor's office, commissioners have to make sure they provide honest and correct information to consumers asking questions about health insurance. "We're trying to walk a fine line depending on the governors we serve, but the customers are our number one goal," Voss said.
"The thing I'm most concerned about, really, is how to help consumers make it through the maze and reduce the fear factor," she said. The Iowa legislature is considering a bill that, if passed, would not require Iowans to buy health insurance as mandated under ACA.
"There's a lot of rhetoric out there," Voss said. "Where does that leave the consumer?"
"We don't want people to think the law has gone away – it hasn't," she said. "Right now the federal law is the federal law and we have to implement it as best we can."
[Find out what a new study says most Americans are feeling about the law.]
Voss said consumers are asking which health plans offer individual policies, and the Iowa Insurance Division has set up an online site to provide that information. But that won't solve the problem. "There are still a lot of people in Iowa without access to the Internet, and we're trying to do a lot of outreach, she said.
"There is a lot of incorrect information out there," she said. "We spend a lot of time correcting what consumers hear."
Insurance commissioners are going to have to "stay grounded," even as all the lawsuits against ACA go through the judicial system, she said.
According to Voss, state health commissioners have 13 new requirements to fulfill under the ACA, including setting rules for the new medical loss ratio requirements, making a set of uniform terms and definitions to be used by all insurance plans and monitoring how health insurance is sold. In addition, educating the public remains at the top of the list.
Under the ACA, states must offer a new high risk health exchange. Only 86 people have signed up in Iowa, according to Voss. Health insurance rates are up 11 percent – not as high as other states, but people want to know why. Voss said she attends "brutal hearings" with people wanting to know why the costs are rising so fast, even with the ACA passed.
Voss said there isn't a single reason for why costs are up. States are required to conduct studies annually of physician fees to try and find some answers. Sometimes physicians are passing the costs of cut Medicare reimbursement on to their non-Medicare patients, she said.
There are often other hidden costs, she said, that the public isn't aware of. For example, there are two new hospitals in Des Moines, but each is only 20 percent full. "If they build it, they will bill it," she said.
