The Worst $650 Cookie Ever!

My colleague, Beth Capell, has already posted her impressions from the National Association of Insurance Commissioners (NAIC) meeting that we attended last week in San Francisco. It was so not what I expected that I thought I would add my reaction as well.

During my federal career at The Centers for Medicare and Medicaid Services and the Social Security Administration, I was responsible for holding public hearings on public policy issues according to federal requirements. The NAIC meeting had no resemblance to any official public hearing that I’ve ever attended. The entire premise is that a public hearing is designed to be a venue for informed expert testimony, but also a forum for probing follow-up questions of the policy experts by the Commisioners and an opportunity for public comment. A federal hearing must meet several criteria:

  • The hearing must be announced 3 weeks in advance in The Congressional Record and must be held in a public setting with access for persons with disabilities
  • There should be no admission charge whatsoever, offer free/reduced rate parking, and the location be accessible by public transportation
  • The sponsoring organization must transcribe the entire hearing and distribute it to all Commissioners and also take meticulous notes that are made available to the public
  • They must hold the hearing for a sufficient duration of time to allow for questions from the audience for the experts giving testimony and for the Commissioners
  • . . .And more

You get the picture. Although the NAIC “public hearing” met some of the above criteria, it was by no means free ($650 fee for each of us to attend just this one session, although they allowed how they would not charge us if we returned our badges.) I thought it had the closest resemblance to a “show hearing” (where they could say they held hearings outside of Washington, DC, but it did not provide any opportunity for new information or a dialogue between the panels of experts, the audience, and the Commissioners.

I was struck by the time constraints of the hearing. In a world where the health care dialogue occupies such a significant amount of time and includes many complicated policy issues, this felt very abbreviated. Out of a week-long conference, it allowed for 3 hours for panels to give testimony (and pretty much stuck to that.) I guess it is easier to shoehorn testimony into that block of time if you don’t have to make allowances for pesky questions from the audience–or much engagement from the Commissioners themselves. Three hours for a fulsome discussion of the most significant changes to health care delivery in 45 years–since the enactment of Medicare and Medicaid–seems way not enough time. This is particularly true when by many versions of health care reform legislation under consideration, significant policy pieces will be developed by NAIC and or be delegated to them to enforce. And what about consideration of whether and how is it effective to delegate regulatory functions to a non-governmental entity like NAIC? This was not discussed at all.

Two consumer organizations gave testimony at the hearing and raised some significant issues for consideration, including AARP and Consumers Union, the publisher of Consumer Reports. (The third “consumer voice” at the table was represented by The Hemophilia Association, but their spokesperson was the former Insurance Commissioner from Indiana, so I’m not exactly sure that counts.) In addition, each of the consumer organizations were asked to truncate their testimony because of time constraints (although no similar request was made of other testifiers, such as the doctor speaking on behalf of the American Medical Association. He was able to expound at length about how underpaid doctors are.) I found it curious that although some of the consumer testimony ran counter to accepted orthodoxy at NAIC, it did not generate substantive questions of the consumer panel or an engagement by the Commissioners in any meaningful dialogue.

And, you may ask, how about the showing of California’s contingent at this NAIC meeting on our home turf? What probing questions did our Insurance Commissioner ask? What leadership did he demonstrate among his peers after California’s recent foray into enacting health care reform here? Mr. Poizner was not in attendance. Although he may have directed some of his staff to attend, they were in no way visible at this hearing. There were insurance commissioners from other states in attendance who raised issues from a protection-of-consumers perspective or discussed challenges they had faced in their states. Honorable mention goes to the insurance commissioners from PA, OK, and RI who added to the content of the hearing.

There was one distinct highlight of this hearing–that I would say could have taken the place of several so-called experts who were given equal time. That was Jon Kingsdale, who is the Director of the Massachusetts Connector and has the closest thing to real experience in what may be part of our new health care reality. He talked about the technology challenges he faced, how he staffed the health care exchange with real talent from public service and the private sector, how they rank on the report card from Bay Staters, and how he publicized the individual responsibility with the cooperation of the Boston Red Sox and CVS Pharmacy and got 98.9% compliance (and, as he acknowledged, that he “just didn’t send all of the outlaws to New Hampshire!”)

So, on balance, it was worth attending, and it was educational for us, but I have to admit it was a particularly mediocre cookie for my (hope I don’t really have to pay) $650.

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