On Friday, two intrepid Health Access staffers took a field trip to San Francisco to venture into the wilds of the National Association of Insurance Commissioners which was holding a “public” forum on health care reform, as part of their regular quarterly conference that moves around the country.
We thought this was important to do since the Senate version of federal reform gives the NAIC considerable responsibility in implementing health reform. We joined colleagues from AARP and Consumers Union, organizations that have worked closely with NAIC over the years on the regulation of Medi-Gap and Medicare Advantage policies.
So what did Health Access observe?
First, to get into the “public” forum, each of us was required to put $650 on our credit cards: the staff promised that this would be refunded if we dropped off our “official” badges. We put our badges in a drop box after 5pm on Friday. We will let you know if we get charged or not.
What kind of public meeting is that requires consumer advocates to present their credit cards to get in? Well, it’s not a public meeting. It’s a private trade association advantaging the insurance industry it purports to regulate.
Second, we picked up the list of attendees: no surprise: page after page of insurance company representatives, at least one Pharma representative, lots of lawyers (presumably for insurers), and brokers.
Third, the attorney who presented an “impartial” analysis to the Insurance Commissioners called the Obama health care team the “Taliban”—and no one but no one challenged this characterization or even seemed to take it amiss—except of course for the Health Access team and our other consumer colleagues.
Fourth, our colleagues from AARP and Consumers Union, who were invited speakers, asked for “transparency” and public process. What was plain is that lots of the work of NAIC is done in conference calls in between quarterly face to face convenings that move around the country. Some of the commissioners or their staff said that they would try to provide notice so that there could be public input.
Good grief! In California, when important regulations are under development, there is plain statute requiring notice, the opportunity for the public to participate, an obligation for regulators to respond to comments, and a cop on the beat to enforce these requirements: the Office of Administrative Law. For instance, when the Department of Managed Health Care substantially rewrote the timely access regulations in late 2006 and gave only 15 days (over Christmas) for the public to respond, the Office of Administrative Law tossed out the regulations and forced DMHC to start over again.
But at NAIC, consumers are apparently at the mercy of whatever the Commissioners determine constitutes adequate notice and adequate public process.
When considering health reform, the NAIC should consider some reforms of itself.