SEATTLE–Activists angry about lobbyist efforts to influence states’ implementation of the Affordable Care Act have been out in force here at the summer meeting of the National Association of Insurance Commissioners (NAIC).

Protesters entered one NAIC, yelled that there was an “infestation of lobbyists” in the room, and handed out “lobbyist pandemic kits.” The protesters left before security could arrive.

Outside of the Washington Convention Center, 60 protesters were handing out lobbyist pandemic kits as attendees left the building.

Joshua Welter, a spokesman for the Washington Community Action Network, which organized the protest, said the group was there to support insurance commissioners’ efforts to implement the Affordable Care Act (ACA), the package that includes the Patient Protection and Affordable Care Act (PPACA), and especially the new minimum medical loss ratio requirement, which will require issuers of small group and individual coverage to spend at least 80% of premium revenue on medical care and quality improvement efforts, and issuers of large group plans to spend at least 85% of premium revenue on medical care and quality improvement.

“We have to support the insurance commissioners against more than a thousand lobbyists,” Welter said. “The money should be going to people’s health care, not to health care companies’ profits. This is an important thing that is affecting many people’s lives.”

Shortly before the protesters entered the convention center, Kansas Insurance Commissioner Sandy Praeger gave a presentation on efforts by the NAIC, Kansas City, Mo., to implement ACA mandates.

Praeger said commissioners want to make sure that health insurance premiums are high enough for insurers to avoid insolvency but are not excessive. The U.S. Department of Health and Human Services will also play a role in reviewing premiums and deciding if rates are excessive.

Policy language will also need to be uniform and understandable for consumers, she said.

By 2014, states will have to set up a “health insurance exchange” insurance distribution system.

“We have a lot of work to do,” Praeger said. “When you stop and think about it, we have just scratched the surface on implementation issues. The work is ongoing.”

Earlier in the meeting, Ann Frohman, director of the Nebraska Department of Insurance, talked about NAIC efforts to work with the new Federal Insurance Office that was created by the Dodd-Frank Wall Street Reform and Consumer Protection Act, and to deal with the systemic risk provisions in the Dodd-Frank Act.

State legislatures have to give regulators the authority to get information about insurance holding companies’ non-insurance affiliates, Frohman said.

“You can’t stop failure,” Frohman said. “But we can catch things and change the thinking upstream.”

The FIO is supposed to speak for the United States on international insurance trade issues.

“We need their assistance,” Frohman said. “It does make a lot of sense… Our job is to educate them.”