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Regulation and Compliance > State Regulation

PPACA, State-by-State: A Q&A with Washington Insurance Commissioner Mike Kreidler

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Washington State Insurance Commissioner Mike KreidlerQ: What challenges do you anticipate your particular state running into with upcoming health care reform provisions?

Mike Kreidler: The challenge is to make a complex and critically important law work. Congress and the president crafted the law, but implementation is falling largely to state insurance regulators. The good news is that we’re working closely together – through the National Association of Insurance Commissioners – and are trying to provide consistency and uniformity. As a longtime insurance regulator and a former health care provider, I feel strongly that the nation’s health care system was unsustainable. The specifics of health care reform may require changes and tweaking, but reform itself, I believe, was inevitable.

Q: For producers licensed to sell health insurance in your state, what developments might they look out for in the short term?

MK: Producers are a critical part of the nation’s health care infrastructure, and the public is clearly hungry for help navigating their health insurance options. They want a variety of reliable, trustworthy resources to help them – and producers have long filled that role. I can’t predict how the future will take shape, but I do have some suggestions and observations.

  • First, be engaged. Learn how the health exchanges will work. Remain a trusted resource.
  • Secondly, know that not everything will change. I believe that we will still have a substantial large group market that will likely continue to function as it does today.
  • Finally, I expect there to be a long transition period, Definitions need to be created, rules need to be developed, and there’s a key role for the industry to play in that process.

Q: What should producers concentrate on the most over the next 10 or so years with regard to health care reform’s affects in Washington?

MK: Some of the changes encompassed in federal health reform were launched earlier at the state level here. Among them:

  • “Group of one” coverage allowing single-person businesses to qualify for small-group coverage. Under federal health reform, this change won’t take effect until 2014; in Washington it’s the law now.
  • We also had a state high-risk pool prior to the federal law.
  • We allowed parents to keep dependent children on the family’s coverage until age 25 at a time when many other states didn’t. Federal reform increases that another year, until a person’s 26th birthday.

And so far, so good. All these things have been critical lifelines and have helped keep people covered.

Q: Is your state doing anything differently or preparing in any special way for health care reform?

MK: We’ve got some experience with some of these changes, which helps. But for a regulatory agency like ours, which has a pretty small staff, there’s also a tremendous amount of work involved. Our rate review staffers, including actuaries, are closely vetting rate requests. Our forms experts are scrutinizing new policy filings to ensure that they comply with the new law. Our policy staff is looking at what state laws may have to be changed to comply with the federal law. And people throughout the agency are retooling their jobs to deal with these major changes in our nation’s health care system.

Q: What did you get out of President Obama’s recent meeting with several state regulators?

MK: It was a valuable opportunity to discuss key details, such as medical loss ratios. I think it was also an important recognition of the role that state insurance commissioners play in implementation. There’s a reason that the National Association of Insurance Commissioners was mentioned so many times in the legislation itself. Regardless of what individual state officials may think of the legislation, it is now the law of the land, and it’s up to us to help make it work.

Mike Kreidler was re-elected to a third term of office in 2008 and has served in a variety of elected offices and appointed posts.

Washington Facts At-A-Glance


United States


Total population



Median annual income



Health costs and budget

Health spending per capita


$5,283 (by state of residence)

Average employee contribution for family premium (% of total premium)



Health coverage

Uninsured population (% of total population)



Uninsured children (% of children)



Medicaid enrollment (% of total population)



Medicare enrollment (% of total population)



Monthly CHIP enrollment, June 2009



Health status

Infant mortality rate (per 1,000 live births)



Teen death rate (per 100,000 population)



AIDS diagnosis rate (per 100,000 population)



Overweight or obese children (% of children)



Adults who visited the dentist/clinic (% of adults)



Adults with disabilities (% of adults)



Source: Kaiser Family Foundation State Health Facts


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