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Let's fight ACA-related policymaker paralysis

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State insurance regulators do plan to talk about Consumer Operated and Oriented Plan solvency and receivership this Sunday, in San Diego, at the National Association of Insurance Commissioners meeting.

As far as I can tell, that’s about the only public sign of life in the area of health plan failure policy discussions.

NAIC’s Health Insurance and Managed Care Committee set up a CO-OP Solvency and Receivership Subgroup in April. The committee gave the plan failure topic some attention by scheduling this weekend’s CO-OP solvency session.

But, at press time, the subgroup had not published anything on its section of the NAIC website other than the telephone and fax numbers of its NAIC staff contact and the fact that it had a private, regulator-to-regulator session in April.

Policymakers in Washington don’t seem to be saying much more about efforts to help the consumers, providers and commission-payment-seeking agents and brokers affected by the failures of CO-OPs or other health plans. Tonia Khouri, a Republican candidate in Illinois, mentioned the failure of the Illinois Land of Lincoln CO-OP in a recent interview, but in-depth candidate comments on the topic are not easy to find online.

The creepy silence about the health plan failure issue seems to echo the nation’s general approach to talking about Affordable Care Act problems: We bottle up the fact that we’re a nation with an undeclared Red-Blue war, in which policymakers can’t solve any problems, no matter how nonpartisanly alarming (see: Zika fight starts to bite Republicans ahead of mosquito season) by keeping our mouths shut and hoping other folks will get blamed for the problems.

Republicans talk about how terrible and obstinate the Democrats are. The Democrats complain that the Republicans do nothing but try to kill the Affordable Care Act. Officials from the Centers for Medicare & Medicaid Services (CMS) send an official to a congressional hearing, and have the official say something along the lines of, “I’m sorry, but I don’t have that information at my fingertips. I’ll talk to my staff and have someone get back to you soon. Promise.”

Related: Bad lessons

Meanwhile, at the state regulator level, there’s the reality that regulators take time to react to problems. NAIC is now busy with proposals for preventing, and coping with, the kinds of financial problems that hurt life insurers during the Great Recession, about eight years ago.

Of course, no one wants to say anything that will hurt a creaky health insurer that could survive if everyone is patient, but the lack of serious public health plan failure discussions is disturbing.

Providers who treated patients covered by the failed, New York City-based Health Republic Insurance of New York plan had to fight hard to persuade anyone to come up with a plan for paying them.

Meritus, a failed Arizona CO-OP, said CMS was trying to get its CO-OP startup loan money paid back even before providers got paid.

Patients and providers are finding that, in some states, such as New York state, no guaranty fund provides any protection against the failure of a plan that’s organized as something other than a traditional insurance company. It’s possible that, in some states, a consumer who buys a honeymoon from a travel agent might have better statutory protection against agency insolvency than a consumer who signs up for health coverage from a non-insurance company issuer has against issuer insolvency.

It would be nice to see policymakers saying more about these issues, in public, without leaning on the “Democrats are all socialist monsters” crutch, or the “Republicans have always had it in for Obamacare” crutch. The problems are real. The efforts to address the problems should also be real.

Allison Bell is the health channel editor for


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