Ben Nelson, shown in this file photo, talked about health policy Sunday, in a panel discussion organized by the National Governors Association. (Photo: Chip Somodevilla/Getty Images)

One of the most deeply experienced insurance policymakers in the world says the best hope for fixing the U.S. health insurance system lies in private conversations between members of Congress.

Ben Nelson is a former insurance company chief executive officer, a former Nebraska insurance director, a former Nebraska governor, a former U.S. senator and a former executive director of the National Association of Insurance Commissioners.

Related: Ben Nelson to leave top NAIC post

Nelson talked about what he sees as an urgent need for informal lawmaker conversations Sunday, during a panel discussion in Washington, at a meeting of the National Governors Association. The NGA put Nelson on a panel about “negotiating a health care solution.”

Nelson, a moderate Democrat who was served in the Senate when the bills that created the Affordable Care Act were being debated, and who cast some of the votes that let the act come to life, said lawmakers who really want to improve the health insurance situation need to be talking informally.

“It seems to be a lot safer to do things informally right now,” Nelson said.

Lawmakers who want to try to change the ACA through formal channels, because of the problems the current ACA system clearly has, have to go home to face the wrath of crowds of people who are terrified that any efforts to change the ACA system mean full ACA repeal, Nelson said.

Nelson is now a partner at Heartland Strategy Group, an Omaha, Nebraska-based lobbying firm. He said the root of the problem with changing the ACA is that the unpopular parts pay for the popular parts.

Would-be ACA changers “don’t know what they can get rid of to save any money,” Nelson said.

One key to keeping a health insurance system stable is finding some way to make coverage nearly universal, to make sure the healthy people are in the system along with the people who are expensive to cover, Nelson said.

Haley Barbour, another panelist, agreed with Nelson that changing the ACA will be difficult.

In this video, Ben Nelson, Haley Barbour and other panelists talk about the politics of Affordable Care Act change. (Video: National Governors Association/YouTube)

Governors’ role

Barbour, a two-term Mississippi governor who served as chairman of the Republican National Committee, said anyone who thinks Congress can replace the ACA in a matter of weeks “just ignores the difficulty of doing it.”

“You can repeal Obamacare fast,” Barbour said. “You can’t replace it fast successfully.”

Barbour said that about 80 percent of the uninsured people who got covered because of the ACA obtained coverage through Medicaid.

The importance of Medicaid to the ACA makes governors critical of any efforts to change the ACA, because most governors know a great deal more about Medicaid than many members of Congress do, Barbour said.

Nelson agreed with Barbour on the importance of Washington giving governors as much flexibility as possibility, but Nelson said governors also have to watch out for moves by Washington to dress up steep budget cuts as an increase in flexibility.

Nelson joked about that problem in connection with Medicaid block grant proposals, or proposals to replace the current complicated federal Medicaid funding system with blocks of cash that states can use as they wish.

“When I was a governor, I loved block grants,” Nelson said. “As long as they were fully funded.”

The punchline — “as long as they were fully funded” — got a big, grim laugh from governors in the audience who are skeptical about the idea that any federal block grant program replacing an existing federal funding mechanism will ever be fully funded.

Related:

Governors weigh what ACA ruling could mean for their states

Health Care A Large Chunk Of State Budgets

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