The Summer 2010 Meeting of the National Association of Insurance Commissioners (NAIC) in Seattle Washington wrapped up last week. For those of us not lucky enough to spend a long summer weekend with a group of insurance commissioners, some friends of Community Catalyst provided the inside scoop on the meeting.

Victory on Medical Loss Ratios. The Executive Committee of the NAIC approved the medical loss ratio recommendation made by the subcommittee on this issue. In spite of receiving a lot of pressure from insurers, brokers and other industries, the Commissioners stayed the course and remained respectful of NAIC process by voting yes on the recommendation, with very few changes.  Thanks to the consumer representatives on the NAIC, who have worked for months to ensure the MLR definition is based on actual medical costs and evidence-based quality improvement efforts. And, thanks to advocates to who called their Insurance Commissioners about this issue. This is good news – and we expect HHS to accept the NAIC’s recommendation.  What this means for advocates: This is a procedural win that is gets us closer to a tool to fight unwarranted premium increases and get consumers better value for their insurance dollars. It also demonstrates that we need to monitor these decisions and make our voices heard as necessary to ensure consumers are protected.

Brokers feel the love. In a bizarre turn of events, the NAIC spent their summer weekend drafting an “ode to brokers.” The resolution, sponsored by a number of Insurance Commissioners, expressed support for the work that brokers do for the insurance market.  A clause in this resolution suggests that brokers should be favored as Navigators, the entities that will help to explain and enroll people in coverage and plans through the Exchange starting in 2014. This is inconsistent with the intent of the ACA, which clearly lists potential Navigators as “trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused non-profit groups, chambers of commerce, unions, small business development centers, other licensed insurance agents and brokers, and other entities.” (Section 1311(i)). It is unclear what weight this NAIC resolution holds.  But one thing is certain: brokers were flexing their muscles in Seattle, and many Commissioners were impressed. What this means for advocates: We need to educate Insurance Commissioners and others in state government about the importance of community-based groups in providing public education, health plan information, and enrollment assistance, other critical roles of Navigators.

Everyone’s thinking about Exchanges. NAIC created a tentative workplan for the subgroup charged with working on Exchanges. They are dividing into 14 smaller workgroups (leads should be posted on the NAIC website soon).  But we hear that one of the subgroups will work on a “skeleton” model law for states, which will basically track the statutory requirements and no more. Other subgroups are likely to respond to HHS’s request for recommendations on (1) network adequacy, (2) marketing standards and (3) quality measures.  Another group will tackle “principles and priorities” on a number of other big exchange topics such as governance and operations. (TBD). Another high-level liaison group will work with state Medicaid heads on plans for collaboration. What this means for advocates: The NAIC may have helpful resources as states begin to design Exchanges.  More to come.

— Lastly, though not specific to NAIC, rate review grant announcements were also made last week. A number of Insurance Commissioners talked about using the funds to increase consumer involvement in the process and get more information out to public. What this means for advocates: If your state applied for and received a grant to increase rate review, now is the time to work with your Commissioner on a plan to increase consumer involvement in the premium oversight process.

— Christine Barber, Senior Policy Analyst