Regulatory pros oversee PPACA implementation
New players draw on past experience to work through ambitious reform process and tight deadlines
Despite continued wrangling in Congress and some state houses over the high cost of expanded healthcare coverage, most of Washington now is focused on implementing the rules and requirements of the Patient Protection and Affordable Care Act (PPACA).
The Office of Health Reform (OHR) is working overtime to meet deadlines for 2010 policies. OHR Director Jeanne Lambrew coordinates these efforts with the White House Office of Health Reform headed by Nancy-Ann DeParle, as well as with officials at the Treasury and Labor departments who have key tax and employment-related provisions under their purview.
Particularly important for insurers is HHS's new Office of Consumer Information and Insurance Oversight (OCIIO), which oversees the development of exchanges and market reforms. This group will enforce medical loss ratios and establish high-risk pools.
At the helm of the operation is an experienced insurance regulator and consumer health advocate, Jay Angoff. Previously an insurance official in Missouri and New Jersey, Angoff understands rate regulation and health insurance operations. At a recent press briefing to announce grants to help states beef up rate review operations, Angoff noted that the program would help state regulators stop "unreasonable" increases.
Former Maryland Insurance Commissioner Steve Larsen heads OCIIO's Oversight Division, which is responsible for ensuring that insurers comply with new rules. Larsen gained notoriety in 2003 for rejecting a request from insurer CareFirst Blue Cross Blue Shield to convert to for-profit status and become part of WellPoint.
He recently headed external affairs at Amerigroup and chaired Maryland's public service commission. Larsen's office reviews insurer rates and policies on such issues as rescissions and exclusions. A main focus is to implement the forthcoming medical loss ratio standards, which are proving difficult for the National Association of Insurance Commissioners to shape.
Richard Popper, another Maryland insurance official, will head the Office of Insurance Programs. Previously in charge of Maryland's high-risk pool, he now will manage the federal temporary risk pool program and related state initiatives. In addition, this group will implement the early retiree reinsurance program, another operation that is slated to run only until 2014, when state and regional insurance exchanges are scheduled to provide individuals and small groups access to affordable coverage.
Rounding out the OCIIO leadership is health policy expert Karen Pollitz, most recently with Georgetown University's Health Policy Institute. Pollitz heads the Office of Consumer Support, which is charged with creating a Web site listing insurance plans and prices for consumers seeking coverage options in their state. The new portal goes live this month, but only with summary information on private plans, Medicaid and children's programs. In October, there will be more detailed pricing and benefit information, based on emerging requirements regarding information insurers will need to submit to HHS.
The information on coverage options will allow OCIIO's Office of Health Insurance Exchanges to oversee and govern the state-based exchanges when they are launched in 2014.
Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.