Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Kansas Insurance Commissioner Sandy Praeger and key members of her staff were among the millions who watched the president’s televised health care summit with congressional leaders on Thursday.

“It sounds like they’re having a good dialogue,” she said after watching some of the give-and-take from an Insurance Department conference room. “The tone seems to be one of at least trying to find common ground. That’s encouraging.”

Praeger is a two-term Republican who has bucked her party by supporting elements of the health insurance reforms backed by the White House and Democrats in Congress. She has been among the handful of state insurance commissioners dealing directly with Congress on health reform on behalf of the National Association of Insurance Commissioners.

Despite the encouraging tone of the discussions, Praeger said she heard a lot of the same old things repeated and that ideological differences between Republicans and Democrats in Congress are still likely to make a bipartisan compromise difficult to achieve.

She offered a suggestion for the Democrats:

“I agree with my Republican colleagues on tort reform,” she said, referring to GOP proposals to limit damage awards in medical malpractice cases. Something supporters say could cut defensive medicine costs by one-third and help solve physician shortages in some areas.

“Tort reform is a key component of helping to bring costs under control,” she said.

Near the end of the day, President Obama said he was open to further compromise on tort reform, if Republicans were seriously willing to negotiate.

“I’d be interested in seeing if we could work something out,” Obama said, acknowledging that he would have to overcome opposition among Democrats.

Protecting consumers

But Praeger said some other ideas pushed by GOP leaders at the summit could hurt consumers.

Allowing insurance companies to sell policies nationwide is a bad idea, she said, because some states are weaker than others when it comes to regulating consumer safeguards.

“It isn’t enough just to have a piece of paper that says you have coverage if it won’t buy anything,” she said.

Praeger parts company with many Republicans on that point, including Kansas Congressman Jerry Moran, who issued a statement that included the sale of policies across state lines among the alternatives to what he called Obama’s “broken plan.”

Selling across state lines was among the planks in Arizona Republican John McCain’s health reform plan when he ran for president.

“The plan President Obama proposed in his health care summit today was not focused on new ideas, but a recycled plan that the majority of Americans oppose,” Moran said.

Sen. Pat Roberts, R-Kan., said in a prepared statement released late Thursday that while he appreciated the president’s willingness to “finally listen” to Republican ideas, he was disappointed that “he refused to take the steps for a real bipartisan agreement.”

Praeger said the president’s plan wasn’t perfect, but it contained three essential elements:

• Individuals must be required to purchase health insurance. Without a mandate, she said, young and healthy people could wait until they were sick to purchase insurance, driving up the cost of coverage for everyone. “That won’t work,” Praeger said. “It makes (coverage) way too expensive for those who really need it.”

• Insurance companies must not be allowed to deny coverage to those with pre-existing conditions

• Subsidies must be available to help low-income Americans afford coverage. “You can’t require somebody to have coverage that they can’t afford,” she said.

State vs. federal regulation

The reform proposal advanced by President Obama earlier this week – a blend of the bills that have passed the U.S. House and Senate – called for a new federal panel within the Department of Health and Human Services to review proposed increases in insurance premiums. It was added after California’s largest health insurance company proposed increasing premiums for some individual policies by more than 30 percent.

Praeger said she and other state insurance commissioners favor a federal advisory panel to help states develop standard review criteria but are opposed to a federal entity with power to approve and deny rate increases.

“That separates what we do now in terms of overseeing the solvency of companies from the rate review process,” she said. “And the premium is the key element in determining whether the company is going to have sufficient reserves to pay claims.”

Kansas law requires the insurance commissioner to oversee rate filings, but does not give Praeger the authority to deny proposed increases. Still, she said, the department has been effective in moderating some proposed rate hikes.

“We have not denied rate increases but we have worked with companies on a couple of occasions here in the last six months to get rates reduced,” she said.