The power play behind Proposition 45 could be fodder for an episode of House of Cards:
“Power is a lot like real estate. It’s all about location, location, location. The closer you are to the source, the higher your property value,” so goes protagonist Frank Underwood, who plays the menacing House majority whip scheming to get closer to the president.
You'd never think there'd be such positioning over who gets to regulate health insurance.
But this is California. And no less than three state agencies want to have a say in this one.
“I’ve taken a look at the regulation at the Department of Insurance and concluded it’s abysmal,” says Dave Jones the state’s insurance commissioner. “It’s too weak, it doesn’t provide enough teeth.”
Jones wouldn't like this comparison, but he's the Frank in this fight. Now, I’m not saying Jones is sneaky or evil. But he is campaigning for Prop. 45 to give himself the power to reject rate hikes in health insurance, even though there are two state agencies that already review rates: the Department of Insurance and the Department of Managed Health Care.
“But neither department has the ability to actually reject health insurance rates that are excessive,” Jones says. “And review simply isn’t enough. We’ve been reviewing for four years now and rates continue to climb.”
It's a message that resonates with a lot of voters. Many have been waiting for someone to do something about skyrocketing health premiums. Like Josh Libresco, a market researcher in San Rafael who buys his own insurance. Health care costs for his family have gone up more than a thousand percent in the last fifteen years.
“It has become our single biggest expense. Bigger than my mortgage. Bigger than my daughters’ college tuition, which is incredible,” he says.
Testimonials like this make Prop. 45 seem like a slam dunk. But here’s the plot twist.
The commissioners’ own allies are against him on this one.
Covered California is the state agency tasked with implementing the Affordable Care Act in California. Susan Kennedy is a member of the board. It’s a stretch, but let’s cast her as Jackie Sharp from Season Two of House of Cards.
“I’ve been in politics and government for the last 25, 30 years,” Kennedy says. She served as cabinet secretary for Governor Gray Davis and chief of staff to Gov. Arnold Schwarzenegger.
In the show, Jackie and Frank are united on most issues –- until they aren’t. Similarly, Commissioner Jones and Covered California are on the same side when it comes to Obamacare.
But they disagree big time on whether Prop. 45 would help health reform or undermine it.
Jones says Prop. 45 is the missing piece of the Affordable Care Act; Kennedy says the timing is all wrong, and that the measure would interfere with Covered California’s ability to do its job.
“It would be one thing if we were to vote for Prop. 45 before we had begun implementing Obamacare, but I just don’t see how it’s possible to inject an entirely different system into an existing one and not expect it to cause chaos, delay, and cost,” she says.
Covered California has its own power to negotiate with insurers who want to sell health plans through the state’s individual and small business marketplace. The agency keeps an eye to cost already, but Kennedy says that’s not its only priority.
“For the last hundred years, health care reform has been about controlling the cost of health care. And, we want to improve quality of care and the outcomes of health care as opposed to just the cost,” she says. “Those are sometimes very conflicting goals.”
In the Hollywood version of this debate, one side self-implodes, or pulls out a dirty trick to throw the others’ credibility into question. But in real life in Sacramento, this is where the debate spirals into a long he-said-she-said and ends with Dave Jones swearing it can all work out and everyone can work together.
“The Department of Insurance, which has had over 25 years’ experience with rate regulation for all these other insurance products has reviewed Prop. 45 and concluded that Prop. 45 can be implemented consistent with Covered California,” he says.
Polls show support for the measure is slipping, with a third of voters still undecided.
So I guess by my own metaphor, this makes me journalist Zoe Barnes, a comparison I do not appreciate, thank you very much. I assure you there were no shady deals in the making if this story. Though I’m pretty sure Dave Jones and Susan Kennedy will not be responding to my texts for a while.