>> today on c-span, "newsmakers" with ben nelson, the ceo of the national association of commissioners. then a hearing on transportation challenges facing seniors. >> joining us from "newsmakers" omaha this week for "newsmakers" is ben nelson. the ceo of the national association of insurance commissioners. this is the deciding vote for the affordable care act. welcome. >> thank you. >> welcome. >> thank you.

>> enchants commissioners are divided about whether to go along with the request to allow carriers to reinstate canceled policies. there has been a deep divide. who is right? explain what it is all about. it is based at the state level. the latest information we have states ofr or not t going to go along, i think 17 states as of right now have go ahead do this, and extend renewals and not cancel the policies. 18 states have decided not to go along with that recommendation and are chosen to go another way. a third.ce is about oure that have not decided

still looking to do whatever they think they can under their laws. not surprising that there are different approaches when you have a state-based system as we do. >> has though been anything you're able to do? there has been a lot of controversy over this. some commissioners said they did not want to go. the naic has learned is we do not enter into the policy considerations. it is an ample mention -- implantation job. there are some who are elected. there are some that are appointed by governors. they may be appointed by a commission. in policyent generally. to >> before we leave this topic, to be clear, even in the 17 states that are deciding to

go along with that, there's no guarantee that people keep their policies will get the same rates. is that correct? >> that is correct. of questionsmber that have come up about the decision to have the health and human services department not implement that part of the law that basically required terminations by a certain date in cancellation notices were sent out accordingly. the concern is about having the policies extended into the next year, some people will decide to do that. some people will decide not to. there's always a concern that people with health conditions will want to extend the coverage. others will choose to opt for other coverage elsewhere. is now there will

be two different pools of individuals -- those who are having their coverage extended and then the other pool which is a larger pool of people who will be buying policies and going into the affordable care act as a result of the first of the year. this is a challenge. under the law actual oriole -- actually approaches, it is based on large numbers. you want a large pool so you do not end up with people with simply health commissions or that will skew the rates and make them much higher. that is the challenge. that is the challenge this has created. the problem with trying to do something at the very end or in ends up hour is that it with other challenges and conditions. in this case, the consequences.

this is the latest pickup in the implementation of the affordable care act. >> is that the only thing they have made as this tries to lock out. you did both in support of the law and afterward you stuck by your support for the affordable care act. are you having any doubts about of the affordable care act giving the problems we have seen over the last few months? what lenny express it this way. -- >> let me express it this way. i do not discuss the policy. i am not in the position to discuss what i think about it today. i am assisting the states in implementing it. some of the states are opposed

to the affordable care act are very supportive. i support both sides. it is not appropriate for me to go back and reconsider and discuss policy at this point in time. think that is probably understood. robustrly, there is a debate not only about whether the law should be repealed or are the stepswhat that should be taken to ensure that the law works as it was intended. your members, even some of whom opposed the law, believe it is a good public policy reasons for engaging in discussions on how to improve it. the top fewthink of things that need to be done legislatively or administratively to make the law work better for consumers and the states?

there are a lot of things that have been discussed. unfortunately, the act is frozen in time with changes to the act by notto the white house enforcing certain provisions such as cancellations. there are a lot of things that implemented. the rolling of the act has this for the act itself. one thing that is important is to note that in the act, states have the option to have their own exchange. cases they have had very successful results.

there haveioners worked to try to have their own exchange. they are having good results. what can be done to make it better were some people have some concerns about what it does? if you're looking at some positive acts and why some , youngsupported so much people can stay on their policy -- their parents policy until they're 26. after the first of the year, pre-existing conditions are not enforced against adults or young people. they are not enforced against young people right now. there are things that people for positive.

0 maybe this could be just as successful such as open enrollment, closed enrollment . these are being discussed. i do not think there are any answers right now. there does not seem to be much of an interest in opening up the act to try to change it right now. maybe that will change after the 2015.of the year and into >> do you believe nebraska should be running to making its own exchange? a lot of folks think it might make sense for other states. that remains to be seen.

there will be the governor's election next year. with the new governor coming in. the new governor may see it differently. the legislature may see it differently. points in the the act. the states have the rights to make that decision based on what they think is in the best interest of their people back home. the same thing with expansion of medicaid. some have chosen to do it. some have chosen not to do it. the ability to make those of what manypart people favor with in the act. addition to the discussion about renewing canceled policies, there's also been some extending thist past the end of march to allow more americans to enroll in

health coverage given the problems with the healthcare.gov website. what you think about the wisdom of doing that? >> you are changing the rules after it has been said. to thees that do arearial calculations that in place right now under the assumption that you would have a certain number within that pool? in the sense of getting more people in the pool, that has more than appeal. that is important to the nature of the pool. the larger the pool, the better of having have perhaps lower rates because you will have the only people with health conditions but you will have healthy people in the pool as well. there is an advantage in doing it. i just do not know what the consequences of changing that

particular structure would have on the rates. have controlhey over us what to do in response to the position to delay open enrollment for 2015 by a month to presumably give carriers in m -- an extra month of claims data . it is decided to move this around. what are your members thinking about doing? the consensusink is there? >> some states do have authorities over rates. others did not have any authority whatsoever. that is a concern. health and human services has some control or authority with respect to rates. i suspect that remains to be seen, how they are going to

react to what ever the claims timeshows for that extra frame. everybody understands that when to not be the rules, surprised if there are some surprises. it is difficult enough when you have a closed time for thislations based on timeframe. it is only harder when the timeframe has opened up an additional data is brought in after rates have been established. we will all whether through this. has.ndustry shield hasblue announced they are allowing covers should be extended. will perhaps have to look

tok at the first of the year try to calculate how this all worked. large piece of is subject to a andain amount of revision fixes and so forth. there has been quite a few of them down at the 11th hour. how much of this to you think was avoidable. >> of this has not become frozen in time -- if this had become frozen in time where there is no effort to try to approve it, change it without regard to whether it is being appealed or not, perhaps it would be a different situation.

these plans can never simply be static. lavishly this -- legislative changes have been made over the year. when that does not happen, it is very difficult to take advantage d/or betterce an/ ideas on how to approach something. if it is established that the is insufficient to get people to join, maybe you move away from that info to open or closed in roman times. if it stays frozen in time, -- open or closed enrollment periods. some stays frozen in time, of the stuff that should be a prude will stay there and not

get it approved. that should be approved will stay there and not get approved. bill that can a now be improved or at least changed. not everybody agrees this is an improvement. to thaw out it take the legislative process? my name is benjamin, not berlin. time. to take some are so polarized right now that it is obviously not possible for it to occur. a change in the polarization, maybe it is someble to have cooperation and working together

to try to find some fixes to the things people are identifying as being problematic. >> the reports are suggesting that groups are planning a major the healthically on care law. what possibility is therefore this thawing out you are describing knowing we're going into the midterms with this opposition? >> i do not know. very often the midterm elections and up with the white house in having more of the opposition elected in the house or even within the senate. there are some exceptions but that typically is the case. i do not know. i do not imagine that there will be many people running next year in opposition to the white house that will be running to say i want to improve and send me to washington to improve the affordable care act.

i do not imagine that will happen. i do not have a crystal ball. i am going on past experience. this could change. keeps the law frozen in time? both sides are willing to come together and able to commongether and find legislation and agreement about how to change the law, it'll stay frozen in time to the unablethe white house is or chooses not to make certain changes in implementation as in the policies. that will be more in the arena or time to change the law and leading it up to the states and industry to make certain adjustments.

not be consistent everywhere, obviously. it is not mandated. it is not have the full force of the law. not be an there will overall comprehensive change to the law even coming from those directions. >> one of the polarizing issues contraception coverage requirement, it was not something considered to be controversial at the time. it has emerged in a very big way including in your own state. is there any suggestion that you might have or idea out there for a way that there might be a in aomise that results decision before it reached the supreme court decision stage? >> i do not know. polarization is pretty severe in this situation.

i have heard all of the arguments. knows thehink anybody answer to that. apart from having options for companies to choose whether or not they are going to cover or not. that does seem to be the one area where some people are in agreement. there are others that want to mandate how coverage to be included. it has never been mandated in the past. use policies to cover or not cover it. itthe absence of a mandate, will be in this area of disagreement. >> we have five minutes left. you a little bit more about a job that your

members are doing. you alluded earlier to the great variation that exists between states in terms of what insurance regulators are able to do. as some have great authority to review and reject insurance premiums they deem unjustified and other states. there's little authority to change rates. that one ofo say the goals of the affordable care act was to increase oversight of insurance premiums and what insurers are doing. see the statesto that do not have strong oversight systems to improve them legislatively if necessary? >> i support the state-based system. the president said, referring to announcement, i support the state-based system. i think they can make certain decisions about what is in the

best interest of their constituents. consequently, i happen to be a jeffersonian democrat and believes very strongly in the laboratory of democracies and having multiple approaches rather than a single approach. you can see what happens when you try to have a single approach. i think it is in the best interest of the people back home when their governor does what they feel is best for their people. i am very supportive of the differences. some of the best legislation to protect consumers has a developed. not out of washington but back home. i am strongly supportive of state right to be able to make thatof these decisions

have been engaged in the civil and legislation. overall, i think the states have served people back home very well, doing it their way. >> final question. i am a former insurance commissioner as well as governor. i can look at it from the eyes of a commissioner as well as from the eyes of a governor and a senator. having seen all of those different views and looked at the viewpoints, i strongly support what is happening with the states having that right. apparently, the president does as well. >> asking you as a former insurance commissioner, do you feel the states with rate review authority or trying to negotiate with carriers have seen more competitive premiums? do you think it is not as clear- cut as some would suggest? >> i know some of the states

that do not have it right now -- ofe right now a rate approval have been seeking it and perhaps they will end up getting it through their state legislatures. a state issue. some believe in open competition without regard to dealing with approval of rates. withseem to be satisfied it. others would rather have more control over rates. states have control over rates. is really, i think it a state issue where commissioners and governors and legislatures can decide what is best and what works best. if it does not, they have the opportunity to change it. one of the problems we're seeing right now with having a single approach out of washington is that it is very difficult for washington to deal with every issue that comes up.

we're seeing that right now. >> that is it for our time, senator nelson. thank you very much for joining us. we appreciate your time. >> thank you. it is always a pleasure to be on your show. thank you. to >> let me ask you about what is ahead for consumers. though there are still a lot of the insurgency among which states will be participating in certain aspects -- absurd aspect that won't. -- and a certain aspects that won't. >> there would always be discussion over medicaid expansion. their markets existed even before the law kicked in and mitigated some of the impact. over the last couple of weeks, some of the changes that have to thewn is coming back state insurance commissioner.

some of the most important people in the room have gotten forgotten. you're going to see this very different experience across state lines for a law that was supposed to be federal in uniform. >> the consumer experience in california is going to be very different. -- from nebraska. that is different than the number of health plans a consumer might have, how aggressively regulators were looking at the prices and pushing back on insurers to make sure the prices were as low as possible. the problems over the past few weeks with the canceled policies and responses from different states is only going the difference is further. if you are a consumer and connecticut or colorado, you might look at this law as a great thing. you get a lot of different things to do. if you get in a state where it is not working so well, you

might look at this as a terrible thing. the statestics of going into the law are almost predetermining the likelihood of states passing them. they often set up exchanges which are working better. in some cases commissioners have been more aggressive about negotiating great spirit and taxes, it might feel like you're getting a bad experience but you predisposed. we learned the supreme court is set to review it. we will hear the case may be as early as march. what does this add to the mention of understanding what the provisions of the law actually will be? is there a possibility that the review will go farther? who supported the requirements, they are very concerned of the consideration.

you can our group does argue whether there's some debate over whether they can have this on their own. did would see this as they with the legislative amendment that was put forward. they're certainly very nervous about it. >> it is important to keep in mind that there has been a lot of talk of the law is back before the supreme court. the case that was before the supreme court last year and the decision they made was on the fundamental foundation of the law. chanceemember there is a that the entire locking get thrown out. this is a very -- law can get thrown out. this is a very careful point of the law. if you believe contraception can or cannot be covered, this is an important issue.

what the justices decide, i do not think it will fundamentally change the law or make its future more or less certain. >> last question. november 30 was the self-imposed deadline by secretary sibelius on fixing healthcare.gov. how important is it to the actual success of the law but it works this time around for people? the folkse to look at who are running around the states who are in the same position as the people who are more anxious than anybody. stressful fory the administration setting the deadline. you tos them calm thank them from supporting legislation that has more fundamentals of the law. are that itations will still be problematic going forward. there are probably going to be other things that are not going to work quite well.

the administration may say it is a lot better. i think it is a lot better. people are getting through. >> it seems to be sure that whether or not they are seeing commercials for health care ads, 2014r political will be there. thank you for being with us. >> thank you. >> next on c-span, the history and role of women in politics followed by a senate hearing on transportation challenges facing seniors, especially those in rural areas. they discuss the impact of technology on the economy in the next 3 -- five years. hundred 75 years ago a white center from charleston south carolina became the first american woman