While President Obama has said that expanding health coverage to all Americans is a national priority, the nuts and bolts of such an endeavor bear much consideration. Accordingly, the Senate Finance Committee convened a roundtable discussion with a variety of industry and regulatory leaders.

Kansas Insurance Commissioner Sandy Praeger, said that any effort to increase access to insurance must first address the rapidly rising cost of health care. “While the health care challenge in this country is generally expressed in terms of the number of Americans without health insurance coverage, the root of the problem lies in the high cost of providing health care services in this country,” she said.

Another participant, Karen Ignagni, president and CEO, America’s Health Insurance Plans, stressed a streamline regulatory structure as a catalyst for expanded coverage. “Another important priority is to rethink regulatory structures to make them work better and provide for a more consistent approach in areas such as external review, benefit plan filings, and market conduct exams,” she said. “In a reformed market, policymakers should be driven by striking a balance between the traditional roles of the federal government and the states, and the objectives of achieving clearer and “smarter” regulation that promotes competition and avoids duplication of existing functions.”

Scott Serota, president and CEO of the Blue Cross and Blue Shield Association, countered that states should continue to be the primary regulators of the insurance industry. “Federal rules should set minimum standards upon which states can build, and all insurers offering coverage in a state should be required to abide by the same rules,” he said. “States have a long, successful history of regulating health insurance and protecting consumers—a role that could not be replicated effectively at the federal level.”

Praeger, attending on behalf of the National Association of Insurance Commissioners, agreed. ”In developing a national direction for health insurance reform, we encourage Congress to develop broad standards rather than prescriptive rules wherever possible to maximize state flexibility to implement reforms in a manner that is responsive to local and regional market conditions,” she said.

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