Pounded by the Obama administration for raising premiums, health
insurers now must reckon with a foursome of longtime industry watchdogs
who are helping steer the federal government’s effort to overhaul the
private insurance market.

The four have top spots in the newly minted Office of Consumer
Information and Insurance Oversight, whose work will be key to the
success — or failure — of the new health-care law, which vastly
expands federal authority over health insurance, traditionally a
state-regulated industry.

On this year’s to-do list: writing rules to define when premium
increases are "unreasonable," creating coverage for people who cannot get it because of health
conditions and making sure insurers comply with consumer
protections.

The new director of the office is Jay
Angoff, a former Missouri insurance commissioner who once played
keyboard in the Brooklyn Bridge rock band. He gained a reputation in
Missouri as a demanding but fair regulator who saved the state millions
of dollars by creating a "competitive bidding" process for insurers that
wanted to cover state employees. A top priority now, he said in an
interview, is to "make sure consumers have as much market power as
possible."

Joining him are former Maryland insurance commissioner Steve Larsen, who
in 2003 rejected the sale of nonprofit insurer CareFirst Blue
Cross Blue Shield; former Georgetown University professor Karen Pollitz,
a longtime critic of the individual insurance market; and Richard
Popper, who runs Maryland’s insurance program for people who cannot get
coverage because they have health problems.

Their appointments suggest that insurers will continue to face tough
scrutiny as the administration and Democrats — with an eye to the
November elections — play up the benefits of the new law, while
Republicans denounce it as a costly government intrusion.

"It will be them against the insurance companies, them against
employers, trying to do everything to advance these policies to make the
plan look better," said James Gelfand, director of health policy for
the U.S. Chamber of Commerce, which opposed the law.

Angoff played down possible conflict, saying, "We work with industry
where we can, and where the industry is overreaching or not complying
with the law, we will make the changes we need to." He said he is
pleased that many insurers have volunteered to keep young adults on
their parents’ policies up to age 26 — even before the law requires it.

In putting the law into effect, his office will have to work closely
with states.

That’s "one of the most delicate dances of federalism" ever, said law
professor Sara Rosenbaum, chairman of the department of health policy at
George Washington University. "You could not ask for three better
people to be the dance partners."

Still, "they have an impossible job ahead of them," said Robert
Laszewski, a former insurance industry executive who runs a consulting
firm. "Any decision they make will wrong someone, somehow."

— Jay Angoff. Angoff was most recently head of the insurance
litigation department, which sues insurers on behalf of consumers, for
the Washington-based law firm Mehri & Skalet. As Missouri’s
insurance commissioner in the 1990s, he required Blue Cross of Missouri
to create a $400 million foundation to convert to a for-profit entity.

Before that, as a New Jersey insurance official, he helped draft a state
law requiring insurers to charge applicants similar amounts, whether
they are sick or healthy. In 2005, in a report for the New York-based
Center for Justice and Democracy, he angered medical malpractice
insurers when he used industry-provided data to show they were
overestimating future costs — and overcharging doctors as a result.

Earlier in his career, he worked for Ralph Nader’s Congress Watch, where
he became friends with Harvey Rosenfield, who founded the
California-based advocacy group Consumer Watchdog. Rosenfield describes
Angoff as "shrewd, analytical, incisive, politically astute and a detail
guy."

— Steve Larsen. Larsen, who will run the oversight division,
served as Maryland’s insurance commissioner from 1997 to 2003. In 2003,
he rejected the request from CareFirst to convert to for-profit status
and be acquired by insurer Wellpoint, saying the deal was not in the
best interests of consumers.

Later, he worked for the insurer Amerigroup, which runs Medicaid and
Medicare managed-care programs, and served as chairman of the Maryland
Public Service Commission, which regulates public utilities.

— Karen Pollitz. Pollitz, who led research efforts at Georgetown
University’s Health Policy Institute, will head the office’s consumer
support division, which is responsible for creating a Web site listing
insurance options and prices and other consumer tools.

Her research often focused on how state and federal regulations played
out in the market — and on the difficulties faced by small businesses
and consumers who purchase insurance themselves. Her 2001 study found
that people in less-than-perfect health are commonly rejected for
individual insurance coverage or charged rates that far exceed standard
premiums, practices that will be barred beginning in 2014.

— Richard Popper. Popper will head the office’s insurance
program division, responsible for overseeing state and federal efforts
to create insurance programs — high-risk pools — for people who are
uninsured because of medical conditions.

Since 2002, he has headed Maryland’s high-risk pool, which has more than
18,000 policyholders, and is credited with requiring insurers to
include applications for the program when they notify applicants that
they are being rejected for coverage.

"He’s the right person to make sure the public knows what’s in federal
reform and how people can access it," says Vincent DeMarco, president of
the advocacy group Maryland Citizens’ Health Initiative.

KHN (http://www.kaiserhealthnews.org)
is an editorially independent news service and a program of the Kaiser
Family Foundation, a nonpartisan health-care policy organization that
is not affiliated with Kaiser Permanente.