Consumer-Friendly Dave Jones Rubs Some in Insurance Industry the Wrong Way

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SACRAMENTO, Calif. — California Insurance Commissioner Dave Jones is something of an anomaly.

Following the 2010 elections, which saw historic victories for Republicans across the country, Jones, a Democrat, came into office saying that he intended to be "an activist" who would "make the California Department of Insurance the strongest consumer protection agency in the nation."

Jones, 49, has tried to make good on that promise by being an outspoken supporter of the federal Patient Protection and Affordable Care Act. At a time when state legislatures and regulators in other states were working to limit the impact of the Affordable Care Act, Jones made implementing the law his top priority. He has also pushed the state legislature to pass a series of policyholder protection bills that would affect a number of insurance lines.

"We're trying to ensure there is a level and fair playing field for consumers in California, which hasn't always been the case," Jones told Best's News Service.

But perhaps the most high-profile aspect of Jones' first year in office has been his push to expand his rate review authority by rallying for the passage of A.B. 52, a bill that would allow him to reject health insurance rate increases that are deemed excessive. Under California law, the insurance commissioner has that authority for automobile and homeowners insurance but not for health lines.

However,  the bill was pulled from consideration after its chief sponsor said it didn't have enough votes to pass the Senate (Best's News Service, Sept. 1, 2011). Jones has pledged to try again next year.

That effort has drawn praise from consumer advocacy groups, but it has put Jones at odds with the health insurance industry in the state.

"People are trying to hang on with these ever mounting rate increases, and the problem is only going to get worse after 2014, when the individual mandate goes into effect under the federal Affordable Care Act," Jones said. "I think insurers will act as rational economic actors and will have a greater opportunity to raise prices since the have a totally captive market."

Although he serves as California's top insurance regulator for PPO plans the Department of Managed Health Care regulates HMO plans  Jones did not start his career focusing on insurance issues. As a lawyer, Jones represented a range of clients that included low-income California residents and Attorney General Janet Reno in the Clinton administration.

Jones first became actively interested in insurance issues after he was elected to the California Assembly in 2004. During his six years in office, Jones frequently clashed with insurers doing business in the state.

In 2007, Jones supported legislation that would have required health insurers to spend 85 cents of every premium dollar on medical care for patients, with the other 15 cents going to administrative costs. At the time, that bill drew fire from the Council for Affordable Health Insurance, a group comprised mostly of
health insurers, who said the loss ratio shouldn't be one-size-fits-all. (Best's News Service, July 17, 2007). That bill was ultimately defeated, but a similar provision was included as a key part of the Affordable Care Act.

Jones has also been pushing to give the insurance commissioner health insurance rate review for years. A 2007 bill Jones authored came close to that goal but fell short in the Senate health committee.

The latest incarnation of that proposal, A.B. 52, has been a flashpoint for health insurance industry trade organizations in recent months as it appeared headed for passage.

Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, criticized the bill as being "ineffective" because it would "do nothing to cut back on the real cost driver — the rising cost of medical treatments."

Richard Wiebe, a spokesman for the Association of California Life and Health Insurance Companies, pointed to an analysis conducted by the Assembly Appropriations Committee that found that A.B. 52 could cost as much as $30 million to implement, Wiebe said, "Rate regulation only adds another layer of costs." Jones has called the $30 million estimate "outrageously inflated" (Best's News Service, May 16, 2011).

Those who know him say that Jones has made consumer protection an overriding theme of his career, regardless of the job he had.

State Controller John Chiang, who has been friends with Jones since high school, said, "He doesn't like to fight by nature. But if he has to for consumers, he has no problem doing it."

While health insurance has been the focal point of his first year in office, Jones has also pushed for policyholder-friendly legislation in other lines as well.

Earlier this month, the California Legislature passed a bill that would allow employers to negotiate the terms of arbitration proceedings, including whether to negotiate and resolve arbitration disputes in California (Best's News Service, Sept. 7, 2011).

That bill was important, Jones said because "quite a few businesses complained to me that they would be dragged to Florida, Delaware or New York to resolve disputes with their carrier, and they couldn't afford to do that."

Jones has garnered praise from the industry on some issues. Mark Sektan, president of the Association of California Insurance Companies, said he has had positive dealings with Jones on workers' compensation issues. "We expect to work closely with him and his office next year as workers' comp issues heat up," Sektan said.

Jones has drawn fire from other insurance sectors for going too far in his effort to protect policyholders.

During an investigative hearing into whether life insurers have been using the Social Security Administration's Death Master File to cut off life annuity payments but avoid using the database to find life insurance beneficiaries who may be owed money, Jones grilled Todd Katz, executive vice president at MetLife, about the company's policies for using that file

Katz said that the issue had been overblown and that a sweep of all of its life insurance policies dating back to the 1960s had uncovered only about $83 million in unpaid life settlements and that the company had already paid out $51 million of those benefits. Katz noted MetLife had paid out over $44 billion in life settlements during the same period. (Best's News Service, May 24, 2011).

Either way, consumer advocacy groups have praised Jones for pushing back against insurers during his first nine months in office.

"He set the bar high by calling himself an activist at the outset. So far he has lived up to that. We hope he continues to do so," said Douglas Heller, executive director of Consumer Watchdog.

(By Jeff Jeffrey, Washington Correspondent: [email protected])

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