Pa.'s insurance chief trying to make health insurance work

Just because Pennsylvania Insurance Commissioner Joel Ario went to a Christmas party at President Obama's house in Washington . . .

Just because the two of them wound up sitting next to each other in the White House's Roosevelt Room when Obama dropped in on a recent meeting of insurance commissioners, insurers, and U.S. Secretary of Health and Human Services Kathleen Sebelius . . .

Just because Ario got prime seating at Arcadia University last week when the president spoke there about health care . . .

. . . doesn't mean the president and the insurance commissioner are bosom buddies.

But "I like him," Ario said. "I was certainly impressed with the guy. It was a nice experience to have. He's very low-key, a very empathetic listener, and I think quite persuasive."

It is Ario's leadership in an organization of state insurance commissioners that put him in contact with the president over issues involved in the current debate on health care.

"I think it's important for the president to be out there," Ario said last week, speaking in two interviews, one just outside Arcadia University in Glenside and the other from his office in Harrisburg.

"He puts the issues in broad context," Ario said. "He puts the broad questions out there and ties them together thematically. If he's not out there, what tends to get covered is a lot of parliamentarian rule - a lot of fragmented stories about process."

These days, the final push is on to enact some legislation that would expand coverage to 30 million people who lack insurance and would eliminate some insurance-company policies, including denial of coverage based on existing medical conditions.

Last week, a senior administration official told the Associated Press that Obama would delay his Thursday departure to Asia until Sunday in anticipation of final passage of sweeping health-care legislation.

"I've been working with the White House and Health and Human Services on messaging," said Ario, who is vice chairman of the National Association of Insurance Commissioners health-care committee. He had been chairman until 2008.

Ario knew Sebelius before she got to Washington. She had been a fellow insurance commissioner in Kansas and had, as a leader in the association, appointed Ario to his first leadership role in the group in 2000, when Ario was still the insurance commissioner in Oregon.

As to the message - this is what Ario would like to convey and does every time he gets a chance, even holding sessions in his church in Hershey:

For health reform to work, Ario preaches, everyone must buy insurance, the government must help those who can't afford it, and insurance companies must end their most egregious practices.

And to make it all happen, individuals and small businesses who are buying insurance need to have access to the same kinds of buying pools that allow risk to be spread over a bigger group, the way large companies do.

At Arcadia University, Ario did not get a chance to talk to Obama, but the situation was different March 4 in the Roosevelt Room, when Obama sat down next to Ario, and Sebelius scooted over one chair to make room.

Ario chimed in after Aetna Inc.'s president, Ron Williams, explained to Obama that hospitals were driving up the cost of insurance premiums.

"I agreed with Ron that costs were a problem," Ario said, recalling his comments. Even if insurers were doing everything right, new technology and an aging population eager to use it would push up costs.

But, Ario pointed out to Obama, medical costs were rising faster than inflation, at 6 percent or 7 percent. So "when you see premium [increases] of 20, 30 or 40 percent, that is some people paying more and other people paying less - that's how the pie is carved up.

"Why is the pie becoming more and more segmented?" Ario said he asked as the president listened. It was a rhetorical question, but even so, Ario said, the president turned to others in the room and asked, "What's the answer to Joel's question?"

In interviews last week, Ario explained: "It's the less-healthy paying a lot more so the younger, healthy people can pay a lot less."

When large companies provide insurance to their employees, all premiums cost the same - whether the employees are older or younger, healthier or sicker. That spreads the risk over a large group.

But insurers charge smaller companies and individuals based on age and gender, and sometimes medical history. And because the group is smaller, each person's status has more of an effect on the premium.

That means that a small company with a few women in their childbearing years or with a couple of baby boomers will pay more than a company employing young men. Or one person diagnosed with cancer can dramatically affect the small company's premium the next year.

Pennsylvania is one of two states in the nation that doesn't put some kind of limit on premiums for small companies so that the cheapest and the most-expensive available policies are not widely out of line with each other, he said.

The Senate bill in Washington says that the most-expensive premiums an insurer offers can cost no more than three times the least-expensive. The House bill set a 2-1 ratio.

These days, Ario is doing all he can to get the message out. After offering some sessions at his church, he even managed to convert the pastor to the idea that the government must mandate that everyone buy coverage.

Part of the problem is that so many people find the subject inherently dull. Ario understands, although he does not agree.

"Insurance is complicated, and people don't readily understand it, and the details get confusing," he said.

"Understanding the mechanisms of insuring is boring to most people." But, he said, "people turn to insurance in the most desperate moments in their lives, and it's our job to make sure the insurers treat them fairly."