State Insurance Commissions are Children’s Coverage Partners Too

According to 2014 Census data more than half (61 percent) of all children in the United States are covered by private insurance, and 43 percent have public coverage (some children with private insurance are also enrolled in Medicaid.)

Over the years many efforts, including much of the children’s coverage work at NASHP, have focused on improving public coverage for children. However, with the large number of children enrolled in private health coverage it is important that child health policy officials and stakeholders are familiar with the role of state insurance commissions in regulating this coverage. NASHP recently held a webinar exploring opportunities for states to improve private health coverage for children through the actions of their state insurance commission.

During this webinar, Brian Webb from the National Association of Insurance Commissioners (NAIC), discussed the dual missions of state insurance commissioners – encouraging a robust insurance market while protecting consumers.

Insurance commissioners aim to promote these robust insurance markets by striving for competition to provide ample consumer choice among health plans. They are responsible for reviewing and approving fully insured health plans offered in their state as well as the rates the plans charge. Commissioners are tasked with enforcing the state and federal laws that regulate private insurance. Also highlighted in the webinar, was the fact that many states have their own consumer protection laws and regulations for the private market, such as specific network adequacy standards, beyond what is required by federal regulations.

In addition to regulation enforcement, insurance commissioners also handle customer complaints regarding health plans. In this role, they provide education about the costs, provider networks, and benefits offered by health plans that are available in the state’s market. It’s important to note that insurance commissioners are not responsible for direct management of the health plans sold on the market. This means state insurance commissioners do not have as much flexibility to make policy and procedural changes to private insurance as state Medicaid and CHIP officials do within public health coverage.

In addition to understanding the role of state insurance commissions, it is important to know the differences between public and private coverage from the consumer perspective. As more families transition into or enroll in private coverage for the first time, they will need help to understand differences in costs, benefits, and provider networks in order to access the care they need. Public coverage officials, insurance commission staff, and child health advocates can work together to help families understand these differences.

For more information on the role and responsibilities of insurance commission offices, please see the slides and recording from our recent webinar. Also stay tuned for another blog post that will highlight some of the details shared during the webinar on benefits, network adequacy and more.