My Plan to Fix
California’s Insurance Market
Every American has a right to health insurance that is available, adequate, and affordable.
This is personal for me. When I was 22 I was diagnosed with a leaky heart valve. My doctor assured me I would be fine. But it meant I would eventually need heart surgery – and just like that, I was uninsurable unless I was employed. I’m fortunate: I had good insurance when the time for surgery came, and everything went well. But you shouldn’t have to be fortunate in America to have available, adequate, and affordable healthcare.
The Affordable Care Act finally fulfilled the promise to make health insurance available to all Americans. Unfortunately, more and more Americans are finding that insurance to be increasingly unaffordable because of rising costs and higher deductibles, and increasingly inadequate because of reduced coverage, longer delays and more aggressive denials.
This growing health insurance crisis is national and ultimately requires action by the federal government to be fixed. Furthermore, California’s regulatory system is uniquely dysfunctional because we are the only state to have a split regulatory oversight. Most health insurance is regulated outside the Department of Insurance by a separate government agency: the Department of Managed Health Care, which reports to the Governor.
Nevertheless, there are important steps the next Insurance Commissioner can take to address the crisis in health insurance. Here are two major reforms I will take as Insurance Commissioner.
Reform California’s Dual
Regulation of Health Insurance
California is unique in having two different regulators for health insurance: the Department of Insurance, and the Department of Managed Healthcare. This dual regulation creates complexity and confusion, which often slows down or degrades effective regulation. To give just one example: it took the Department of Insurance five years to enact the regulations that implemented the access to mental health care as passed in 2020.
Think tanks have argued for years that California should combine its regulation of health insurance into a single entity. But bureaucratic turf wars have prevented anyone from championing this effort. That will end under my leadership.
As Insurance Commissioner, I will lead the effort to enact landmark legislation to combine the regulation of California’s health insurance under one agency. I will cut through the bureaucratic fiefdoms that prevent reform. My priority will be to combine the best of both agencies into a single department that provides California residents the regulatory oversight they deserve – even if that means reducing the span of authority of the Department of Insurance.
Force Radical Transparency
of Claims Denials
Health insurance companies do not reveal details about their denial of care. This is completely unacceptable. It is also within the power of regulators to fix.
As Insurance Commissioner, as long as any part of the health insurance market is under my regulation, I will require all health insurance plans regulated by the Department of Insurance to provide detailed information about claims fulfillment and denial rates, such as:
The time from when a doctor’s order is placed to fulfillment or denial
The rate of denials
The reason for denials
Many states are recognizing the growing crisis of health insurance denials. Even though the Department of Insurance only oversees approximately 5% of health insurance plans in California, implementing radical transparency will expose the details of the crisis of health insurance denials and hold insurance companies accountable for their bad behavior and drive comprehensive reform.
