Of all the hot-mike incidents in recent memory, the one involving a candidate for the post of Georgia insurance commissioner probably isn't going to break any YouTube records. But to understand the state-level ground war raging over the new Affordable Care Act, this unguarded moment of accidental honesty is as instructive as any.
The victim: Ralph Hudgens, a Republican state senator in Georgia and one of nine candidates vying to be the GOP's candidate for the post of insurance commissioner. The setting: a syndicated radio talk show. The unfortunate comment, audible to those listening to the show through the live-stream version online: "The insurance commissioner can't do squat about health care."
Such a statement is practically blasphemy in a race in which candidates are competing to see who can criticize and even demonize the new federal reforms most effectively. After the incident, which happened during a commercial break and which reportedly prompted the show's host to send Hudgens a note of apology one of Hudgens' Republican opponents, Maria Sheffield, said via Twitter and Facebook, "Seriously, Ralph? Georgia needs a conservative to stop Obama. I will." (Georgia's governor has joined the multistate lawsuit attempting to prove the new law is unconstitutional.)
Hudgens had no choice but to stand by his statement, which happens to be basically true. Despite heated rhetoric from Republicans running to be state insurance commissioner this year the post is elected in 11 states the position itself is administrative. New rules governing everything from coverage of pre-existing conditions to how much insurers can vary their prices will, in many cases, fall to these regulators to enforce. The Affordable Care Act "is the law of the land," notes Sandy Praeger, the insurance commissioner in Kansas and head of the health-insurance committee within the National Association of Health Insurance Commissioners (NAIC). Praeger, a moderate Republican, is being challenged in her primary by a candidate touting his conservative credentials and opposition to Obamacare. Praeger, meanwhile, is helping draft regulations authorized by the new health-reform law in her leadership position with the NAIC.
"There's a lot of political posturing here," she says, noting that opposing the law carte blanche means opposing free preventive care for seniors, easy access to an obstetrician-gynecologist and allowing children to stay on their parents' health-insurance policies until age 26.
Indeed, when asked, anti-Obamacare insurance-commissioner candidates are on the fence about which new insurance regulations they might support and readily admit that, if elected, they will enforce all existing laws state and federal even if they are personally opposed to some, campaign rhetoric notwithstanding.
John Doak, a Republican insurance commissioner candidate in Oklahoma, says on his website, "I am opposed to the President's proposed 'universal' health-care plan because the federal government cannot provide adequate health insurance to Oklahomans ... As insurance commissioner, I will be a conservative voice opposed to federally mandated insurance." But what could Doak, a former insurance agent, do to affect the outcome for Oklahomans? "Stand up for Oklahomans in a leadership voice," he says in an interview with TIME. But in terms of his actual responsibilities as insurance commissioner, "What the law indicates is what will be done," he says. "If this stays in place and is the law of the land, the insurance department will act accordingly." When asked which new insurance regulations many of which are universally popular he opposed, Doak couldn't answer. Does he favor a ban on lifetime coverage limits? Not sure. How about the 2014 provision that will require insurers to cover all pre-existing conditions? "I am in favor of that, but there are many questions."
Sheffield, the Georgia candidate who called out Hudgens for his hot-mike comment, sounds practically indignant about the Affordable Care Act in a series of videos posted on her campaign website. "I will refuse to participate in any Obamacare policies that come across my desk," she says in one clip. "I will make sure the Obama Administration and other Big Government allies in Georgia will not, in any manner, be able to use the Department of Insurance as a vehicle to impose Obamacare on our state."
But Sheffield admits an insurance commissioner can't pick and choose which laws to enforce. (If a commissioner does this, the Federal Government has the authority to step in and take over enforcement responsibilities.) According to Sheffield, the difference between her and Hudgens is that she will keep pushing to overturn the Affordable Care Act, no matter how futile the effort might be. "If you're not willing to lead on these issues, you're just being a bureaucrat and not attempting to even offer solutions to people," she says.
Insurance commissioners, with such a vital role to play in enforcing the new health-reform law, have a lot on their shoulders. Offices will need to bulk up, actuaries will need to be hired. California, which recently investigated insurer Anthem over its proposed rate hikes in the individual-health-insurance market, had to hire an outside actuarial firm to review the company's books. (Mathematical errors were found.) The incident showed just how strapped insurance commissioners' offices are even with their current responsibilities. "The fact that they had to send it out to an outside agency is not good," says Gary Claxton, an insurance-market expert at the nonpartisan, nonprofit Kaiser Family Foundation.
To help states build up their regulatory infrastructure, the Affordable Care Act authorized $250 million in grants. The first $50 million will be sent out soon and Nancy-Ann DeParle, director of the White House Office of Health Reform, says state insurance commissioners and governors are eager for the funds, regardless of their ideology. "I haven't met a single one who thought they had all the resources they need," she says.
Told that some Republican candidates for insurance commissioner are campaigning on a platform of opposing the new law, DeParle dismissed such rhetoric as just that: "They take their jobs very seriously. They know they have a role to perform. I don't think people who get elected to that position believe they've been elected there to advocate for the repeal of insurance reform."
But in an election season in which public opposition to the new law is high about half the population, according to recent surveys the calls for repeal may strike an election-winning chord in some states, even if those calls don't exactly translate to reality.