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Teresa Miller was dubious. What value could a public hearing add to the state of Oregon's highly technical review of a Regence BlueCross BlueShield of Oregon's rate increase request?
Sure, Oregonians are mad about rate increases. But how many are steeped in state insurance law or actuarial tables?
How many are versed in the factors that drive health insurance costs? Miller is, because she heads the Oregon Insurance Division. A Pendleton native and former assistant attorney general, the 36-year-old Miller is confident that -- with or without hearings -- state regulators dig deep, push back and give rate requests the scrutiny they deserve.
On June 2, when the division held a public hearing on Regence BlueCross BlueShield of Oregon's requested 22.1 percent rate increase, Miller had low expectations. As The Oregonian's Bill Graves reported Wednesday, it was the first such public hearing the division had held in more than 20 years.
"I was a little bit blown away at the hearing," Miller said Wednesday. "I was incredibly impressed by the level of comments that day."
Curious? You can go online at www.oregonhealthrates.org, read all the background materials and see the hearing. Somewhere between 150 and 200 people attended, but many more people have watched the hearing online since then. And this week, the Insurance Division announced a decision that will please many of those Oregonians:
Instead of a 22.1 percent rate increase, the state will allow Regence to raise individual premiums by 12.8 percent. That's still a whopping increase, of course. But people who buy individual and family policies directly from Regence (not from an employer) will feel the difference.
Laura Etherton, health policy advocate with the Oregon State Public Interest Research Group, estimated the lower rate will save Oregonians $12.5 million. But can we draw a line between the fact that a public hearing was held, and the fact that the state approved a rate 9 percent lower than Regence wanted?
No. Not a straight line, anyway. It's impossible to say that the same thing might not have happened without a public hearing. In allowing a much smaller rate increase, the division pushed back on Regence's underlying assumptions about the cost of federal health care reform. The division also gave greater weight than the nonprofit had to its $570 million surplus.
Still, we agree with state Sen. Chip Shields, D-Portland, who told Graves, "The more sunlight we put on rates, the lower they will be." Shields pressed for a package of reforms this year that would have illuminated the rate-setting process even more. Although the package fizzled out, Shields was on the right track.
But it isn't just ventilation and transparency that make the difference; it's also the education and immersion of the public that develops when you open up the process. Advocacy of the hot-headed variety doesn't advance arguments; cool, well-informed advocacy can deepen understanding and have an impact. Over time, public hearings can contribute to development of a deeper, broader troop of advocates.
What Miller realized at the public hearing is that it isn't enough to tell Oregonians that the Oregon Insurance Division will be vigilant in protecting them. "People need to see us to know they're being protected," she said. Particularly gratifying to Miller was seeing some people who showed up, angry, to testify, leave in a different state of mind after they saw their concerns reflected in the caliber of questions the Insurance Division was asking.
"People found value in just being heard," Miller said. "And if they found value in that, I want to hear what they have to say."
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