Godfread: Graham-Cassidy still achievable
Herald editorial board
Jon Godfread has been commissioner of the North Dakota Insurance Department for nine months and, despite a few frustrations, he says he has been pleasantly surprised by the job.
Godfread visited for an hour recently with the Herald editorial board, allowing the newspaper to ask him questions about all things related to insurance.
His goal with the visit was to release new health insurance premium rates for Affordable Care Act-compliant plans to be offered in North Dakota in 2018. But the conversation eventually evolved into one about Medica's decision to pull out from the North Dakota marketplace, and even to Godfread's efforts to build morale and communication in his Bismarck office.
And he believes the Graham-Cassidy Bill—the Republican-backed alternative to the Affordable Care Act—still has merit, despite its death this week when U.S. Sen. Mitch McConnell decided to not hold a vote due to lack of support.
Godfread earned his position by getting 64 percent of the vote in the 2016 general election. The first-term commissioner is a graduate of Grand Forks Red River High School, the University of Northern Iowa and the University of North Dakota Law School.
Following are his comments—edited for clarity and length—to several questions posed by the Herald editorial board:
Q: You're here to release the ACA market rates. What are your thoughts?
Things are in flux, for sure. Last week, you probably saw that Medica is pulling out of our individual market on the federal exchange. Who that truly impacts is the folks who receive a subsidy, as they'll no longer be able to get that subsidy for Medica insurance.
The good news/bad news is that Medica covers about 3,000 out of roughly 42,000 on the individual market in North Dakota. It's a really small piece of that market. But in my opinion, it's a sign of things to come. If this doesn't get fixed, we're likely to see more of this.
Q: Why did Medica pull out?
In my opinion, it has everything to do with the cost share—the payments that are supposed to go to the insurance company from the federal government.
Those payments are in flux for 2018. The companies asked me to approve rates that would assume those payments will not be made, which would have bumped up their rate about 8 to 10 percent on top of the 18 percent. I said I wasn't willing to do that. ... Frankly, it puts our consumers in a situation where they are paying inflated premiums. If I do it for Medica, I have to do it for everybody. It's a guessing game, and my opinion is that it shouldn't be on the backs of consumers. ... It's not their fault. It's frankly the inaction of Congress at this point that's causing a lot of this.
Q: Do you have thoughts on achievable health-care reform?
I still believe the Graham-Cassidy legislation is achievable. In a lot of respects, it's everything we asked for. You get more flexibility, and in our calculation we got more money. It removes some of those strings and allows us to tailor what we need.
Health insurance by its nature is population driven, and our population is different than Alabama's and New York's. We have different needs, and we should be able to tailor some of that.
I wish (Sen. Mitch McConnell) would have held the vote. You would have known one way or another where everybody stood and put them on the record. This is a big campaign promise for a lot of our congressional folks.
The thing that disheartens me the most is you see some of these rate increases. ... In some states, you have folks facing 50, 60 and 70 percent increases in the individual marketplace because those states are down to one carrier, and that carrier can kind of get away with whatever.
These are real people. These are small-business owners, farmers and ranchers—real folks who are really taking it. This needs to be fixed.
Q: Did the National Association of Insurance Commissioners take a position on the bill?
They generally don't take positions on individual bills because every commissioner is different—some are elected, some are not, some are of various parties.
But the one thing we have all come to agree on is the need to stabilize CSR (cost-share reduction) payments.
We thought those things were no-brainers, but even they can't get agreed to. It's a hyper-partisan world that they're living in in D.C. and it really makes it tough on average folks who are trying to figure out how to pay for health care.
Q: After nine months in office, what's your takeaway from the job?
I thought I would enjoy it, and I'm enjoying it a lot more than I thought I would. The great thing about it is it is really something different every day.
One of the great things about North Dakota is we are still a small state so, for lack of a better term, we can be a pilot project for some of these things. We can react quickly and, as slow as government moves at times, in North Dakota we can move more quickly because we are so small.
We are basically a moderately sized city, as a state. It gives us some different tools.
We're able to make some impact on some folks, and that's been fantastic.
It's also good to have a renewed sense of collaboration with our agent community.
Q: How so?
As much as this office regulates the agents—we're a consumer protection agency, so we're in charge of making sure our agents are acting appropriately—they are the first contact with the consumers. So if we don't have a good, collaborative relationship, it makes it hard for us to know what's going on in the marketplace.
They're the first eyes and ears, and especially on insurance fraud. They're the first ones to know about it, way before I will, so I need them to be able to tip me off and give me information.
So renewing that collaboration with the agents has been good. And that's all without the legislative session, which was the first thing I walked into, and which was an interesting experience with all the budget issues we've had.
It's been fascinating and never a dull moment. It's everything I'd hoped for—that's the cheesy way to put it.
Q: What were the goals you set before getting the job? How are they progressing?
The goal I wanted to initiate right away was being more proactive and outreach-focused. One of the first things we did was hire Ashley (Kelsch) as public information officer. That position had been combined with another position for a number of years, and it wasn't necessarily an area of focus for the office. I think it's important.
So we have been a lot more active on social media and just being more forward-facing on issues and more guidance-centered. I think we've done a good job with that.
Also, there was a mentality among the agent community that there was an adversarial relationship between the department and agents. There was a guilty-until-proven innocent mentality that they had. So breaking that down right away has been good. I don't know if I'm there yet. Right now we doing agent forums, going to seven cities around the state to have discussions with agents and hopefully show them that we're here to work together. ... We're here to listen, and we have done some of that.
We have had some different associations the agents represent come in, and we have worked on issues together. Even in this last legislative session, we have made some changes that agents have been waiting for to allow them to do their job.
I'd much rather have them out there servicing their consumers and clients than worrying about some archaic regulations we have.
Internally, we are hopefully empowering people within the department to own their jobs and enjoy what they do. I'm not sure everybody loved coming to work every day the last number of years, and I believe there has been an opportunity to, again, invest in them and say, "this is your department, and you have been running this for 20 years, so own it. I will get involved when you need me to. When you need me, I'm here, but you have to own this, too."
It has been good, and I hope people are getting excited about coming back to work.
There are a lot of great things we do in the insurance department, and a lot of great things that insurance does for people. But nobody tells that story, and nobody is out talking about it. It's not necessarily the sexiest topic, anyway.