Election 2020: Insurance Commissioner

Name: Trinidad Navarro

Trinidad Navarro

Party: Democratic

Age: 51

Family: Wife, Melissa; son, Jordan, and daughters Kylie and Hannah

Residence: Bear

Occupation: Insurance commissioner

Name: Julia M. Pillsbury

Julia Pillsbury

Party: Republican

Age: 68

Family: Spouse, three sons and a daughter, three granddaughters

Residence: Dover

Occupation: Pediatrician

Why are you running for this seat?

TN: I am running for reelection because I am the person who can best protect, educate, and advocate for consumers, and I have successfully done so as Insurance Commissioner. I have devoted my career to serving our community in Delaware, and standing up for residents when they need help the most. My track record of creating positive outcomes for residents of our state, generating cost savings, increasing insurance access, and holding insurance companies accountable is something that residents can count on. I believe that I can continue to deliver excellent service to our residents, seniors, homeowners, drivers, business owners, healthcare providers, and insurance companies. It’s important to be clear that this office serves residents on so many things — from car insurance, to Medicare assistance, to claim arbitration, to regulating the bail bond industry — I think it is easy for folks to assume we are focused on health insurance, when the reality is we do so much more.

We have made incredible progress over my term, working with the General Assembly to pass more than a dozen consumer-friendly bills, including legislation that ended the use of discriminatory practices in premium pricing, protecting residents from data security breaches, ensuring mental health parity protections, and codifying the Affordable Care Act. After decreasing ACA Marketplace premiums by an average of 19% last year, our efforts to increase health care affordability have continued. We are creating an Office of Value-Based Health Care Delivery to develop a more effective and affordable primary care system, and have begun to regulate the multi-billion-dollar Pharmacy Benefit Manager industry to address rising medication costs.

All the while, we are confronting new trends in the international and local insurance markets, including those associated with rising auto repair costs due to increased technology, the introduction of cost mitigation devices in property insurance, inflated health care costs, and the emergence of big data’s collection and use throughout the industry.

JP: Health insurance has become a serious problem in DE since the ACA was approved. People are spending large amounts on premiums for high deductible coverage. We currently have only one payer. Families do not have a choice.

What do you see as the major issues in this election?

TN: With the current and future health and economic impacts of the Coronavirus impacting residents, business owners, health care providers and facilities, and insurance companies, steady and strong leadership is needed during this unprecedented time, and I am the proven choice. There are a number of pressing issues for our next term, and the use of data is high on the list.

We know that for a long time, insurers would redline residents through high premium costs, using insurance credit scores. This is why my first priority in this term was to end discriminatory practices used by insurance companies to determine auto and homeowners insurance premiums. With the help of the General Assembly, we passed House Bill 80. This protects lower income and minority communities from discriminatory underwriting practices by forbidding the use of credit scores, zip codes, education, employment, marital status and other factors to determine premiums. While this decreased premium costs and helped residents, insurers have gotten more crafty on how they use big data, using algorithms that pay claims less frequently in urban areas, and collecting vast amounts of information through third party vendors to determine pricing. I have been working with insurance commissioners on this issue — this is both the forefront of premium pricing, and the forefront of possible discriminatory practices.

Currently, the complex algorithms use data such as magazine subscriptions, televisions shows, social media interests and several other factors that could be intentionally or unintentionally discriminatory. My staff and I participate in the NAIC (National Association of Insurance Commissioners) Big Data Working Group to develop regulations on this sort of data collection and use. Holding insurers accountable in this way, and in all ways, takes an experienced leader, and I have shown time and again that I am that person.

This issue is even more critical because of the pandemic. Already, insurers are requesting changes to their forms related to COVID-19. Life insurers, for example, are requesting to ask policyholders if they have been exposed to COVID, if a family member has had the virus, and other more arbitrary questions — like if they travelled outside of the country in the last year. COVID status could be a point of data that becomes a point of discrimination in the future.

JP: We need to have a choice of payers and affordable health care rates for all people in DE. We need to address the insurance needed for small businesses.

What is the biggest problem facing the state?

TN: While I’ve discussed several issues our state and its residents are facing as part of this discussion, I think the economic challenge tops the list. The pandemic has only exasperated the existing economic inequalities, the lack of a living wage for hourly and tipped workers, and the costs of childcare, medication, and other vital necessities. Delawareans, like people across the country, are having to make difficult sacrifices, like having to lose their income and health insurance because they have to stay home with a child who is learning virtually. When we see choices like this being made, we also see how existing inequities are amplified. For example, the issue of the gender pay and employment gap: right now, there are 1.6M fewer women in the national workforce than a year ago. 865,000 women have left the workforce in the last month alone — when school began — and this is not something we should forget as we discuss how to safely reopen our schools and our economy.

We’ve seen residents facing the impossible choice of having to find ways to manage their pain, illnesses, or addiction without help from employer-based insurance. I’ve worked with local partners throughout the state to train residents on life-saving techniques and distribute opioid rescue kits with Nalaxone, but it’s clear that this is a deadly choice to have to face that is escalating as a result of the pandemic — we are nearing 300 overdose deaths this year.

The economic challenge we face has given people choices to make on the most basic of necessities as well, choices like whether to pay their utility bill or pay for food. We worked with the Governor’s office to ensure that those facing economic distress early in the pandemic did not have to choose to go without insurance, putting a multi-month moratorium on insurance policy cancellations for nonpayment. Choosing to forgo insurance could have led to so many lost homes during our intense weather events this year, and driving without insurance can lead to license suspensions and a cycle of fines, fees, and even jail time that just isn’t acceptable in the face of this economy. I was glad to see similar moratoriums and payment plans enacted in the utility systems of our state.

With the closure of schools, community centers, and senior centers, food insecurity has been something that keeps thousands of residents up at night. We’ve come together as a community to fill this need wherever possible, but we know not everyone can access the help they need. I’ve been volunteering with the Food Bank and seen the despair of thousands of people waiting in line for hours for food for their families.

On the state side, the budget was often unpredictable, even without a pandemic, and now, with the state’s unemployment trust fund depleted, the state has had to borrow from the federal government at 2.4% compounding interest that will require repayment. Delawareans need those unemployment dollars, but it places questions into what the lasting impact will be on our state budget and the services that can be provided to residents. Similarly, the state’s investment of tax dollars, which included several industries that saw huge hits from the pandemic, like oil and gas, is bound to have lower-than-normal returns that result in budget impacts. The major rating agencies have been telling us for years that our other post-employment benefits, or OPEB liability, needs to be addressed or our AAA rating will be downgraded, and this too could thrust the state’s financials into uncertainty at a time when borrowing may become more necessary.

The economic challenges our residents and our state face aren’t simply because of the pandemic, but they have certainly been amplified by it.

JP: The Covid crisis and its impact on small business and the people of DE. Health insurance choice is poor in DE. According to the AMA, DE came in 4th in “States with the least competitive commercial health insurance markets, 2019,” 8th in PPO markets, 2nd in least competitive exchanges and 5th in market share of largest insurer.

What can the insurance commissioner do to help Delawareans deal with health care needs, especially during the pandemic?

TN: We have played many roles in responding to both the health-oriented impacts of COVID-19 as well as the economic ones. Focusing on the health side, our team acted rapidly in response to COVID-19, working to ensure that testing was covered by insurance and easy to access without pre-authorizations. We also worked to ensure access to telemedicine for both users and healthcare providers, and worked with insurers to reduce or eliminate consumer cost-of-care. Many employers who have had to cut hours or pay, or have had to furlough staff reached out to us, and we helped them to continue offering insurance benefits even during a time where employees may not be reaching hourly requirements. Even outside of formal bulletins, collaborative efforts on the Governor’s Emergency Orders, and working with the General Assembly on legislation, we’ve aimed to be responsive to consumer contact and trends, for example, we responded to the increase in overdose deaths with Narcan giveaway and training on life-saving techniques in an area that had become a hotspot of substance abuse.

Our response to the pandemic has been successful because of the efforts we have taken for four years — not just because of recent efforts, but because we have been fighting for affordable, accessible healthcare nonstop since I came into office. After years of double-digit increases, we fought to pass a reinsurance program that decreased Affordable Care Act rates a cumulative 20% over two years — the first two rate decreases in the history of our state. This increased affordability led to increased enrollment, and it has helped residents who have had a qualifying event outside of the open enrollment period, such as the loss of employer-sponsored care, have greater access to insurance. All of this has been despite the federal focus on the ACA being a largely negative one, with reductions in marketing funding and the shortening of the open enrollment period. We stepped up to pay for marketing and worked to inform the public and direct them to navigators who help people determine the appropriate and most affordable ACA plans.

Because of the reinsurance program and our many other efforts to reduce consumer cost-of-care, Highmark ultimately paid out a smaller percentage of premiums on medical services than the required medical loss ratio provides for — so we made sure that they paid those dollars back to individuals and small businesses, totaling $21.5M in refunds. And, like with individual ACA rates, we approved a decrease to small business plan premiums for the upcoming year as well.

We can always improve, and I believe that telemedicine’s expansion is a vital improvement that should become a permanent change. It is so beneficial to so many people with limited in-person access, like those without local providers, those with limited access to transportation or childcare, people who can’t take off of work to go to a facility, individuals with disabilities and many others. Our Insurance Code already dictates that providers should receive payment as they would for in-person visits, which will be key to healthcare provider solvency, as small non-hospital-affiliated practices face financial instability after COVID closures and reductions in visits. I’m proud that the General Assembly temporarily codified the provisions, and look forward to long-term legislation next year.

Addressing the limited provider pool is also critical moving forward. As a member of the Health Care Commission, we have long been discussing how we can better incentivize young people and those pursuing life-changing education to pursue healthcare degrees and careers, and — most importantly — how to incentivize them to stay here in Delaware to practice after their education is complete. This can help us to build healthcare infrastructure to create a healthier Delaware that is more ready to respond to any future pandemics.

JP: The Insurance Commissioner needs to be more aggressive in seeking affordable health and small business insurance.

Do you have any additional thoughts you wish to share?

TN: To learn more about our successes in office, please visit Trinidad-Navarro.com.

JP: I have experience that the current commissioner lacks, I understand the needs of small businesses which have only increased in 2020. I feel I am the best candidate for this position.