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President Obama, in a meeting with state insurance commissioners Thursday, made it clear that he expects careful scrutiny of rates for 2015 health-insurance plans, according to Washington Insurance Commissioner Mike Kreidler.

Kreidler was among more than 40 commissioners who met for an hour in the State Dining Room with the president, Vice President Joe Biden, outgoing Health and Human Services Secretary Kathleen Sebelius, Medicare administrator Marilyn Tavenner and other top health officials.

“The president was fully engaged throughout the whole meeting,” Kreidler said. “It was a very robust discussion.”

That the president allotted such a significant amount of time to the insurance regulators, Kreidler said, shows that he recognizes “just how deeply essential our role is” in the rollout of the Affordable Care Act, which just completed open enrollment in 2014 plans.

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Rates for the 2015 plans, of course, were on the commissioners’ minds. Washington has one of the earliest deadlines for insurers to submit their proposed rates — May 1, ahead of the deadline for plans to be sold through the federally facilitated exchanges, Kreidler noted. And insurers will have only a scant few months of experience on which to base new rates.

“We don’t anticipate a major rate adjustment based on what we know at this time,” Kreidler said. He credits, in part, Washington’s decision to expand its Medicaid program. Because of that, “there’s a lot less uncompensated-care bad debt by hospitals passed onto ratepayers,” he said. “States that didn’t do the Medicaid expansion, that’s going to be a problem for them.”

His office reviews rate proposals to make sure companies can justify rate increases, Kreidler said, but balances downward pressure on prices against the need for companies to bring in enough to stay solvent.

“If insurance companies can show they have a need for a rate increase, we’re not going to say, ‘You don’t get it.’ That’s a recipe for insolvency.”

Kreidler said he got the clear message that the White House expects commissioners to look “very closely” at rate increases. “I have to worry about that; how that might come into play,” he said.

Another issue on Kreidler’s mind: Washington’s lawmakers, like those in other states, sometimes require insurers to cover particular conditions — mandates that may not fit with federal requirements. States have been able to establish their own “essential benefits,” but that grace period expires in 2016, when the law calls for moving to a national standard.

If that happens, it could mean the state would have to bear the cost of state mandates — such as one passed in the last legislative session that requires insurers, beginning in 2016, to cover certain dietary formulas for patients with inflammatory gastrointestinal conditions collectively known as eosinophilic gastrointestinal associated disorders.

He said he wouldn’t be surprised if the federal authorities gave states a year or two more before they move to establish the national standard. “We have enough other challenges,” he said.

Those include “making the market shopping experience much more palatable,” said Kreidler, who couldn’t resist a plug for new insurance rules he hopes to adopt next week to ensure health-plan networks of doctors and hospitals are adequate to provide covered benefits to patients.

Carol M. Ostrom: or 206-464-2249. On Twitter @costrom

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