On the steps of the Insurance Building on the state Capitol campus, Insurance Commissioner Mike Kreidler pauses to ponder a question about his motivations.
“I love predictability,” Kreidler says — at first glance, an odd statement, from a man now at the center of health insurance’s biggest upheaval in decades.
With his moves watched by policymakers, insurance regulators and companies across the country, this affable 70-year-old politician has had anything but a predictable life in the past few years.
Consumer advocates say he may be the most respected insurance regulator in the country, but some state legislators tried to have his office abolished in the last session.
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Now, midway through his third term in his position, Kreidler is taking full advantage of his independence — only 11 states elect insurance commissioners — to wade into some of the most challenging issues of his long career.
Earlier this year, he adopted new rules to address narrow networks of doctors and hospitals included in health plans, spurring vigorous protests from health providers, insurers and businesses.
He decided that many low-cost “association” coverage plans, favored by small businesses in Washington, were illegal under the Affordable Care Act (ACA). That drew sharp criticism from the business community.
And when Kreidler, a lifelong Democrat, quickly dismissed President Obama’s offer last year to let people temporarily keep their discontinued health plans, many policyholders reacted in anger.
To some, it seems unlikely that Kreidler, a doting grandfather who eats the same lunch nearly every day — with a generous dollop of Tabasco sauce — would find himself the target of so much animus.
Observers say he is usually slow to anger or to take a political joust personally. He is a politician, not a wonk, but talks easily about “risk pools” and underwriting, and admits to a certain pride when praised by an actuary.
Occasionally, he refers to himself in the third person, as in: “No one is more identified with health reform at the state level than Mike Kreidler.”
In the hot seat
What he means is that he’s become a target.
In the past legislative session, vexed by what she considered Kreidler’s intransigence, Republican State Sen. Randi Becker of Eatonville sponsored a bill to replace his elected position with a board selected by legislative caucuses. Becker said her bill, which failed, would have made the office “more accountable.”
John Conniff, a lawyer and former deputy insurance commissioner who now represents businesses, says Kreidler’s decisions are too often “rigid and ideological,” and ignore the real costs to people running small companies.
In the latest storm, the insurance office’s chief administrative-law judge accused Kreidler’s chief deputy of trying to pressure her to decide cases Kreidler’s way — or lose her job. A leaked copy of the judge’s complaint halted an ongoing high-profile case and, later, she said she had accidentally — and improperly — sent it to a lawyer in the case.
Mike Padden, a Spokane Valley Republican and former district-court judge, said the allegations suggest “really improper” conduct may have occurred. He has scheduled a legislative work session focusing on the independence of administrative-law judges and may propose legislation, he said last week.
Kreidler appears sanguine. All “painful episodes” seem like the worst ever when they happen, he said, but they blow over.
“I’ll probably be proven wrong, but I think it’s kind of a sideshow right now,” he said.
Kreidler said he’s focused instead on the big picture, where the issues are crucial: long-term market stability, the ability of consumers to get the care they pay for, and preserving the office’s role as a guide — and rule maker — through the ACA.
“I have good reasons why I’m doing what I’m doing,” he said. “In the end, I think we will have a better system as a result of my being strong.”
Path to his dream job
Myron Bradford “Mike” Kreidler, son of two Tacoma-area teachers and grandson of the former dean of women at Pacific Lutheran University, was born in 1943, a fraternal twin who beat brother Peter by 13 minutes.
His sense of leadership was bolstered by his parents’ decision to hold the boys back a year; their birthday was just on the dividing line for entering school. “It was a great decision,” said Peter Kreidler. “We were more mature in terms of athletics, self confidence, our ability to talk to other people.”
They wore the same clothes all the way through Curtis High School in Tacoma, where Mike was elected student-body president. A high-school civics-class debate ignited a “driving interest” in health reform.
While in college in Oregon, Kreidler married Lela Lopez, of Forest Grove, Ore., and received a doctorate in optometry. After two years’ active duty with the Army Reserve, he received a master’s in public health.
In 1972, he began two decades as an optometrist with Group Health Cooperative. But he couldn’t resist the lure of political opportunity when it came knocking — literally.
At his door was a Democratic Party worker, ginning up turnout for a precinct meeting. He asked Mike if he’d serve as precinct chairman. “That got him going,” Peter Kreidler recalled.
Soon, still working as an optometrist, Kreidler won a seat on the North Thurston School Board in 1973. After that, his political career included the state Legislature for 16 years, Congress for a single term and stints in regional and federal agencies. Much of that time he continued to practice optometry on a flexible schedule.
At home, tragedy struck when a baby boy born with a severe birth defect lived only three months. A year later, the Kreidlers adopted a son, now their middle child.
In 2000, Kreidler was elected insurance commissioner — the job of his dreams. He succeeded Deborah Senn, inheriting an individual health-insurance market in disarray.
For the next decade, Kreidler’s favorite watchwords were consistency, stability, fairness and, yes, predictability. He regained accreditation for the office and successfully pushed for consumer legislation. Health insurance, always a small part of what the office handled, wasn’t often big news, and disputes were mostly about “humdrum” matters, Kreidler said.
Rep. Eileen Cody, a West Seattle Democrat who chairs the House Healthcare & Wellness Committee, said Kreidler has been good for both consumers and insurers. “He has a reputation for being fair,” Cody said. “The insurance industry has not bitched to me about him like they did about Deborah [Senn].”
The advent of the ACA suddenly nudged Kreidler into the spotlight. Insurers pushed for narrow networks, consumers pushed for more access, and every type of provider pushed to be included, noted Cody.
“All the little pigs come to the trough,” she quipped. “He’s in somewhat of a horrible position.”
Last year, by all accounts, started badly. A dust-up over a gift resulted in the exodus of two employees in Kreidler’s office, including his chief deputy, Mike Watson. Kreidler said the dispute arose when Kreidler argued that ethics rules allowed him to keep a potted plant sent by a trade association.
Watson, a friend and campaign manager for four decades, wouldn’t talk about the details. “I will tell you, I said for many years that I was one bad day away from retiring. I had a bad day, and I retired,” he said.
They remain friends, both said, and Watson still serves as Kreidler’s campaign treasurer. Meanwhile, other employees, including most of his deputies, began peeling away from the agency for different, individual reasons.
In April of last year, Kreidler had extensive open-heart surgery, just as the crazy first year of the ACA hit. Suddenly, it was a new, more intensely competitive game.
His office, which reviews insurance plans, was prepared for insurers trying to skirt the law banning discrimination on health conditions — for example, by excluding certain drugs from coverage. But it wasn’t prepared to see such narrow provider networks, he said.
“We were truly overwhelmed,” Kreidler said. Soon, it became clear that the informal “desk-drawer” rules his office had used in the past wouldn’t stand up; it needed formal rules.
“Much of what we had been doing was really bluster,” Kreidler said. “We didn’t really have that kind of authority.”
An episode that caused a rift began last year, when Kreidler refused to approve several plans aimed for sale under the Washington Healthplanfinder insurance marketplace. The board of the Washington Health Benefit Exchange, which operates Healthplanfinder, sent the issue back, saying, essentially, “make it work.”
He needed new, formal rules to protect consumers in the new world, Kreidler said, and he had the authority to do just that.
Kreidler says he doesn’t expect the next few years to ease up. Soon, he’ll begin revising the network rules for 2016 plans.
He grows animated about his plan to create “transparency” to let purchasers see whether a plan includes the drugs or doctors they need.
What critics characterize as Kreidler’s unwillingness to compromise, others see as strength of conviction. “He’s very intense,” says his wife Lela. “When he gets onto something, it really means a lot to him to see things through.”
Other insurance regulators are watching closely as Kreidler walks the tightrope, says Sally McCarty, a former Indiana insurance commissioner, now with Georgetown University’s Center on Health Insurance Reforms.
“They’re all looking at what Washington is doing,” she says, and particularly at Kreidler’s effort to update network-adequacy standards, “because Washington is first out of the gate.”
Kreidler is eager to take it on. “I can’t imagine anything better than being at the center of health reform. This is something this country has desperately needed for 100 years,” he says. “It couldn’t be a better job.”
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org. On Twitter @costrom