Sen. Jay Rockefeller (D-W.Va..)

On Tuesday, Sen. John J. Rockefeller (D-W.Va.) chaired a Commerce Committee hearing on the Affordable Care Act's summary of benefits and coverage provision, which requires insurance companies to summarize all benefits in a standardized, four-page document. It's something akin to a nutrition label for health insurance. We spoke afterward about that part of the law, as well as the Medicaid expansion, the possibility of rate shock and why he isn't worried about getting Americans enrolled in health law programs. What follows is a transcript of our conversation, edited for length and clarity.

Sarah Kliff: The hearing you held today was about the summary of benefits and coverage, the four-page document that insurers must use to summarize benefits. How do you think that part of the health reform law will change health care?

Sen. Jay Rockefeller: To me, the idea is that people have a right to know. The history of health care is not being able to know what you don’t know, thanks to the insurance companies. It’s truly amazing what they’ve done from receissions to fighting everything in sight. Now the MLR [the medical loss ratio, or 80/20 rule] is making them all soft inside. What we do is through this provision, give consumers clarification and closer analysis.

SK: What else do you think could be done to increase price transparency in the health care market?

JR: I would like them to add the breast cancer example back in [to the form, as one of the sample situations where insurers lay out expected health care costs.] Breast cancer is a huge factor and a major potential danger shared by a whole lot of people. So I think it's important to have that in the group of three.

I think on premiums, too, there could be more. There's the whole question of what are you not getting. It's a tricky one, to have an open approach to consumers. They're going to be buying this new product, about 32 million of them. That's an awful lot of people.

SK: Enrollment for the health law's benefits starts just about six or so months from now. How difficult do you think it will be to reach people and make sure they sign up?

JR: I think [the law will] struggle more in the rural areas or areas where people don’t get together as much. I think word of mouth is going to be a savior. And transparency, too. If you're a skeptic, and I can produce for you a sheet which says here's what you'll get,  here's what it's going to cost, that will help. You might get some push back, like, I live in rural area and costs are more. But I think word of mouth will counter that.

SK: There's a lot of survey research right now that shows very few Americans are aware of the health law's new programs. Does that worry you?

JR: People have been so busy either being desperately for it or desperately against it, and I don’t worry that much. This is the nature of large, game-changing bills. You just assume people are going to find out about this. When you get the Consumer's Union involved, and the media too, it's going to get known.

Look at the Medicaid expansion paradigm. I mean, there was no chance it was going to work, and, all of a sudden, it's going to work. The president is not a master at dealing with Congress, but he's very good with the American people. He's on television a lot. It's going to go along. You will have people struggling with the idea of exchanges. That's terrifying to a lot of people.

Do you remember the public option?

SK: Yes, I do.

JR: Do you remember how the entire press corp decided that, if, it didn't pass, we didn't care about justice or anything like that? There was just one problem: It couldn't get the votes. Al Franken and I introduced that as an amendment and it got nine votes. Chuck Schumer introduced another one and it got only 10 votes. What do you do? You search around and somebody comes up with the idea of the [Medical Loss Ratio]. One of the beauties of that is that nobody understands what the name means.

The public option sounded so good, but it was never achievable. But the MLR just came along, and it's been wondrous. You get that, and you smile, and you let it take its work. It's saved over a billion dollars. That's wonderful.

SK: I wanted to ask you about the Medicaid expansion in your own home state, West Virginia. It's the only state with a Democratic governor who hasn't committed to the expansion.

I've had a lot of conversations with our governor about it. Obamacare, as its called in West Virginia, is not much more popular than the president. He carried no counties at all in 2012.

I think the governor is doing what he should be doing...He’s being very careful, he’s talking to all stakeholders. He's the only Democrat who hasn't done it, but that's not considered a disgrace at all. I think he's biding his time. He's very much aware of the 100 percent followed by the 90 percent.

My guess would be that [Gov.]Earl Ray Tomblin will end up doing it. He will pave the way very carefully and very cautiously smart.

SK: One issue that came up in your hearing was the idea of rate shock, that young people will see their premiums spike under the health care law, and decide not to buy coverage. Do you think that will happen?

JR:  The fact is that the young people, they're the ones who take the most risks and they’re the ones who never get health insurance because they think they'll live forever. When they do get care, they go to the emergency room. It's just not fair. They would say it's not fair to make them pay for health insurance, but it's not fair for them not to have it, so other people are paying for anything that happens to you. Depends what side you're on.

When the Senate passed conscription after Pearl Harbor, it was a crosscut of Americans who got conscripted, nobody was allowed to opt out...everybody took their chances or their opportunities fighting for America. People complained a lot but there's no fairer system that's ever been. That would have no chance of passing now, parents would go crazy.

SK: You just touched on the problem there a bit, that people can opt-out of buying health insurance and pay the penalty instead. 

JR: I think there will be some of that, from the cavalier and confident. But I think as time goes on people will stop doing that. After all people who are in their 20s and 30s decide to get health insurance and it's for a reason, isn’t it? They’re beginning to have kids, or have been through a couple of bad accidents as they get older. They haven’t gotten to that point yet.