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Ginsberg: This is Seth Ginsberg filling in for Lisa Wexler here. Jay Angoff, you just spent three years with the US Department of Health and Human Services.  You’ve devoted your entire career to protecting the rights of consumers and holding insurance companies accountable and you are actually the only person to have ever served as the lead federal health insurance regulator, the director of an HHS region and a state insurance commissioner. What an impressive bio because you’re truly one of the nation’s leading insurance experts.


Angoff: Thank you for your kind words


Ginsberg: Basically, you’re the man, is it fair to say a primary architect of the health reform and the affordable care act?


Angoff: No, I think that’s both giving me too much credit and too much blame. I was the head of the unit that was responsible for implementing the private health insurance reforms of the Affordable Care Act the first year, the first year after the law was passed so I was in charge of things like the patients Bill of Rights, the provisions that allow kids to stay on their parents’ policies until the age of 26, the provisions that prohibit insurance companies for cancelling people or cutting off coverage at a certain dollar amount. Also, for regulations like the medical loss ratio rule which require insurance companies to spend at least 80 cents of the premium dollar on healthcare and no more than 20 cents on overhead expenses and profit.”


Ginsberg: How much did the anti-Obamacare partisan politics play a role in these problems? I mean the delays and the challenges in the presidential election and then the Supreme Court. I mean all these things lend themselves to failure and granted, you might be a little bias given your perspective but I mean from on the inside was this a challenge?


Angoff: Well, sure, it was and there’s no question that what you say is true. The opposition to Obamacare and to President Obama, obviously, is maniacal and the people who were opposed to both were absolutely committed to obstructing law by any means necessary.  I’m not sure that the people on our side, the people charged with implementing the law were as committed to running over if necessary the opposition of some of the states as the opponents of the law were to absolutely obstructing and destroying the law and this President. And I think a lot of people can learn that lesson but it may be too late.


Ginsberg: Sure. Sure. I mean it was basically ‘let’s do anything to tear this house down.’


Angoff: That’s right. Now, Seth you sound to me like you’re probably too young to remember this but when I was a kid I remember George Wallace standing in the courthouse door and saying ‘segregation today, segregation tomorrow and segregation forever’ and that really is exactly the same attitude that many, not all, but many of the opponents of the Affordable Care Act have today.


Ginsberg: Are we ignoring a lot of the other positives and some of the really great strides forward that this healthcare reform act has set into place and if so, what are they?


Angoff: Sure, number one. People know, under the Affordable Care Act, people know that regardless of their health status regardless of their health status, if they are unlucky enough to be born with it was some kind of condition, if they are unlucky enough to get a serious disease at sometime, if they are unlucky enough for bad things to happen to them. And during our lives, most of us do have some bad luck and bad things do happen to us. For the first time, the Affordable Care Act gives all of us the security of knowing that we have insurance. I mean that’s just a terrific thing, that’s an invaluable thing and it’s ironic when some of our Republican friends in Congress are now so upset about the people who are having their existing policies non-renewed, they have the opportunity to buy insurance through exchanges but for the first time in my lifetime, I’m seeing some of our Republican friends express concern about people who are uninsured. And if they would simply transfer that concerned 50 million people today who are uninsured are they maybe there would be hope for some bi-partisanship.


Ginsberg: So bottom line are there some states where it’s better than others to live with a chronic condition or fall ill?


Angoff: Well, sure. New York, for a longtime has been, New York has had a generous Medicaid program. New Jersey, California, the more progressive states have generally had –Massachusetts -have generally had the more generous Medicaid programs. And again, that’s the irony, they’re the ones, the states that have done the best job of taking care of their citizens have had the least to gain under an expanded Medicaid program because they’ve got the largest percentage of people in Medicaid already. The ones that have the most to gain, they don’t want any of it. I is astonishing.


Ginsberg: It is. Well, Jay we are going to have to leave it there. We really appreciate it. Jay Angoff, former HHS official who was deep in the trenches about a year ago for about two and half years, three years during the implementation of the Affordable Care Act. We thank you very much for joining us here today for shedding a little bit of light on this. There is a lot more to talk about and we hope you will come back and join us again soon.