If you read the news lately you might think that Sen. Phil Berger has taken the approach of South Carolina or Louisiana in rejecting a state-based health benefits exchange. As a reminder, an exchange is an organization that will allow individuals to shop for insurance in a standardized, understandable way and purchase policies at group rates. Each state can set up its own exchange, have the federal government set up an exchange on its behalf, or establish a partnership exchange between the feds and the state.

As another reminder, the NC Institute of Medicine convened meetings among stakeholders of every stripe to discuss how an exchange should be structured. That group came to a general consensus about legislation where everyone got something but no one got everything they wanted.

Blue Cross and Blue Shield of North Carolina had its friends (Reps. Brubaker and Dockham) ignore the IOM recommendations and file a bill that gave the state’s largest insurer everything it wanted. (The North Carolina Medical Society also had some input on the bill.) The House moved the legislation along despite objections from a wide range of organizations that the bill was fatally flawed and probably not compliant with federal regulations.

Then this clunker landed in the Senate. The Senate took a short look and many folks concluded that this thing needed a serious overhaul. But with budget writing and other priorities there was not much time to fix the broken bill sent from the House. So Berger wisely took a pass.

Unless you are an insurance commissioner or an insurance industry lobbyist you probably don’t think much about the National Association of Insurance Commissioners (NAIC). The NAIC is a national professional organization of state insurance commissioners. While the NAIC has always enjoyed some power and prestige its importance was elevated by the passage of national health reform.

One would imagine that this group would be sympathetic to consumers. It is, after all, an organization of insurance regulators. But a key NAIC vote last week revealed otherwise.

For more background on the vote see this News & Observer editorial by Consumer Reports President Jim Guest. In short, the Affordable Care Act created a new rule that insurance companies must start spending a minimum amount of each premium dollar on health care. This rule means that in the future insurers will spend more on your medical treatments and less on executive pay, trips to Cabo, fancy new buildings, and agent commissions. It turns out (surprise!) that agents don’t like the idea of insurance companies spending less on commissions.

So insurance agents are trying to effectively reclassify commissions as medical care or quality improvement. Last week the NAIC took up the issue and voted on a resolution urging Congress and Health & Human Services to weaken health reform and suspend or delay implementation of the new rules.

Sadly, North Carolina Insurance Commissioner Wayne Goodwin made the motion for the resolution and voted in favor of this ill conceived recommendation.

There are those defining issues raised in the General Assembly every so often that pit the state’s most powerful interest groups against the needs of consumers and average citizens. The vote on today’s health benefits exchange is one such issue.