Did you hear the one about the actuary and the federal regulator who walked into the bar? No? Neither has anyone else. Which is why attention to the health reform law is dropping off the cliff now that all the "death panel" jokes are forgotten. Yet what’s happening now, as reams of specific rules and regulations are written to make the law come to life, is at least as important as the long legislative battle. When you see a news story about "health reform regulations," you’ve got a pocketbook reason to read it instead of hunting up the "squirrel love" slide show again on YouTube.

Here’s a tiny specific example. What’s "medical care?" How would you define it? How would an insurance company define it? One of the immediately effective parts of the new law is a demand that insurance companies get more efficient, spending more of your premium on health care and less on administration and profit. So the definition of what health care is will make billions of dollars of difference in what we pay for health coverage in the next few years. The Department of Health and Human Services sent out pages of questions last week seeking comment on that one section of the new law. 

The law says the definition of what consititutes health care and what is defined as "administration" will be written by the National Association of Insurance Commissioners (NAIC), and "certified" by the Department of Health and Human Services. Sounds reasonable — state-level public servants will apply their expertise and make a balanced decistion, right? But the truth is that NAIC members and staff move in and out of jobs in the insurance industry, and the industry largely funds the activity of the NAIC. The NAIC is a private body, and doesn’t have to make its deliberations public.

So granting the NAIC the power to define health care is an insurance lobbyist’s victory. Insurance companies like Wellpoint are already writing their own definitions and applying them retroactively to shove what used to be administrative work into the "health care" column. Here’s what we wrote about that sneaky move.

Here at Consumer Watchdog, we’re spending hours and hours deep in technical language, hoping to persuade the Department of Health and Human Services that it has the power to guide the writing of these definitions, the power to make the process open to the public, and the power to rewrite a bad definition.

All because of one multibillion-dollar phrase.

The glory part of passing a health reform law is over, but the mischief is just beginning.