“I care very much that people see this agency as being transparent and fair.”
Texas Medicine: TMA has been very ac- tive in the rulemaking process as new legislation and new regulations come up to make sure the interests of physicians and patients are represented. As commis- sioner, how do you plan to communicate with and involve the medical community in those public processes?
a lot of experience working with differ- ent groups to solve complex issues and address them through legislation, and I think that skill translates reasonably well to this environment. I think Governor Perry was thinking: “Here is somebody who can translate what the legislature wants into implementation in the insur- ance community.” And I hope that I am going to be able to do that.
Texas Medicine: What are some chal- lenges on your plate right now, and what do you want to accomplish in your ten- ure at TDI?
Commissioner Rathgeber: I care very much that people see this agency as be- ing transparent and fair. Entities that we regulate may not always agree with us — we are a regulatory agency —but [I care] that they understand how decisions are made, that they understand that their input was carefully and respectfully con- sidered, and that decisions are based on sound science and the law. I hope that is the hallmark of our agency in the future. There are a number of organizations and associations that come by and want to visit, and I love doing that because the more you are able to be accessible and transparent and open, then you have a better working relationship when something goes awry. So I have tried to be very accessible from a meet-and-greet standpoint. At the same time, I am try- ing to make sure I am spending enough time here in this agency to talk about
38 TEXAS MEDICINE October 2013
what we are going to do in the future. A perfect example is one of the meet- ings I just left: There’s an expert panel developing good science for the wind- storm association, and that panel held a public hearing so the public could come and talk to them about what next steps they are going to take in developing that science, and there will be additional hearings on the coast. I realize that’s not [health care-related], but I hope we are going to see an awful lot of that. Another initiative we have is an initiative to en- sure that we can take some options to the legislature to reduce the regulatory burden on Texas businesses. We need to be able to protect Texas consumers, but we also have to be sensitive to the fact that we are a regulatory agency. We don’t need to run the businesses that we regulate.
I have priorities that are internal to the agency and priorities that are exter- nal to the agency. My internal priorities are to make sure that people are doing a good job, that we base decisions on good science and the law, and that we don’t deviate into areas where we are mak- ing up policies or procedures that are not statutorily authorized. I’m more of a strict constructionist from that stand- point. Externally, I am very focused on implementing the legislation that passed this last session. We are spending our time and priorities on captives, on wind- storm, and on helping Texas businesses handle the Affordable Care Act (ACA).
Commissioner Rathgeber: We will be continually including TMA, as we have for many years, in the rulemaking pro- cess. I feel it’s incumbent upon us to set out our objective and then work with all of the stakeholders to ensure we can achieve that objective in a manner that is the least intrusive and most protective to consumers. The medical aspect of the Texas economy is just huge. It touches so many lives — everybody’s lives — in some way, shape, or form, and I don’t lose sight of that. As we are working to develop regu- lations that help consumers and busi- nesses, the medical community is one of our clients, and we need to make sure we work with our clients well. And I will continue to involve them to the extent they are interested in participating.
Texas Medicine: The federally-run health insurance exchange or market- place is expected to launch in Texas on Oct. 1, and physicians and patients could be dealing with a lot of new insur- ance products. (See “Ready, Set…?” Au- gust 2013 Texas Medicine, pages 49–52.) What can you tell us about TDI’s inter- actions with the federal government in that process and TDI’s role in the future?
Commissioner Rathgeber: We do not have the statutory authorization to im- plement the ACA. But we will be work- ing with consumers to help them and direct them to the appropriate places and address their concerns to the ex- tent we can. We are working with Texas companies as they struggle to implement the ACA. To the extent we can provide some flexibility in Texas law … we are going to try and do that so we don’t put our companies at a disadvantage when they are grappling with something that’s really huge and very difficult to imple- ment. We are trying to provide guidance
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