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Kim Holland has taken a once-dysfunctional state office and transformed it into an advocate for the state's uninsured - drawing kudos along the way.
The letter C may typically signify an average student. But in the case of Tulsan Kim Holland, that same letter seems to stand for a most excellent insurance commissioner.
One colleague calls Holland, who leads Oklahoma’s Department of Insurance, “a communicator, a coordinator and a consensus builder”; another extols her for her “competence”; and yet another praises her “commitment.”
All those Cs go a long way in explaining how Holland has made great strides in helping lead a group of dedicated individuals to improve health care opportunities for Oklahomans, in creating productive connections among the private and public sectors. and in taking the Insurance Department from dysfunctional to, those who work with it say, highly functional.
The once-quiet agency made headlines when Holland’s predecessor, Carroll Fisher, was sent to prison on embezzlement and perjury charges. Gov. Brad Henry appointed Holland as Fisher’s replacement in January 2005.
One of her first tasks, Holland says, was “getting the office back on its consumer-advocacy track by rebuilding its infrastructure, restoring its integrity and re-engaging the fine people who worked there.”
In doing so, Holland has apparently converted what could have been a dry, administrative post into an opportunity to advocate for those in need. In part, it seems, through the force of her personality.
“Kim has an uncanny ability to work with people from all different areas and to get everyone to the table to talk to one another,” says state Rep. Doug Cox, R-Grove, who worked with her while he co-chaired a 2008 bipartisan Health Care Reform Task Force.
As its name suggests, the task force was charged with reviewing the state’s health care system and, in particular, finding ways to insure the large numbers of uninsured Oklahomans. Which is also one of Holland’s primary goals — the commissioner was on the task force’s advisory committee.
“Kim can make doctors, insurance companies, government officials and hospital boards see the benefit to everyone of solving health care problems,” Cox says.
“Word has gotten out about her abilities, which is why we see her on national television talking about the problems of poor health behaviors and citizens without health insurance, problems that aren’t just statewide but nationwide.”
All this in spite of her relative newcomer status to Oklahoma politics. When Henry appointed Holland, she had been working for a Tulsa insurance company since 1984. But although she had never held public office, she had been active politically and served consistently as a volunteer. She had been on the board of the state’s Health Care Authority since 2003 and on the Oklahoma Employees Benefits Council for most of 10 years starting in 1992.
“When Gov. Henry appointed me, I had been practicing in Oklahoma for almost 25 years and had had two interactions with the Insurance Department,” she says. “I had no idea what the job was until I got there. Most people don’t understand what the office does.
“To help Oklahomans understand, I, and many others in my office, go often into communities for town hall and civic group meetings throughout the state. I was in Norman at a Rotary meeting and a member came up after I spoke to say, ‘You know, I saw you on the agenda and I thought, “Ewww, insurance.” But this was really interesting, and I’m very glad you came to talk to us.’ Sometimes I feel like the Rotary Queen.”
Holland says that while her insurance expertise, much of it focused on employee benefits and group health insurance, allowed her to understand quickly the multiple, often conflicting demands of her office, her background in insurance consultation and marketing has helped her get things done.
“When I was in my business, I learned quickly that nothing happened if I didn’t initiate it,” she says. “It’s instinctive now for me if I don’t know something to just pick up the phone and find out. And I like engaging with people and hearing their issues and being able to let them know that government can work for them. Having spent my entire career in the private sector, I really appreciate the role government can play in our lives. I saw early on that this office had the opportunity to have a real impact on people’s lives, but that to do so we needed to tell our story. ”
Good Business
After settling the storms that had taken place in the Insurance Department, Holland set out on the next chapter of her story — getting a handle on just what the office could do for the profession.
Holland says the insurance industry in Oklahoma generates $220 million in tax revenues, not counting job generation. About two-thirds of that goes into the state’s general fund, making insurance generally second or third highest in revenue to that fund.
That means, she says, that in addition to serving as a consumer advocate, part of her department’s responsibility is to create an environment attractive for the business of insurance.
Holland and her management team meet quarterly with the Independent Insurance Agents of Oklahoma, CEO Dan Ramsey says.
He says Holland “works closely with us on legislative issues. Her accessibility and availability have made her great to work with. She is always willing to listen and, more importantly, to respond to our concerns.”
Working to support those in the insurance business not only supports the industry but also makes for a more competitive environment, which, ultimately, is good for the consumer, Holland says.
Holland even oversees a 10-member law-enforcement team that aggressively investigates more than 700 reports of insurance fraud each year.
“We investigate and then turn cases over to the appropriate law enforcement entity for prosecution,” she says. “We work hard at getting restitution, something our traditional law enforcement bodies don’t do. We can get the bad guys brought to justice, but we can also get people’s money back.”
Voice for the Voiceless
While this chapter might have a lot of action, the next chapter in Holland’s story has more heart. It details her commitment to Oklahomans’ health and well-being in all the areas for which her office is responsible, with special attention to those with less ability to protect themselves: senior citizens and children.
A major test came less than a year after Holland’s appointment — shortly after November 2005, when the federal government rolled out a new health plan for seniors, Medicare Part D.
The addition to Medicare coverage, to be administered by private insurance companies, subsidizes prescription drug costs for Medicare beneficiaries. Its complexities quickly created a mare’s nest of confusion and concern for consumers, who had been inundated with marketers promoting products related to the plan.
Soon after, Holland began a national series of impassioned pleas on behalf of seniors whom the private insurance companies were aggressively seeking as customers.
In February 2006, she presented the results of an independent examination of one such company showing “chronic and blatant disregard for state regulation and for senior policyholders” to officials of the Centers for Medicare & Medicaid Services in Washington, D.C.
In May, she returned to speak before the U.S. Senate Special Committee on Aging.
In June, she testified before the U.S. House Committee on Energy and Commerce, arguing that all state insurance departments should have the right to regulate marketing behaviors, a right that the federal government had preempted.
“Our seniors are plagued by aggressive and frequently misleading advertising, agent high-pressure sales tactics and a lack of responsiveness if not outright neglect from their insurance company,” she told members of the committee, adding that “ … (state) insurance departments across the nation are receiving complaints of a similar nature from seniors, their families and caregivers against many insurers.”
The federal government has yet to cede jurisdiction to state insurance commissioners, Holland says, but she plans to continue her efforts before the U.S. Congress to bring Medicare Part D under state insurance department control. On the bright side, she says, the Centers for Medicare & Medicaid Services “has come to be more collaborative with the states in ensuring the protection of our consumers.”
Beyond Medicare
Holland also recognizes her department’s role in assuring a healthier citizenry overall.
Starting in 2005, she has convened an annual Summit on the High Cost of Health Insurance, an event that brings together consumers, providers, insurers and policymakers with national health policy experts.
Summit task forces research and report on four areas of importance: access to affordable health insurance, maximizing the distribution and use of health care dollars, quality of care/industry performance and consumer education/information.
Holland also holds monthly meetings of those working on the Oklahoma State Coverage Initiative, a national program of the Robert Woods Johnson Foundation to help state leaders move health care reform forward.
In addition, her department has promoted CHAT, Choosing Healthplans All Together, a computer program that helps determine what services and benefits consumers think a basic health care plan should include. Oklahoma House Speaker Chris Benge created a Health Care Reform Task Force of seven lawmakers. He named Holland to its 30-member advisory board.
The task force report, issued in December 2007, recommended a variety of actions and further areas of research based on what they had gleaned from more than 40 CHAT sessions with more than 450 Oklahoma residents. Members analyzed the data from perspectives like urban versus rural and income ranges. Different groups offered different suggestions. Some were willing to accept lower benefits but with broader coverage; some wanted more optional coverage such as dental and vision.
The importance of this initiative to the state is clear. Oklahoma, Holland says, ranks 48th in the nation in the percentage of population without insurance, about 600,000 people.
“We have a large number of factors contributing to our poor health status — and our poor economy and lower-than-average incomes result in the high percentage of uninsured and underinsured individuals who wait to go to the doctor until there’s a crisis and often don’t get the medications they need,” Holland says.
In a similar vein, in May 2006 Holland launched a statewide insurance education campaign, “Insure U,” a National Association of Insurance Commissioners program designed to help consumers learn about insurance and to assist them in making informed decisions.
“Insure U” is available online in modules geared to different demographic groups. Her first two years in office, Holland took staff from the department on what she called “Road Shows” to present parts of the educational program to Oklahomans in 25 to 30 communities, averaging one a month across the state. She says thousands have used the elements in Insure U. She was pleased with the positive response from those she talked to and plans to take her show on the road again in her continuing efforts to “demystify insurance.”
As CEO of Tulsa’s OSU Medical Center and president of the Hillcrest Health Care System, Earl Denning has become keenly aware of the impact of the number of Oklahomans who are uninsured. At OSU Medical Center, he says, 20 percent of patients are uninsured and another 30 percent rely on Medicaid, making it a major provider of medical services to Tulsa’s lower socioeconomic population.
Denning speaks of Holland’s impressive “competence” in addressing this issue.
“She was one of the first people to make an appointment to see me when I moved to Oklahoma two years ago to explain her efforts to insure Oklahomans,” he says. “I have been impressed with her town hall meetings here and her testimony in Washington. I’ve heard from colleagues in other parts of the country, and they’re saying good things about her, too.”
Destiny by example
Holland comes to this passion from past experiences.
The fact that she grew up to become an insurance person may have been influenced by growing up with the insurance business. Her maternal grandmother was one of a very few women insurance agents in her day.
“I’m a product of a military family, so we moved around a lot,” Holland says. “My grandmother either lived with me or I lived with her. I worked at her agency and just kind of ended up always working in an insurance-related environment.
“When I moved to Oklahoma, I worked for an independent agent in Claremore before moving to Tulsa, which quickly became and still is home for me.”
Holland did not want to give up her community when she became commissioner, so she became a commuter. Each weekend, she heads home to Tulsa and husband Jim East, who owns a consulting firm, Strategies for Oklahoma LLC, specializing in government affairs and economic development. Like his wife, he’s a community activist. He’s president of the board of the Community Action Project and a board member of Youth Services.
“I used to roll my eyes when I heard elected officials refer to themselves as what I thought of as the ‘royal we,’” Holland says.
“What I have come to realize is that it isn’t that at all. There is no way anyone could do this job without the support of family. Jim understands politics much better than I do. I couldn’t do this without his knowledge, understanding and support. And he’s the one who takes care of the dog and keeps the house in good order.”
Home is where more than the heart is, however. Holland also has brought state government to Tulsa, she says, by maintaining a satellite office here.
“We may not have a large physical presence, but we have a large personality presence thanks to Pam Nielsen, Tulsa regional outreach coordinator, who is fully engaged and very engaging,” she says. “I work hard to interact with our Tulsa insurance community as well as with the Mayor’s Office. I want to be available to whoever on this side of the state needs our assistance or is interested in what we are doing.”
Greg Burn, division vice president of marketing for Blue Cross Blue Shield of Oklahoma, has worked with Holland for more than 20 years. He’s the colleague who calls her “a communicator, a coordinator and a consensus builder,” skills he says have been instrumental in achieving several victories in her focus on the complicated goal of providing affordable health insurance to Oklahomans.
“She can create honest, open discussions in a way that doesn’t anger people,” he says. “There may not be total agreement on how to achieve goals, but there is agreement that we have to achieve them. That hasn’t always been the case in the past.
“Kim has said in several public settings that she wants to create a ‘culture of insurance’ in Oklahoma, a culture in which individuals see the value of being insured and corporate and governmental bodies see that they have to help make that happen for many reasons.
“She makes clear that at the end of the day, it is about dollars and economics, but it is also about doing the right thing. She’s not going to let up until she gets action.”
Halfway through her first elected term, Holland has a report card any public official would be proud of. Don’t let the straight Cs fool you. She’s sitting at the top of her class.
