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Profile: Insurance Industry’s Trenton Face has followed Policy ARC

Who he is: Wardell “Ward” Sanders

What he does: President, New Jersey Association of Health Plans

Hometown: Originally from Lancaster, PA, where he also attended Franklin & Marshall College. For 15 years, he’s made his home in Lambertville, where he serves on the city council.

Age: 53

Why you should know about him: If you have health insurance in New Jersey, then there’s a good chance it’s been shaped by Sanders. Not only does he serve as the face of the insurance industry in Trenton whenever policy changes are proposed at the state level, but also he oversaw the small-group and individual insurance markets for 10 years at a state agency prior to his current job.

Learning to be a lawyer: After graduating from Villanova University’s School of Law, Sanders worked in the New Jersey Attorney General’s Office on issues related to an insurance pool for high-risk drivers. At the end of his tenure, he worked on the implementation of New Jersey’s 1992 health insurance reform. He said of his time there that it was “a great place to learn to be a lawyer,” adding that he was impressed with the number of committed public servants in the office.

Health insurance lessons for the state — and nation: The 1992 reforms created two new state boards to oversee the individual and small-group health insurance markets, which were housed in the Department of Banking and Insurance. Sanders served as the executive director of both boards for 10 years.

He was able to see first hand how New Jersey’s experience set a precedent for the Affordable Care Act. As the state attempted to establish individual and small-group health insurance markets in which consumers were guaranteed that they would be issued insurance without regard to any preexisting health conditions they had.

While the small-group market worked well, the individual market had a mixed experience, Sanders noted. Challenges resulted from requiring insurers to offer insurance without also requiring healthy individuals to purchase insurance, which were noted when lawyers defending the ACA argued to the U.S. Supreme Court for the necessity of an individual mandate to buy insurance. The Court ultimately upheld most of the law.

Sanders noted the importance of having different stakeholders, including both business and labor representatives, on the state insurance boards. He said this is broadly true of health policy.

“I always feel that when you build something like that, you have a better chance for success because you have input early on,” Sanders said. “When you’re involved in building a house, you’re less likely to tear it down.”

A local politician: A Democrat, Sanders was recruited in 2008 by Lambertville Mayor David DelVecchio to serve on the city council. He said it was hard to avoid getting involved in the town. “It’s a very social place — it’s very hard to take a five-minutes walk in town,” Sanders said. “It becomes an hour jaunt” as you talk with neighbors.

He’s put his legal and insurance background to work for the 3,900-resident city, shopping for the municipal workers’ insurance (Lambertville chose the State Health Benefits Plan). He also worked on the merger of Lambertville’s schools with three other districts into a regional school district. “It was crazy to have four school boards, four attorneys, four auditors — and it was a great opportunity,” he said.

A common thread: Sanders said both state health policy and local politics have taught him the importance of listening before reaching conclusions.

“When people understand issues and understand each other better, there’s a greater opportunity for reaching results that make sense for more people,” Sander said. “It’s so easy to have knee-jerk reactions to specific issues. If you can put those aside and sit down and listen to different points of view, then you can really make some progress and make something work better.”

Looking forward: Sanders said the importance of the state addressing different problems that result from having healthcare providers outside of insurers’ networks is at the top his agenda for the coming months.

He said he feels the state can fix the problems that are caused by some doctors and hospitals persistently charging high prices while refusing to engage with insurers’ networks. He described these providers as “outliers,” adding that when insurers pay high costs, consumers ultimately pay through higher premiums. “Every provider and hospital should have the ability to go out of network and to have that threat, but they don’t need the threat to just pillage the system,” Sanders said. “That’s not necessary. That’s what we’re trying to stop.”

“This is a big issue — this needs governmental interventions to solve it,” Sanders said. He attributed some of the problem to existing state laws that require insurers to pay for emergency room visits, as well as a change made in 2009 that required insurers to pay out-of-network providers directly rather than paying them indirectly through patients, which gave providers more weight in negotiations.

Insurers also want to have a voice in opioid legislation: Sanders also said the health plans want to address the rising problems from opioid overdoses. His association has already supported some bills and “want to be helpful” as the Legislature and Gov. Chris Christie consider a 21-bill package.

New Jersey insurers and the ACA: The rocky launch of the individual health insurance marketplace behind them, New Jersey insurers are hoping for a more settled second open-enrollment period, Sanders said. “Businesses like predictability, and the first year was inherently unpredictable,” he said.

Concerns about the long-term future: Sanders said the biggest change that he’s seen in state government since he first become involved in policy has been the departure of many knowledgeable state workers, adding that there are fewer and fewer people who are on track for a career in public service. He noted that the unit that he worked in in the Attorney General’s Office is one-quarter the size it was when he worked there.

“I think it’s vitally important for talent to be attracted to state government,” Sanders said. “I just hope it continues to be attractive to folks that want to contribute.”

Human rights work with Korea: Sanders’ first job was working at the International Center, a human rights group in Washington, D.C. He worked to help organize the return of Kim Dae Jung, another former political prisoner who later become president of the country. Sanders then went to law school.

A reader and a listener: When not engaged in policy debates, Sanders enjoys reading (his favorite book is Michael Chabon’s novel “The Amazing Adventures of Kavalier & Clay”) and music (his favorite band is Guided by Voices). Music is important in his life in other ways: His wife Erica Rubine, a folklorist who teaches at Rider University, is in a rock band, Strange Brew Crew. The couple has two children, ages 15 and 12.