Gomez seeks balance in OCI’s philosophy
The son of an insurance agent, Jorge Gomez couldn’t help but have an intuitive sense of the industry he is now charged with regulating.
During his childhood in California, Gomez heard plenty about the insurance business from his father, who owned and operated an agency for more than 25 years.
"He sold all lines of insurance: individual, group, property and casualty and health," Gomez says of his dad, who is now retired. "I never sold insurance myself, but growing up I felt I got to know the industry because I was always surrounded by insurance guys."
Appointed by Gov. Jim Doyle in mid-February, Gomez succeeds Connie O’Connell as insurance commissioner for the State of Wisconsin. O’Connell, who was appointed commissioner by then-Gov. Tommy Thompson in January 1999, recently left her post to join a Madison law firm.
Watching his father run the agency also gave Gomez an understanding and appreciation for the challenges of managing a family-owned business. He carried those early impressions with him when he moved to Wisconsin in the mid-1980s to pursue a career in law.
After earning his law degree at the University of Wisconsin-Madison in 1986, Gomez joined Legal Action of Wisconsin in Madison, where he represented farm workers in employment and income issues. Two years later, he went to work for the Milwaukee County District Attorney’s Office, where he prosecuted cases in all criminal divisions, including homicide.
In 1996, he became a partner at the Milwaukee law firm of Michael Best & Friedrich, pursuing trial work, commercial litigation and white-collar criminal defense. Gomez also represented physicians and physician groups in government regulation compliance issues.
When Doyle called on him to take over insurance regulation for the state, Gomez was working for United Government Services in Milwaukee, a Medicare and Medicaid claims processing company and affiliate of Cobalt Corp. and Blue Cross & Blue Shield United of Wisconsin, the state’s largest health insurer.
At United Government Services, Gomez was responsible for all legal affairs but also oversaw the areas of regulatory compliance, internal audits and quality assurance.
His diverse career history suits him well to regulate the state’s insurance industry, those who know him say.
"Jorge Gomez brought to us a lot of experience, having worked at Michael Best & Friedrich and the district attorney’s office," said Sandy Coston, president of United Government Services. "In those roles he had a lot of exposure to compliance matters and health care related issues with providers and beneficiaries. Based on his organizational skills, his prior experiences and his ability to manage people and multiple projects, he will do very well in the role of insurance commissioner."
In particular, Coston has praise for Gomez’s people skills.
"He has a talent for interacting with people at all levels, not just his peers in the management ranks," she said. "That’s really a very strong suit of his, as well as his negotiation skills and business planning abilities."
As commissioner, Gomez and his staff of 135 are responsible for examining the insurance industry’s financial health, business practices and the market conduct of hundreds of insurance companies operating in Wisconsin.
The department also licenses insurance agents and administers the State Life Insurance Fund, the Local Government Property Insurance Fund and the Patients Compensation Fund.
Although he’s been on the job for little more than a month, Gomez already has had to address a contentious issue over the governor’s proposal for a one-time shift of $200 million out of the Patients Compensation Fund to help eliminate a $3.2 billion state budget deficit.
The proposal would shift the funds to help maintain medical assistance programs for the poor and the elderly. The Wisconsin Medical Society, representing hundreds of Wisconsin physicians, is against the idea, suggesting it would undermine the fund and possibly push the state into a medical malpractice insurance crisis.
The fund helps cover medical malpractice claims against Wisconsin health providers.
In recent testimony before the Legislature’s Joint Finance Committee, Gomez defended the governor’s proposal, noting that the fund currently has assets of $600 million.
"We have evaluated the impact of the one-time fund transfer, and we believe there will be no immediate risk to cover any claims," Gomez said in an interview a day after his testimony. "There is no risk of a patient not being covered by the assets of the fund."
Other issues that Gomez said will be on his department’s "radar screen" include: credit scoring as a form of insurance underwriting; the marketing practices of insurance companies selling products to the elderly; the practice of debt cancellation contracting; and the problems small employers face in obtaining health insurance.
Asked to describe his philosophy as a regulator, Gomez said: "I have a real desire to make sure that consumers are protected in all sorts of insurance-related matters. With that said, I also recognize that the industry, if it is going to be a healthy industry, has to be able to honestly resolve issues with this office. A healthy tension has to be maintained between this office as a regulatory body and the industry so that there is dialog and an understanding that issues will come up from the consumers’ side of the fence."
Some who represent consumer interests hope the new commissioner will not only aggressively regulate the industry to protect the people, but also help Wisconsin residents find – and keep – their health care coverage. Although the state’s uninsured population remains low compared with those of other states, the number of Wisconsin residents going without health insurance is increasing.
"Under its new leadership, I hope OCI takes a more proactive stance on health insurance issues and regulations by working with a coalition of health care stakeholders and by formulating policy before problems arise," said Barbara Zabawa, staff attorney for the Center for Public Representation, a consumer advocacy group.
However, representatives of health insurance companies say the OCI already has a track record of balancing consumer interests with maintaining a financially secure insurance market. Joseph Kachelski, spokesman for the Association of Wisconsin Health Plans, doesn’t think that direction should change under Gomez’s leadership.
"It’s pretty clear that Mr. Gomez understands the role of the agency, and sure, there will be issues that we want to work through (OCI) at some point in time," said Kachelski, whose organization represents HMOs. "We don’t have any reason to doubt that we will have a good working relationship with him."
The new commissioner is better known in health insurance circles than other areas of insurance, said Eric Englund, president of the Wisconsin Insurance Alliance, a trade group and lobbying association for property and casualty insurers.
"He’s not someone we’re previously aware of, but having met with him, he seems to be someone who, because of his work for Cobalt, comes to the industry with a fundamental understanding of how insurance operates. He seems to be a quick study by the nature of his educational and insurance background. We’re looking forward to working with him."
April 4, 2003 Small Business Times, Milwaukee