If taxes are defined as money that citizens must pay in order to avoid serious difficulties, then surely health insurance premiums are a kind of de facto tax.

That’s certainly the view of Dave Jones, California’s new insurance commissioner, who has been frustrated since entering office by his inability to overrule proposed rate increases by the state’s largest health insurance companies for their individual and family policies.

When Blue Shield on Jan. 1 announced an increase that would hike rates to levels 59 percent higher than what they were last October, it drew a loud protest from Jones, a former Democratic state assemblyman who earlier served as a Legal Aid lawyer. Blue Shield eventually delayed its increase until next January at the earliest because of the outcry from Jones and outraged customers.

What Authority?

But Jones couldn’t simply order Blue Shield to desist. He can stymie sudden increases in car insurance rates and in the price of homeowners insurance and other property policies, but not health insurance.

Interestingly, Republican state legislators who have taken their party’s standard “no-new-taxes” pledge rarely say anything about health insurance rate increases, which are effectively taxes on those who pay them.

Things were the same when Anthem Blue Cross in early March announced it would raise its individual rates by about 20 percent for most of its 700,000 non-group policy holders, making a total increase for them of about 40 percent in the last year. When the same company tried to raise rates by 39 percent in May 2010, it drew so much animosity the company scaled back the increase – for awhile. But as of this May, Blue Cross will be right at the levels proposed a year earlier.

Jones’s Republican predecessor, Steve Poizner, jawboned last year’s Blue Cross increase down, but only by using the bully pulpit his office provided. Like Jones, he lacked the power to simply stop the raise.

Here We Go Again

Even while in the Legislature, Jones sought to change that. “I’m trying to get this office the authority to reject excessive health insurance rate hikes, just like I now have the ability to turn down absurdly high rate increases on auto, property and even medical malpractice insurance,” Jones said in an interview. “In the Legislature, the insurance lobby prevented my bill doing this from passing.” It was mostly Republican votes in the state Senate that killed his bill last year.

The bill is back again this year, with Jones’s 14 percentage-point election win of last fall adding clout to the effort to push it through. If the Blue Shield and Blue Cross rate hike efforts don’t help it along, it’s hard to see what might.

Not that Jones wants to clamp down excessively on insurance companies. He says he just wants to keep their rates in line with expenses. His main aim in office, he adds, is to protect consumers while making sure California has “healthy and viable” insurance markets. Those are the same goals Poizner espoused, but in the reverse order. Where Poizner often saw himself as an arbiter between insurance companies and their customers, Jones might approach his new office more as a consumer advocate.

He’ll also do what he can to bring President Obama’s health care program into California reality. His first act as commissioner, taken the night he took office in early January, was to create a new regulation giving him power to enforce the federal law’s mandate that at least 80 percent of health insurance premium dollars go to patient care and 20 percent or less for administration and profit.

“We are carrying that out, too,” Jones said. “Right now, we’re reviewing a number of rate filings from insurers.”

Where most past insurance commissioners have made car insurance their top priority, Jones indicates he may focus more on health insurance.

He also has re-established a branch of his department that tries to get insurance companies to invest cash reserves in California, where they can get tax credits for it. “I think we’ll see some movement here,” Jones said. “I’m already requiring insurers to report all their investments in the state’s more under-served communities — the poorest Census tracts. I’m aiming to get at least $10 million invested there.”

But talk to Jones and you get the feeling he’ll make his top priority the drive for the ability to regulate health insurance rates just like other insurance prices. If he can do it, he’ll have established a permanent new brake on the profligate profit-seeking of the big health insurers who have lately raised the tax-like premiums they collect from hundreds of thousands of Californians.

Mr. Elias may be contacted at tdelias@aol.com.

His book, “The Burzynski Breakthrough,” is available in a soft cover, fourth edition. For more Elias columns, visit www.californiafocus.net