Early last year, Premera Blue Cross told Jay Ellison, a Kent father of four suffering from a rapidly degenerative form of multiple sclerosis, that it had decided not to cover the stem cell transplant recommended by his doctors because the costly treatment was experimental. A consumer group who had taken on Ellison's case set up a meeting with state Insurance Commissioner Deborah Senn, who immediately swung into action. Ellison recalls: "She called [Premera] on the phone right in front of me and said, 'I want to know why you're not going to save Jay Ellison.'" When that failed to produce results, her office showed Ellison how to get Premera to hold an expedited appeals hearing, to which Senn sent a delegate. Again, Premera refused to pay for the operation.
After the hearing, Ellison remembers, "We were all crying on the way home in the car," when the commissioner called him on his cell phone. "It's not over," she said, persuading him to let her hold a news conference asking the public for donations, which she did the very next morning. "Within four hours, I was cleared for a transplant," he says. An anonymous donor had come forward. Performed last March, the operation, contrary to all expectations, reversed instead of merely halted the progression of his disease. Once confined to a wheelchair, Ellison can now walk a few hundred feet at a time.
He believes he owes it all to Senn. "She said, 'Look, this man is worth saving.' By her involvement in my case, I was saved."
To put it mildly, Senn now has Ellison's support in a fight of her own, one to capture the US Senate seat long held by Republican Slade Gorton. It won't be easy. As usual, Democrats from Olympia to DC think they can topple Gorton this time, believing that his consistently narrow margins of victory make him vulnerable. But the intellectual and well-organized Gorton has proved a persistent survivor and awesome fundraiser. A close advisor to Senate Majority Leader Trent Lott, he is arguably at the height of his power.
In Senn, however, the Democrats have an unusual candidate: a hell-raising populist who during her seven years in office has earned a devoted following and a national, even international, reputation for battling insurance companies on behalf of the little guy. Her main preoccupation has been the health care morass, one of the most important, emotional, and complex problems of our time. Not only has she personally gotten involved in numerous cases like Ellison's, but she has challenged insurance companies' proposed rate hikes and drawn up rules that have dramatically changed the way they do business.
In the process, she has been labeled abrasive, and some charge that she has actually made matters worse. But consumer advocates like Ralph Nader can't speak highly enough of her. "She is the best insurance commissioner in the US, hands down," Nader says. "Most other insurance commissioners just do what industry wants them to do."
To her backers, the logic of her candidacy is what Senn volunteer Martha Lynn-Johnson of Bremerton calls a "no-brainer." "She's so dynamic, she's done so much," Johnson enthuses after seeing Senn speak at a Bremerton union hall. "It's obvious she's just going to get out there and fight for people. I can't understand why everyone in the world is not behind her."
That's just it. Everyone is not behind her, even in her own party. The state Democrats' worst kept secret as Senn has been out campaigning over the past year is that they have been searching for someone else to run. Aspirations settled alternately on Governor Gary Locke and state Attorney General Christine Gregoire, both of whom said no. Finally, late last month, former congresswoman and high-tech executive Maria Cantwell ended months of Hillary Clintonesque elusiveness and officially announced her candidacy.
Whatever the comparative strengths of candidates, there is in some quarters an antipathy towards Senn that runs surprisingly deep. "I've never quite seen somebody run a race of this kind that elicits such negative feel- ing," says fellow Democrat and former Mt. Vernon legislator Rob Johnson. The question is, why? Is there really something about Senn that discredits her, or are the Democrats merely too timid and comfortable to embrace a real reformer? Put another way, are the Democrats crazy or is she?
To be sure, the Senn hate club is somewhat mythological. Several people I contact who supposedly can't stand the commissioner end up singing her praises, and in a way that make it seem doubtful that they are changing their tune for the press. But when I hit the right person, I get a stream of vitriol.
"She is the most ruthless politician I have run across in 15 years of politics," says Phil Dyer, a former Republican legislator now serving on the Sammamish City Council. He accuses her of "heavy-duty rhetoric and flat-out lies," and charges that her motivation is suspect. "She's in it for Deborah's ego."
Dyer has had particular cause to clash with Senn. As the vice president of a company that sells malpractice insurance to doctors and hospitals, Dyer was the architect of several bills friendly to the insurance industry, including a landmark one in 1995 that rolled back most of the health care reforms passed two years earlier. In 1997, Dyer then tried to eliminate one of the few remaining reforms, the one prohibiting insurance companies from denying coverage based on preexisting conditions. Though it was the governor who vetoed the bill, Dyer is still steaming at the way Senn expressed her opinion.
In a press conference, Dyer recalls, "She rolled out a shopping cart with a big sack of Gravy Train dog food and said, 'Representative Dyer is only creating a gravy train for the insurance company on the backs of poor people.'"
Heavy-duty rhetoric? Certainly. Flat-out lies? Well, that depends on your opinion. Ruthless? In rough and tumble Chicago, where Senn grew up, the pols would undoubtedly have a good laugh at that, but this isn't Chicago. "Her personal style is different from anything we've ever seen in this state before," says state Democratic Party Chair Paul Berendt, who goes on to hint at how personally some local folks take her aggressiveness. "It's just this thing about respect. . . ." he says, trailing off. "Let me not go down that path."
Senn seems either unable or unwilling to conform to local sensibilities. I ask her about the gravy train press conference as we're driving between campaign stops in one of her assistants' ancient Volvo. Senn laughs. "He'll never get over that," she says of Dyer. "Look, I had a press conference that was creative. The reporters loved it." As an afterthought, she adds, "And the public loved it too."
Given that Senn is also accused of grandstanding for the press and the public, this is an unwise but not uncharacteristic thing for her to say. On another day, Senn lets drop this doozy: "My husband always says to me, 'You have a polling firm in your head.'"
Yet while Senn may play to her audience, she has hewn to a consistent set of liberal values. Fifty years old, she began her career as a lawyer advocating for consumers on utility cases in Chicago. Moving out West, she did a brief stint as a TV news reporter in Alaska and wound her way to Seattle, where she lobbied for the Northwest Women's Law Center and other women's groups before vying for the commissioner's job.
Senn is well aware of the criticism of her. "It's hurtful to hear things like that," she admits. She chalks it up to her "directness," a quality, others add, that is not always appreciated in a woman.
A small woman with short dark hair that comes to a spike in front of each ear, and conscious enough of her appearance to check her lipstick before a press conference, Senn seems to be trying to present a kinder, gentler image. She asks people about their tennis game, compliments an aide for being "sweet," and shares a bit about her family by bringing out old photos of her mother as a dancer. But it doesn't seem to come naturally and the effort shows. She does not exude warmth or passion, even when her work cries out for it.
For instance, she helped put together a press conference last month in support of a state "Patients Bill of Rights," which would give patients the right to an independent appeal of decisions made by insurance companies and ultimately the ability to sue them. It was probably the most emotional press conference I've ever attended. A young father named Dylan Malone, with his wife Christine standing by his side, told of how their insurance company, Aetna US Healthcare, wants to cut off home nursing care for their 4-month-old son, who was born with brain damage. His voice breaking, Malone says the insurance company asked him, couldn't they turn instead to some sort of charity? Or maybe, he says the company suggested, they could get Medicaid if they surrendered their "custodial rights." (Aetna says it raised the possibility of various other kinds of "financial assistance," but denies suggesting the family give the child up.)
As the teary crowd stumbled out afterward, Senn turned to me and declared it "an amazing press conference in terms of the number of organizations involved." In other words, the bipartisan bill has broad support and room was full. She doesn't think to mention that it was amazing for quite another reason.
It may be simply that Senn doesn't wear her heart on her sleeve. "The reality is that Deborah's not warm and fuzzy," says her former chief deputy Krishna Fells, who has had her personal ups and downs with Senn. "But she's deeply caring, utterly loyal, and very honest."
In any case, if you're giving an emotional litmus test, the remote Slade Gorton is unlikely to score any higher. Voters, moreover, probably could care less about Senn's emotional temperature, as long as she delivers. Nor are they likely to shed any tears over a few bruised egos among the powerful. Indeed, it's obviously her very combativeness—on issues that are, after all, about life or death—that appeals to ordinary people. Senn sailed to victory in both her prior races with 83 and 75 percent of the vote respectively.
The argument can be made, however, that Senn's personal style has affected not only her popularity, at least among the establishment, but her effectiveness. In Senn's own office, she drove employees so hard that they launched a bitter union drive that undoubtedly took a toll on work.
In the broader arena, it's useful to hear the perspective of Rob Johnson. He has an unusual vantage point as both a former Democratic legislator and an insurance agent who voted against his self-interest in supporting the '93 reform, for which he says he has been "vilified and hated by fellow insurance agents ever since." Johnson believes that the commissioner "demonizes" insurance companies as uncaring money-grubbers, creating "an increasingly sour atmosphere" that poisons possible accords.
He points to a set of proposed legislative actions she issued last month to try to rectify last year's disturbing collapse of the market for individuals buying their own health insurance. (Throughout most of the state, companies simply aren't selling new policies.) Noting that the proposals had no backing from insurance companies, he says, "she should have already worked out a deal to bring the major carriers back into the market. That should have been sorted out before the Legislature began."
This argument may have something to it. But once you get past Senn's style and consider her substantive actions in office, it's clear her detractors are trying to stick a bum rap on her. "I attribute the entire health care mess to her," says Dyer. He then poses a question that will be Senn's toughest challenge if she goes up against Gorton. "What do you think has happened to health care since she's been in office? Has it gotten better or worse?"
In particular, critics blame Senn for the disappearance of the individual market. They hold her responsible for new rules that require insurance companies to cover preexisting conditions after three months and prohibit them from the old practice of denying coverage at all based on those conditions. Carriers argue that the rules allow individuals to buy coverage only when they're sick or pregnant, driving up the carriers' costs. Yet they say Senn dragged them through prolonged, nasty battles every time they tried to raise rates accordingly (even if she settled in the end for price hikes similar to what they requested) until they finally just left the market altogether.
Senn argues, with justification, that you have to look at the role of the Legislature before assigning blame. When the Legislature passed its historic reform package in 1993, it outlined a system of universal coverage that carried new obligations for insurance companies, but also tried to protect them against undue risk. Most crucially, universal coverage in itself was a protection, because it would have drawn in premiums from healthy people as well as sick.
On the matter of preexisting conditions, the legislature left it up to the newly created Health Services Commission to decide on final rules. In the meantime, it allowed the insurance commissioner to set up temporary ones. Here Senn eagerly stepped in and drew up the rules we have now. It was unquestionably a bold move, perhaps even one that overreached. But the rules were temporary and experimental, and written within the context of a unified system.
Then, in 1995, a Republican sweep in the Legislature empowered Dyer and allies to dismantle that system. Yet at the same time, remarkably, they codified Senn's temporary rules on preexisting conditions. "I put those rules in the bill so that the Democrats wouldn't vote against it," Dyer explains.
The result, almost everybody admits, is far from ideal. "What you have is lots of access [to coverage], but not in a universal coverage environment," says Chris Bruzzo, a spokesperson for Regence BlueShield. Senn says she and others told the Legislature, "If you do this . . . you're going to see rates go up—and that's what happened."
Senn has nevertheless vigorously enforced the rules she created. She defends her position by referring to the 1997 Dyer bill that would have again allowed companies to deny coverage based on preexisting conditions (a process known in the industry as "underwriting"). "Look, in '97, the insurance industry said, 'The rates have gone up, let's go back to underwriting and keeping sick people out.' That's not the solution. I want to go forward, not backward."
It's true that more than anyone else in recent years, Senn has held the line against returning to the way things were before reform. She may have pushed too hard, but practically nobody else has been pushing at all.
Senn's boldness in office extends beyond her conduct in health care. On the day of the press conference on the Patients Bill of Rights, Senn jams in meetings on two other battles. The first concerns a national class-action lawsuit against Prudential over alleged improprieties in life insurance sales. Prudential has settled the case and is reviewing old policies to determine appropriate refunds. Senn tells me that she insisted on having all of Washington state's policies reviewed in one place so that she could send a representative to look over Prudential's shoulder—the only state to go to such lengths.
The second battle, taking her into the realm of foreign affairs, is to reclaim never-paid insurance benefits for families of Holocaust survivors living in the state. Senn helped initiate a movement among many states that are pressing Italian, German, and other European companies to pay up. Sitting around a conference table in her office, Senn and her Holocaust team (including former congressional candidate Jeffrey Coopersmith) discuss how to make the companies divulge a full list of former policy holders, something she says they have been loath to do for fear of alerting people who would otherwise not know about potential benefits.
Given her nerviness, it's interesting to ponder what Senn might do in the Senate. She doesn't seem to know herself. Discussing various public policy issues one day, it's obvious that Senn feels most comfortable talking about health care. She says she would "try to replicate some of the ideas we've done here to create access" and brings up the possibility of "community rating" on a large scale. Done in this state with the small business market, this system throws everybody into a pool together when setting rates, so that sick people aren't stuck with rates that are astronomically high.
On the subject of education, Senn roots around without focus. She ventures a half-hearted criticism of Gorton: "One of the things Slade Gorton has done that differs from Patty Murray is that he's tried to give money to states in lump sums as opposed to specific grants." It's better, she says as if trying a theory on for size, to focus on a problem. She then launches into tangents on income disparity and a literacy function she attended before concluding, "Readers, literacy, that is the key to the success of our people."
Moving on to the environment, she concentrates on the past rather than the future. As commissioner, she enacted regulations that force insurance companies to deal promptly with claims related to environmental clean-up.
At least for now, she is not putting forward any maverick views. In fact, I sense a surprising capacity, even a longing, to be a good Democratic soldier. There is her deference on education to Senator Murray, nobody's idea of a gutsy leader. And then there's her behavior at an intimate fundraising lunch in the Columbia Tower Club for a top congressional Democrat, Martin Frost of Texas: When Frost, a charmer as well as a powerbroker, looks her way, she positively beams.
Nevertheless, Senn's record still makes her look like a rebel compared to rival Maria Cantwell. Consistent with her own record, Cantwell is positioning herself as a "moderate," "pro-business" Democrat who has a better chance of beating Gorton. "It's the moderate that has traditionally done well in this state," says Cantwell campaign treasurer Keith Grinstein, referring to Dan Evans Republicans and Scoop Jackson Democrats. Cantwell also has millions of her own money to spend, whereas Senn has raised about $800,000 to date.
Senn says she's concentrating on her campaign rather than paying attention to anybody else. But on the day that The Seattle Times announces Cantwell's entry into the race, her campaign manager calls to read her the story. She is outwardly calm. It isn't a surprise.
Senn and her handlers also stress the numerous endorsements she's lined up while Cantwell has dithered. Many of those were given, however, when Senn was the only candidate and Democrats feared they couldn't withhold their support any longer. State Democratic Chair Berendt recalls: "She called everyone last January and said, 'Can I have your support?' They said, 'Let me wait a while.' She called again in April, they said, 'Let me wait a while more." She called again in August, they said, 'Yes.'" If the primary were a popularity contest among the party establishment, Cantwell would likely win it.
But, of course, it isn't. Republican political consultant Brett Bader, for one, believes Democratic voters may undermine the preferences of their leaders. Of Senn, he says, "I often equate her to Linda Smith," the former Congresswoman and religious conservative who outraged her peers by standing up for campaign finance reform. Like Smith, he says Senn is "someone who is continuously underestimated yet continues to enjoy the support of the grassroots."
On the other hand, Smith won the primary in her Senate bid two years ago but lost the general election against Patty Murray. She put up a hell of a fight, though. And so, you can be sure, would Senn.