The NAIC data. Our basic source of information about commercial insurers is the annual financial reports that each admitted insurer files in each state, compiled by the National Association of Insurance Commissioners (NAIC). In all states, each commercial insurer files an extensive set of forms with the state, submitting information on premiums
The Impact of Access Regulation on Health Insurance Market Structure. Appendix A: the Health Insurer Database
The Health Insurer Database was compiled by Alpha Center with grant funding from the Robert Wood Johnson Foundation. The Health Insurer Database contains information about every health insurer in the U.S. that wrote at least $500,000 of major medical insurance coverage in any state in 1995, 1996 or 1997. Much of the database was compiled from publ
Blair, R.D., and J.R.Vogel, “A Survivor Analysis of Commercial Health Insurers,” Journal of Business 50, 521-9, 1978. Blue Cross and Blue Shield Association, “State Legislative Health Care and Insurance Issues: Survey of Plans,” 1995-1999. Brown, M.J., and E.W. Frees, “Prohibitions on Health Insurance Underwriting: A Means of Mak
1 - In lieu of requiring waiting periods for coverage of preexisting health problems, insurers may exclude coverage for selected conditions altogether. Permanent exclusions of coverage for specific health conditions are called exclusion riders; for other conditions, the insured group or individual coverage has full coverage under the terms of the
Recent studies of health insurance regulation all have concluded that state regulation of insurance issue, renewal and rating in general either reduces health insurance coverage or, on net, has no impact on coverage. Some of these studies have found that regulation may change the risk distribution of the insured population, raising coverage among
The Impact of Access Regulation on Health Insurance Market Structure. B. Individual Market Effects of Regulation
Guaranteed issue. Federal law does not require guaranteed issue in the individual market, as it does in the group market. As a result, only 7 states had all-product guaranteed issue in any year between 1995 and 1997, and only 5 states required guaranteed issue of some products. Neither of these provisions had a significant impact on the number o
The Impact of Access Regulation on Health Insurance Market Structure. A. Group Market Effects of Regulation
The following sections describe our results with respect to three areas of regulation: guaranteed issue and renewal, limits on preexisting condition exclusions, and limits on rating.
The results of our analysis suggest that state insurance regulation has some impacts on health insurance markets. However, these effects differ in size and direction in the group and individual markets when the analysis controls for other circumstances, and they often have only weak statistical significance (90 percent). Moreover, our analysis ind
In preparing a regulation database from published sources, we discovered that recognizes sources of information about insurance regulation (Institute for Health Policy Solutions, 1999; Health Policy Tracking Service, 1996-1998; and Blue Cross and Blue Shield Association, 1996-99) occasionally disagree. With funding from the Robert Wood Johnson Fou
The Impact of Access Regulation on Health Insurance Market Structure. A. Insurer Response to Regulation
The types of regulation that states have imposed in the small group market, and to a lesser extent in the individual market, reward greater insurer size, especially if insurers already are operating with increasing economies of scale. 5 In general, one would expect that regulation which reduces insurers’ ability to deny risk or to rate risk app
Without exception, the empirical research literature investigating the structure of health insurance markets has investigated only the HMO market (Paul and Chollet, 1997). In part because this literature fails to consider the other sectors of the market, and in part because it fails to consider the types of regulation of interest in this paper, it
The Impact of Access Regulation on Health Insurance Market Structure. B. Individual Health Insurance Markets
The individual health insurance market is much smaller than the group market, both in terms of the dollar volume of premiums earned and the number of insurers writing business. In 1997, insurers wrote $8.2 billion in earned premiums in the individual market – less than 6 percent of the volume of business that insurers wrote in the group market.
The Impact of Access Regulation on Health Insurance Market Structure. A. Group Health Insurance Markets
Group major medical insurers in the US – including commercial insurance, Blue Cross and Blue Shield plans, and HMOs – wrote approximately $145 billion in earned premiums in 1997. HMOs wrote nearly 45 percent of this business, followed by Blue Cross and Blue Shield plans (36 percent) and commercial insurers (19 percent).
The following sections review the structure of health insurance markets in the states and the changes that occurred in those markets between 1995 and 1997. These observations of the states’ group and individual markets underlie our subsequent analysis of regulatory impacts. A more detailed description of these markets is provided elsewhere (Chol
Most states restrict either the factors that insurers may consider in setting health insurance rates in either the small group or individual health insurance markets, and also the extent to which insurers can vary rates for allowable factors. HIPAA does not speak directly to the issue of rate setting in either statute or regulation, although many
The Impact of Access Regulation on Health Insurance Market Structure. B. Preexisting Condition Exclusions
At the time HIPAA was passed, 43 states limited the extent to which insurers could consider preexisting conditions in small-group plans; 45 states limited the length of time that insurers could exclude coverage for preexisting conditions in small-group plans (see Table 2). HIPAA limited the duration of preexisting conditions in small-group plans t
The Impact of Access Regulation on Health Insurance Market Structure. A. Guaranteed Issue And Renewal
At the time HIPAA was enacted in 1996, 35 states had enacted and implemented guaranteed issue in the small group market (see Table 1). In general, these states defined small groups as groups of 2 to 50 employees (as does HIPAA). Most (22 states) required guaranteed issue of only some products – typically a standard product devised by the state i
The Impact of Access Regulation on Health Insurance Market Structure. State Regulation of Health Insurance
At the time HIPAA was enacted, many of its provisions related to guaranteed issue and guaranteed renewal, preexisting condition exclusions and portability were already in place in at least some states. The following sections review state regulation of these features of both small-group and individual insurance plans.
All states have enacted health insurance reforms designed to improve access to health insurance among people with health problems. Even before implementation of the Health Insurance Portability and Accountability Act (HIPAA), many states already had required small-group insurers to guarantee issue and renewal. Many states also had portability requ
Recent studies of health insurance regulation all have concluded that state regulation of insurance issue, renewal and rating in general either reduces health insurance coverage or, on net, has no impact on coverage. Some of these studies have found that regulation has no significant impact on overall coverage, but that regulation may change the r