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
by Deborah J. Chollet, Ph.D. Mathematica Policy Research Adele M. Kirk, M.A. University of California at Los Angeles Kosali Ilayperuma Simon, Ph.D. Michigan State University Submitted to
Variable Mean Std Deviation Min Max Individual Private Coverage Descriptive Statistics
Variable Mean Std Deviation Min Max Small Employer Coverage Descriptive Statistics
Author/Title Reforms considered Data and methods Findings Recent Empirical Studies of the Effects of State Health Insurance Reform Buchmueller, T.C. and G.A. Jensen (Fall 1997). “Small Group Reform in a Competitive Managed Care Market: The Case of California, 1993-1995.” Inquiry 34: 249-263.
Regression Results for Individual Private Coverage Dependent = Private (Individual) Coverage
Regression Results for Small Employer Coverage Firms with <25 workers Dependent = Any employer coverage
Model 1 Model 2 Model 3 Regression Results for Small Employer Coverage Firms with <100 workers Dependent = Any employer coverage
VARIABLE DEFINITIONS Group market characteristics G_NUMINS Number of insurers in the market G_TOPFIVE Share of business accounted for by top 5 firms (percent) G_HMO Share of business accounted for by HMOs G_COM Share of business accounted for by commercial companies G_COMLR Average commercial loss ratio
Browne, M. J. and E.W. Frees (January 2000). “Prohibitions on Health Insurance Underwriting: A Means of Making Health Insurance Available or a Cause of Market Failure?” Working paper (University of Wisconsin, Madison). Chollet, D.J. (Spring I 1994). “Employer-Based Health Insurance in a Changing Work Force,” Health Affairs 13(1): 315-
Baseline Information for Evaluating the Implementation of the Health Insurance Portability and Accountability Act of 1996: Final Report. Question I. Does group to individual portability affect early retirement decisions.
This analysis would be similar to that suggested for Question H. It would use the design shown in Table 2 and the CPS to address whether there was a decrease in the probability of being employed among individuals age 60-64 in the post-HIPAA period. Small samples in this age group included in any single CPS would necessitate pooling surveys. Using
Baseline Information for Evaluating the Implementation of the Health Insurance Portability and Accountability Act of 1996: Final Report. Question H. Are HIPAA induced changes in the small group market related to increases in employee turnover?
This analysis would follow the design shown in Table 1—that is, a comparison of changes in turnover in selected groups of states pre- and post- HIPAA with the change in the control states in group D. Each monthly CPS provides data to measure job change in the past week. This is a rare event, and so very large sample sizes are needed to detect a