Forum Session

Proposals to Reform the Individual Health Insurance Market
June 26, 2009


Kathryn Linehan


The House and Senate have proposed expanding coverage through the individual market by enacting reforms that will affect how these policies are offered, priced, and regulated. Knowing how the individual market operates—and the fundamental concepts underlying insurance—will be critical to understanding the rationale for proposed changes and how bill provisions will likely alter existing practices and market dynamics.

The first part of the session provided an overview of the non-group market, focusing on underwriting, rating, and other practices, such as benefit and network design. Discussion of reform proposals addressed how various provisions such as guaranteed issue, premium rules, and prohibitions on pre-existing condition exclusions might change insurer practices and how those changes might affect access to and the cost of individual insurance.

The second part of the session looked at current state and federal roles in the regulation of insurance,the wide variability in state regulation, and how those are enforced. Discussion of reform proposals then addressed the potential roles for federal and state governments in regulating non-group market reforms. Speakers offered their perspectives on the ability of the states and the federal government to carry out the functions envisioned for them in draft reform legislation.


John M. Bertko, FSA, Adjunct Staff, The RAND Corporation; Gary Claxton, Vice President and Director, Health Care Marketplace Project, Henry J. Kaiser Family Foundation; Brian Webb, Manager, Health Policy and Legislation, National Association of Insurance Commissioners

Slides from the presentations by Mr. Bertko and Mr. Webb are available for download. Speakers' biographies are also available.

Related Materials

See also "Underwriting in the Non-Group Health Insurance Market: The Fundamentals" (Background Paper No. 69, June 4, 2009) and "Glossary of Health Insurance Terms" (December 12, 2008).

Other recent meetings in the Forum's series on health insurance reform include sessions on underwriting, rating, and regulation in the individual market (December 3, 2008); rating rules in the individual market, part II (February 19, 2009); health insurance exchanges (March 6, 2009); risk adjustment and rating in the small-group market (March 20, 2009); health insurance exchanges, part II (April 15, 2009); and federal/state regulatory roles, subsidy administration (May 8, 2009).

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