Small-Group Session

Issues in Health Insurance Reform: Federal/State Regulatory Roles, Subsidy Administration
May 8, 2009


Sally Coberly, PhD


This meeting, the seventh in a series on health insurance reform, addressed two topics: federal/state roles and issues associated with administering an insurance subsidy through the tax code. Considerations that influence policymakers' thinking about how responsibilities for implementing health reform might be allocated, as well as the specific factors that support either a federal or state role, were reviewed. Options to encourage states to implement federally mandated rating and underwriting reforms in the individual market were discussed in detail. The implementation of the advanceable Trade Adjustment Act's Health Coverage Tax Credit by the Department of the Treasury was described. Lessons learned from that experience, and implications for subsidy administration on a much larger scale, were reviewed and discussed.


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; and Stephen Finan, Senior Director of Policy, American Cancer Society Cancer Action Network

Slides from the presentations by Mr. Claxton, Mr. Webb, and Mr. Finan, are available for download. The speakers' biographies are also available.

Related Materials

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); actuarial equivalence (April 7, 2009); and health insurance exchanges, part II (April 15, 2009).

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