Issues in Health Insurance Reform: Underwriting, Rating, and Regulation in the Individual Market
December 3, 2008
This small group workshop provided an in-depth examination of current practices regarding underwriting, rating, and regulation in the individual market. Participants discussed the impacts of these practices on access to insurance and premiums, and considered how various changes, alone or in combination with other elements of health reform, might affect individuals, employers, and insurers. The circumstances under which states can regulate individual policies, and the wide variability in current state regulation around guaranteed issue, underwriting, and rating rules was also discussed. The ease or difficulty with which states could ensure compliance with possible changes was also noted.
John M. Bertko, FSA, Adjunct Staff, The RAND Corporation, Mary Beth Senkewicz, JD, Deputy Commissioner of Life and Health, Office of Insurance Regulation, State of Florida; Guenther Ruch, Director, Division of Regulation and Enforcement, Wisconsin Office of the Commissioner of Insurance; Gary Claxton, Vice President and Director, Health Care Marketplace Project, Henry J. Kaiser Family Foundation
Slides from the presentation by Mr. Bertko are available for download.
Other recent meetings in the Forum's series on health insurance reform include sessions on 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); health insurance exchanges, part II (April 15, 2009); and federal/state regulatory roles, subsidy administration (May 8, 2009).
For additional resources, see:
- "Report to the NAIC’s A&H Working Group of the Life and Health Actuarial Task Force," American Academy of Actuaries’ Rating Filing Task Force, May 12, 2004
- "How Private Insurance Works: A Primer, 2008 Update," Kaiser Family Foundation
- "HIPAA Coverage Provisions (The Basics, March 25, 2008)
- "Fundamentals of Underwriting in the Nongroup Health Insurance Market: Access to Coverage and Options for Reform" (Background Paper, April 13, 2005)