TAILIEUCHUNG - Health Insurance Regulation by States and the Federal Government: A Review of Current Approaches and Proposals for Change

PHI provides a source of insurance in systems with targeted, non-universal access to health care coverage. It plays a particularly large role in countries with a history of private health coverage and an absence of universal coverage. For example, in the Netherlands, nearly all of the population without access to social insurance purchases PHI (about a third of the population), and the majority of the socially insured rely on PHI for coverage of services not included within social insurance. In the United States, the majority of the non-elderly population without public insurance are covered by PHI. However, unlike the case in the Netherlands, significant gaps in. | gEORgETOWtNNIiW ERSlTY Health Policy Institute Health Insurance Regulation by States and the Federal Government A Review of Current Approaches and Proposals for Change By Mila Kofman . and Karen Pollitz Health Policy Institute Georgetown University April 2006 3300 Whitehaven Street NW Suite 5000 Box 571444 Washington . 20057-1485 Courier Delivery Zip Code 20007 202-687-0880 202-687-3110 faCsmile http . edu Health insurance serves several public policy goals it enables consumers to spread the risk of health care expenses and provides them access to medical services which they might otherwise not be able to obtain. Because of the importance of health insurance to the general public welfare states have been regulating private health insurance companies and products since the late 19th century. State insurance regulation has sought to promote several policy objectives such as assuring the financial solvency of insurance companies promoting risk spreading protecting consumers against fraud and ensuring that consumers are paid the benefits that they are promised. The federal government has historically respected the state s role in regulating insurance. In 1944 the . Congress explicitly recognized this role in the McCarran-Ferguson Act which said the business of insurance . shall be subject to the laws of the several States . . 1 Since the early 1970s however the federal government has taken a more active role in areas of insurance regulation that traditionally had been reserved to the states. In 1974 the federal government became the primary regulator of health benefits provided by employers. And in the 1980s and 90s Congress established minimum national standards for group health insurance. This paper provides an overview of current regulation of health insurance including a discussion of state and federal standards regulation and It then reviews three Congressional proposals to change health insurance regulation largely by .

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