Annotated Bibliography
Federal Regulation and Oversight of Employer-Based Health Plans
Employee Benefits Security Administration (EBSA), U.S. Department of Labor. The EBSA protects the integrity of pensions, health plans, and other employee benefits. Its Web site provides information for consumers, employers, and other audiences about federal laws concerning employer-based health care. Enrollees can go to the EBSA Web site to complain if a health plan run by an employer (such as a self-insured plan or a MEWA) cannot pay its claims, or with other issues.
How Insurance Departments Oversee Insurance Company Behavior
Links to state insurance department Web sites can be found on the Web site for the National Association of Insurance Commissioners. Visitors can also find information on model state laws, which can be purchased online.
U.S. Government Accounting Office, Insurance Regulation: Common Standards and Improved Coordination Needed to Strengthen Market Regulation, GAO-03-433, (Washington: Government Accounting Office, September 2003).
Rate Bands and Community Rating
Mila Kofman and Karen Pollitz, Health Insurance Regulation by States and the Federal Government: A Review of Current Approaches and Proposals for Change (Washington: Georgetown University, April 2006). This report provides an overview of current insurance regulation and discusses proposals the U.S. Congress is considering in 2006. It also contains a helpful table that summarizes states’ small group rating rules on page 14.
Georgetown University Health Policy Institute, Summary of Key Consumer Protections in Individual Health Insurance Markets (Washington: Georgetown University, April 2004). This table summarizes states’ rating rules for the individual market, as well as information on whether insurance is guaranteed issue, whether pre-existing conditions can be excluded, and other ways states make coverage available to individuals.
Susan Laudcina et al, "State Legislative Health Care and Insurance Issues: 2005 Survey of Plans" (Washington: Blue Cross and Blue Shield Association, 2005). This report contains charts that list the states that use community rating, those that use rate bands, and the dates that the laws regarding these measures were passed.
Denise Harris and Kathleen Stoll, Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases (Washington: Families USA, 2003). This issue brief explains how insurers may raise prices by re-underwriting at renewal and how state and federal policymakers can stop this practice.
Edwin Park, Lessons from New Hampshire: Senate Health Bill Could Drive up Health Insurance Premiums for Many Small Businesses (Washington: Center on Budget and Policy Priorities, April 26, 2006). This report was written while the U.S. Senate was considering the Enzi bill. It explains how premiums increased for certain businesses in New Hampshire when the state switched from adjusted community rating to rate bands. The experience was so negative that the state later switched back to adjusted community rating.
Mary Beth Senkewicz, Senate Health Bill Would Preempt States' Small Group Rating Rules (Washington: Center on Budget and Policy Priorities, April 26, 2006). This report was written while the U.S. Senate was considering the Enzi bill. It explains how rate bands work and shows that they may still allow large variations in premiums.
Alan C. Monheit, Joel C. Cantor, Margaret Koller, and Kimberley S. Fox, Community Rating and Sustainable Individual Health Insurance Markets in New Jersey Health Affairs, Vol. 23, No. 4 (July/August 2004), pp. 167-175. This article discusses the problems with community rating for the individual market in New Jersey.
Joel Cantor, Small Business Health Insurance in New Jersey: Issues and Options (Rutgers Center for State Health Policy, conducted for the New Jersey Appleseed Forum, April 2005). The presentation includes state-by-state data on premium prices.
The Use of Reinsurance
Randall Bovbjerg and Elliot Wicks, Implementing Government-Funded Reinsurance in the Context of Universal Coverage (Boston: Blue Cross and Blue Shield Foundation of Massachusetts, October 7, 2005).
Donald Cohn, Enrique Martinez-Vidal, and Deborah Chollet, More Answers on Reinsurance (Washington: State Health Coverage Initiative of AcademyHealth, June 2005).
Capping the Surpluses of Nonprofit Insurers
Deborah Chollet et al, Opportunities and Capacity for Community Benefit: GHMSI’s Potential Role in the National Capital Area, Final Report (Washington: Mathematica Policy Research, Inc., December 2, 2004).
The Lewin Group, Considerations for Appropriate Surplus Accumulation in the Rhode Island Health Insurance Market, Preliminary Findings (presentation for the Rhode Island Health Insurance Commission, March 7, 2006).
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