Redefining private insurance in a changing market structure.

Abstract

This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.