Insurance Market Reforms

 VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Insurance Regulation >> Insurance Market Reforms


Health insurance market reforms constitute a sizable domain in the landscape of health insurance regulation. Historically, most insurance market reforms were initiated at the state level, starting with small group reforms in Connecticut in 1990. In some states, these were followed by parallel reforms in the individual market. Along the way, some states have experimented with community rating in either or both markets as well as health alliances that have been open to either or both markets. With HIPAA, the federal government ultimately put a floor under the small group and individual market reforms across all states. Currently, all states have enacted insurance reforms aimed at the small group market. Connecticut was the first to enact these reforms in 1990. The Duke Center for Health Policy and Inequalities Research has developed a draft working paper assessing the costs and benefits of insurance market reforms, including the topics listed below (pdf):

  • Small-group insurance reforms
  • Individual market insurance reforms
  • Community rating
  • Health alliances (voluntary & mandatory)
  • HIPAA (1996)


  • Leigh Wachenheim and Hans Leida, The Impact of Guaranteed Issue and Community Rating Reforms on States’ Individual Insurance Markets (Milliman, March 2012),

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