Health Insurance Regulations to Ensure Fairness and Access

Health Insurance Reform - Building Momentum for Change

For working families, access to and the affordability of health care continue to be a top economic concern.  Feeling the burden of higher prices on all fronts, voters are especially angry at health insurance companies and cite rising premiums, higher out of pocket costs, less coverage, and hassles dealing with claims departm

Health Care for All: Policy Options for 2009

Download a copy of the report in PDF format here.  View the HTML version of the report here.


Families USA explains that Massachusetts' 2006 health care reform law was "built on Massachusetts' expanded public programs and its highly regulated insurance market."  In addition to providing a base for comprehensive reform, the following examples underscore why states need to increase state oversight of insurance rates and clamp-down on industry tactics that hurt consumers:

  • California regulators have been investigating and imposing fines on many of the state's for-profit and non-profit insurance companies.  News reports have documented rampant abuse and anti-consumer tactics, including insurer HealthNet giving bonuses to employees who cancel health plans after members incur costly claims and Blue Cross of California recruiting physicians in canceling coverage. 
  • In Washington State, news that a state-based non-profit insurer transferred $49 million in premium revenue over the past three years to a faltering for-profit subsidiary in Arizona fueled the legislature's passage of stronger oversight and rate regulation in early 2008.
  • The Pittsburgh Post-Gazette reported that health insurer Highmark enjoyed total revenue of $12.4 billion in 2007, growing its surplus to $3.5 billion.  The article went on to report that several insurers are planning premium hikes over the summer of 2008 because "per-share earnings" have not met projections, down from a forecasted $6.41 per share to between $5.76 and $6.01 in the case of the huge multi-state insurer Wellpoint.  However, the Post-Gazette reports that Highmark's $3.5 billion surplus represents 734% of its risk-based capital -- a measure of the money an insurer might need on hand in case of unforeseen claims.  The National Association of Insurance Commissioners note that surpluses exceeding 250% of risk-based capital are troubling.

This section underscores leading options to ensure consumers are treated fairly in the individual and small group markets  and that more of their premium dollars actually go to health care rather than profits and share-holder earnings.

New Families USA Report Shows Lack of State Consumer Protections in Individual Health Insurance Market

The Right, including Presidential candidate John McCain, wants every American to purchase their health insurance in the individual market, where a mere 5% of non-elderly Americans currently get their coverage.  As a new Families USA report makes clear, this would expose Americans to even more volatility than they currently experience in accessing health care and health insurance.

Connecticut Passes First-in-the-Nation Health Care Bill

Early Tuesday morning, the Connecticut Senate joined the House and overwhelmingly adopted HB 5536, the Connecticut Healthcare Partnership.  The legislation will open up the state employee health plan to municipalities, small businesses and non-profits.  Pooling small groups with the state employee plan, which has more than 200,000 members, will generate significant bargaining power and enable small employers and municipalites to negotiate better insurance rates.  As we've written previously, while more than 20 states allow similar pooling of state and municipal workers, Connecticut would be the first to allow small businesses to join the plan at such a large scale.

Colorado Lawmakers Tightening Standards for Insurance Companies

Examples of the kind of tough state insurance regulations that would be undermined by wrong-headed federal preemption include the recent reforms Colorado and other states are pursing in their health insurance markets. 

Gutting State Regulation of Insurance under Bush Administration's Financial Oversight "Reform"

While the financial crisis developed over a number of years in the subprime mortgage sector, federal regulators were asleep at the wheel as greedy lenders often took advantage of working families.  Worse, when states tried to step in with new state policies to tighten oversight of predatory lenders, federal officials blocked those state consumer protections, making the effects of the meltdown even worse for families. 

Washington State to Hold Insurance Companies Accountable

On Friday, the Washington State Legislature enacted SB 5261 which will restore state oversight of the individual health insurance market.  The law authorizes the Insurance Commissioner to disapprove unreasonable rate increases and establishes a sliding-scale medical loss ratio for insurers.

Health-Care-for-All On the Installment Plan

Incremental steps to improve the health care system can lay the foundation for comprehensive reform that provides health care for all. Comprehensive reforms enacted in Massachusetts, Vermont, Maine and San Francisco were, in large part, the result of pragmatic incremental steps those states had already taken. For example, a Families USA report discusses the many reforms Massachusetts put in place over the years that led to its comprehensive 2006 reform. Not every state is as far along in moving comprehensive health care reform, but each state does have numerous options for increasing access to coverage, reducing the growth of health care costs, and improving the quality of care.