Early experience with 'new federalism' in health insurance regulation

PROLOGUE: The insurance reform provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 created new minimum portability and enrollment protections for consumers. At the same time, the law changed the way health plans are regulated by the states and the federal government. However, HIPAA did not disturb existing market and regulatory divisions or address premium costs. Now, four years after the law's passage, employers and consumers are still routinely troubled by access to affordable health insurance. Policymakers wonder if the lessons learned from HIPAA's implementation will be useful in developing future insurance legislation, such as for managed care consumer protections. This paper is among the first to examine the impact of HIPAA's incremental reforms and how its national policy affects multiple insurance markets and regulatory jurisdictions. It finds that HIPAA resulted in major achievements and can be a base for future reforms. However, the law's provisions had gaps and...