Health Insurance and States: NCSL Overview, 2011
Contents
Featured NCSL Links
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Updated: September 2011
Overview
For most Americans, market-based health insurance remains the predominant form of health coverage, although 2009 marked the lowest rate of private coverage since 1987.
In general terms, all 50 states regulate and initiate policies affecting health insurance. These statutes, and the Insurance Departments and other agencies that administer them, play a significant role in virtually every state.
The National Conference of State Legislatures (NCSL) has tracked and evaluated activities in several project areas in health care, and has collaborated with or relied on a number of outside experts in this field.
The list in the right-hand column includes links to several current NCSL projects and publications. In addition, the internal and external resources listed below provide further details.
Latest Information
According to the most recent detailed census report (2010, published September 2011), of 312,250,315 total Americans:
- “The percentage of people with health insurance in 2010 was not statistically different from 2009, while the number of insured increased to 256.2 million in 2010 from 255.3 million in 2009.”
- “The percentage of people covered by private health insurance decreased in 2010 to 64.0 percent, while the number of people covered by private health insurance was not statistically different from 2009, at 195.9 million. The percentage of people covered by private health insurance has been decreasing since 2001.”
- “The percentage of people covered by employment-based health insurance decreased to 55.3 percent in 2010 from 56.1 percent in 2009. The number of people covered by employment-based health insurance decreased to 169.3 million from 170.8 million.”
- “The percentage and number of people covered by government health insurance increased to 31.0 percent and 95.0 million in 2010 from 30.6 percent and 93.2 million in 2009.”
- “The percentage and number of people covered by Medicaid in 2010, 15.9 percent and 48.6 million, were not statistically different from 2009 estimates.”
- “The percentage and number of people covered by Medicare increased in 2010 to 14.5 percent and 44.3 million.”
- “In 2010, the percentage of people without health insurance, 16.3 percent, was not statistically different from the rate in 2009. The number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009.”
Source: Income, Poverty, and Health Insurance Coverage in the United States: 2010, September 2011; http://www.census.gov/prod/2011pubs/p60-239.pdf
- 2011 Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent - - Kiaser/HRET survey, published 9/27/2011.
Full Report (225 pages, pdf) || Summary of Findings (.pdf) || Chart Pack
- 2010 Family Health Premiums Rise 3 Percent to $13,770 in 2010, But Workers' Share Jumps 14 Percent as Firms Shift Cost Burden - Kiaser/HRET survey, published 9/2/2010
These links allow you to download the full original report materials – Summary of Findings (8 pages, PDF) || Full Report (226 pages, PDF) || Chart Pack (PDF) || Slides (PDF)
- 2010 Health Insurance Premiums Include Major Increases: A fall 2009 survey of state insurance regulators by the National Association of Insurance Commissioners found that average insurance policies will increase between 11% to 16%—and as high as 25% to 30%—annually in most states.
Federal Health Reform: Major Effects on State Health Insurance
The 2010 federal health ereform laws make major changes in the way private health insurance is handled and regulated. Several of these changes will be implemented in 2010 and 2011. These include:
- Access to insurance for people with preexisting conditions through federally-funded high risk pools.(July 1, 2010)
- No preexisting condition restrictions for children;
- Restrictions on certain insurance practices;
- Reporting requirements;
- A small-business tax credit;
- Expanded dependent coverage;
- Coverage and access provisions;
- Expanding access to information on health insurance;
- Retirees’ access to health insurance; and
- Access to long-term care insurance.
NCSL Resources
A Sampling of State Laws and Recent Legislation:
Insurance and Fiscal Incentives for Wellness and Prevention- Sample of 2006 through 2010 State Legislation
Archive of NCSL Meetings
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Health Care Reform and Finance- Presentation by Professor Uwe Reinhardt, Plenary Session at NCSL Annual Meeting, 8/19/05. [80 pages, PDF] Audio Link | Video Link
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"Consumer Driven Health Insurance: New State Solutions in 2006?" - Spring Forum, 4/7/06.
From corporate boardrooms to the President's State of the Union, the idea of health savings accounts has attracted attention, support and nagging concerns. In 2005 at least 26 states enacted laws directly affecting health savings accounts and their associated high-deductible health insurance plans. At least three states hope to integrate "CDHPs" into Medicaid via legislation and federal waivers. These market-based tools are aimed at lowering premium costs and requiring increased consumer responsibility. Yet the "bare bones" policies often associated with such plans may leave a family with hefty charges for routine or not-so-routine medical services. This "mini-summit" 2 hour session examined facts, opinions and some unknowns. Funded in part by the Robert Wood Johnson Foundation and the NCSL Critical Health Areas Project (CHAP).
Paul Fronstin, Director, HRET, Employee Benefit Research Institute- Presentation
Tracy Cassidy Watts, Principal, Healthcare and Group Benefits, Mercer Co.- Presentation
Simmi Singh, VP, Cognizant Technology Solutions, Chicago, IL- Presentation
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Health Care Costs & Spending: Latest State Strategies- Presentation by Richard Cauchi for the Iowa Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, 9/19/07. [36 pages, PDF]
- Covering High-Cost, High-Risk People: Whose Responsibility?- NCSL Spring Forum, Sponsored by the NCSL Health Committee, 4/25/08.
State interest in both health "reform" and health cost savings creates special challenges for covering patients considered "high risk" and high cost. The sickest 10 percent of our population often cost tens of thousands of dollars annually, accounting for over 60 percent of U.S. health spending. Yet a cancer survivor may have low annual costs but be uninsurable. How should these people be treated by insurance market underwriting practices? What are the roles of state-sponsored high-risk pools, the health insurance industry, government, providers and the high-cost individuals themselves in providing and paying for care? Two national experts share facts and recent thinking. SESSION PODCAST - Listen here.
Karen L. Pollitz, Project Director, Health Policy Institute, Georgetown University, Washington, DC- Presentation
Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans (AHIP), Washington, DC-Presentation
Facilitator: Representative Susan King, Texas House of Representatives
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State Health Care Reform: 10+ years of laws, debates and innovation- Presentation NCSL by Richard Cauchi for the 340B Drug Pricing Program Coalition Winter, 2/2/2010.
State Health Insurance Mandates and Requirements
Non- NCSL Reports and Resources
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State Insurance Departments - Web sites and contacts compiled by NAIC.
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Insured and Still at Risk: Number of Underinsured Adults Increased 80 Percent Between 2003 and 2010 - New Health Affairs Study Finds Underinsured Adults Skip Needed Care and Struggle with Medical Debt; Affordable Care Act Reforms Could Substantially Reduce the Number of Underinsured. Health Affairs / Commonwelath Fund, published 9/2011.
- Security: What Americans Want from a Job- A new poll shows that health insurance and security are at the top of Americans’ list of desirables in a job, while pay ranked much lower. The national poll, conducted by Princeton Survey Research Associates for the Center for State and Local Government Excellence, surveyed 1,200 adults age 18 and older. Participants were given a list of 15 benefits and characteristics that may be important in choosing a job. 1/3/08.
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Improving the value and cost of US health benefits: Could shifts in the employer role provide the solution? - An overview from Mercer, the commercial benefits advisory company, 1/25/08.
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Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare" - CMS staff analysis as published in Health Affairs web article, 2/26/08.
- Health Care Costs 101, 2008 Edition- A user friendly set of graphs and charts based on CMS data and estimates in 2008. Released by the California HealthCare Foundation, 4/10.
- How Private Coverage Works: A Primer, 2008 Update- It discusses the fundamental aims of private health coverage and sorts out the complicated web of state and federal regulations that govern it. Published by Kaiser Family Foundation, 4/21/08. [27 pages ]
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Health Savings Accounts: Participation Increased and Was More Common among Individuals with Higher Incomes - General Accountability Office (GAO), Released 4/30/08.
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How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007 - The number of underinsured U.S. adults—that is, people who have health coverage that does not adequately protect them from high medical expenses—has risen dramatically, a Commonwealth Fund study finds. As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003. 6/10/08. [11 pages, PDF]
- Women Buying Health Policies Pay a Penalty- New York Times, 10/29/08.
- “Health Plan Differences: Fully-Insured vs. Self-Insured” - EBRI, 2/11/09.
- Health Insurance Coverage Status and Type of Coverage by Selected Characteristics:2008- US Census Bureau, Updated in 2009.
- The Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets- by AHIP, 9/07.
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