Individual Health Insurance: Fact, Opinion and Policy

Originally published as a Conference Transcript by the Center for Studying Health System Change (HSC), October 23, 2002. HSC was a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

On October 23, 2002, in Washington, D.C., the Center for Studying Health System Change (HSC) convened a conference titled "Individual Health Insurance: Fact, Opinion and Policy." The event brought together leading health policy researchers, industry leaders, and congressional staff members to examine the state of the individual health insurance market, evaluate its potential as a vehicle for expanding coverage to the uninsured, and debate the merits of proposed tax credit approaches. The conference was organized into several moderated sessions, each focusing on a different dimension of the policy debate.

Opening Remarks and Overview Panel

HSC President Paul Ginsburg opened the conference by framing the central questions facing policy makers regarding the individual market. The first session, moderated by Ginsburg himself, featured an overview panel on the state of the debate. Panelists Mark Pauly of the University of Pennsylvania, Jack Hadley of The Urban Institute and HSC, and Rob Cunningham of Health Affairs provided their assessments of how the individual market was functioning and where it fell short. Thomas R. Hefty of Blue Cross/Blue Shield United of Wisconsin and John Bertko of Humana offered insurer perspectives as respondents, providing firsthand accounts of market dynamics from the carrier side of the equation.

Session Two: What Does Not Work?

The second session turned a critical lens on the shortcomings of the individual market. Karen Politz of Georgetown University, Kathy Swartz of Harvard University, Mark Hall of Wake Forest University, and Deborah Chollet of Mathematica Policy Research presented their analyses of the barriers that made individual coverage inaccessible, unaffordable, or inadequate for many Americans -- particularly those in poor health or with modest incomes. David Nexon of the Senate HELP Committee and Patrick Morrisey of the House Energy and Commerce Committee responded with congressional perspectives on how these market failures shaped legislative thinking.

Session Three: What Works?

Moderated by John Iglehart of Health Affairs, the third session explored potential solutions and policy approaches that could make the individual market function more effectively. Katherine Baicker of Dartmouth College and NBER, Tom Miller of the Cato Institute, Janet Trautwein of the National Association of Health Underwriters, and Bruce Abbe of Communicating for Agriculture offered diverse viewpoints ranging from market-oriented reforms to expanded risk-pooling mechanisms. Elizabeth Fowler and Dean Rosen from the Senate Finance and HELP committees, respectively, provided reactions from Capitol Hill.

Luncheon Address and Summary

The luncheon address was delivered by Steven B. Larsen, Commissioner of the Maryland Insurance Administration, who brought a state regulatory perspective to the discussion of individual market reform. Larsen's remarks touched on the role that state regulation played in shaping market outcomes and the tension between protecting consumers and maintaining market viability.

Len Nichols, Vice President of HSC, closed the conference with a summary and discussion that synthesized the day's key takeaways. Despite sharp differences of opinion among participants, Nichols identified areas of emerging consensus as well as fundamental questions that remained unresolved. The conference drew a standing-room-only audience of nearly 300 analysts, reflecting the intense interest in individual market reform on Capitol Hill and among the broader health policy community. A companion issue brief published by HSC provided a detailed account of the conference findings and their policy implications.

Sources and Further Reading

HSC Conference Transcript, "Individual Health Insurance: Fact, Opinion and Policy," October 23, 2002. | Health Affairs, special online issue on the individual health insurance market, 2002. | HSC Issue Brief No. 58, "The Individual Health Insurance Market," December 2002.