The Structure and Enforcement of Health Insurance Rating Reforms

Posted: 17 Mar 2000

See all articles by Mark A. Hall

Mark A. Hall

Wake Forest University - School of Law

Date Written: January 2000

Abstract

Requiring health insurers to cover everyone who applies regardless of health status ("guaranteed issue") is severely hampered without accompanying rating restrictions that keep insurance affordable for higher risks. The degree of rating flexibility also determines how much insurers can continue to compete based on their skills at risk selection and how well they can counter adverse selection. Therefore, the structure and enforcement of rating reforms are essential to how insurance market reforms function. Based on an in-depth qualitative study in seven states with insurers, agents, and regulators, this article explains the factors that determine the stringency of rating reforms, and it details how various aspects of rating restrictions can be used strategically to engage in greater risk segmentation than first appears possible. The article concludes by reflecting on the appropriate degree of complexity in rating rules, and it offers recommendations for crafting rating reforms that avoid unintended consequences.

JEL Classification: I11

Suggested Citation

Hall, Mark A., The Structure and Enforcement of Health Insurance Rating Reforms (January 2000). Available at SSRN: https://ssrn.com/abstract=215432

Mark A. Hall (Contact Author)

Wake Forest University - School of Law ( email )

P.O. Box 7206
Winston-Salem, NC 27109
United States
336-716-9807 (Phone)

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