# Presentation: 190590

## Presents

**Individual Health Insurance:**
**Are You Ready for Change?**
**A Web-assisted Audio Conference **
**for**
**State and Local Health Policymakers**
**April 24, 2002**

- The Agency for Healthcare Research and Quality

**Notes:**
The Agency for Healthcare Research and Quality’s User Liaison Program presents “Individual Health Insurance: Are You Ready for Change?”, a web-assisted audio conference for State and local health policymakers on April 24, 2002.

## Individual Health Insurance:Are You Ready for Change?

**Moderator:  Cindy DiBiasi**
**Panelists:**
**         ****Deborah Chollet, Ph.D.**
**	**Senior Fellow
- 	Mathematica Policy Research, Inc.
- 	**Karen Pollitz, M.P.P.**
**	**Project Director, Institute for Health Care Research and Policy
- 	Georgetown University
- 	**Steve Larsen, J.D., M.P.P.**
- 	Insurance Commissioner, State of Maryland; and
- 	Health Committee Chair, National Association of Insurance
- 	Commissioners

**Notes:**
“Individual Health Insurance: Are You Ready for Change?”, moderated by Cindy DiBiasi, with panelists Deborah Chollet, Ph.D, Karen Pollitz, M.P.P, and Steve Larsen, J.D., M.P.P.  Deborah is a Senior Fellow at Mathematica Policy Research, Inc., Karen is the Project Director for the Institute for Health Care Research and Policy at Georgetown University, and Steve is the Insurance Commissioner for the State of Maryland.

## Individual Health Insurance: 

- Are You Ready for Change?

- Market Dynamics
- State Strategies
- New Ideas in State and Federal Proposals

**Notes:**
The web-assisted audio conference on the individual health insurance market will focus on three areas: the dynamics of the individual health insurance market, current strategies states are using to regulate the individual market, and new ideas in State and Federal proposals that may affect how States’ regulate this market. 

## On the Webcast?  	Type in the messaging field and hit Enter.On the Phone?  	Press “14” to indicate you have a question. Ready to E-Mail?  	Send a message to ulp@ahrq.gov. 			Due to the high volume of messages, we may not be able to answer all questions during this session.	

- Question and Answer Period

**Notes:**
During the question and answer period, participants can ask questions in one of three ways: by typing a question in the message field and hitting “enter”, by pressing “14” on their phone to get in the question queue, or by e-mailing the question to ulp@ahrq.gov.

## Individual Health Insurance:Are You Ready for Change? A Web-assisted Audio Conference

- _Interested in free access to the archive of this event?_
- On the internet, visit the AHRQ/ULP Web Site
- www.ahrq.gov/news/ulpix.htm
- _Interested in purchasing audio tapes of this event?_
- To order:	Contact the AHRQ Publications
- 			Clearinghouse at 1-800-358-9295
- 			Ask for AHRQ02-AV06A,
- 		“Individual Health Insurance: Are You Ready for Change?”
- 			The cost is $10.00 for the tape.

**Notes:**
Free access to the archive of the web-assisted audio conference “Individual Health Insurance: Are You Ready for Change”? is available on the internet at www.ahrq.gov/news/ulpix.htm.  Audio tapes of the event are available by contacting the Agency for Healthcare Research and Quality’s Publications Clearinghouse at 1-800-358-9285.  The order number for the tape is AHRQ02-AV06A.  The cost of the tape is ten dollars.

## Individual Health Insurance: Are You Ready for Change?

- A Web-assisted Audio Conference

- Deborah Chollet, Ph.D.
- Senior Fellow
- Mathematica Policy Research, Inc.

- April 24, 2002

**Notes:**
The first panelist for the web-assisted audio conference is Deborah Chollet, Ph.D., Senior Fellow at Mathematica Policy Research, Inc.

## Who buys individual coverage?

- Individuals and families who do not have employer-based or public health insurance
- In 1999, about 16 million people -- 7% of the population under age 65

**Notes:**
Asking the question: “who buys individual health insurance?” helps illustrate the demand side of the market for individual health insurance.  In 1999, seven percent of the population under the age of sixty-five (sixteen million people) bought health insurance policies in the individual market.  These people are individuals and families who do not have employer-based or public health insurance.

## Who buys individual coverage?  (cont’d)

- Most are
- Adults of childbearing age
- Employed full time and all year
- Live in urban areas
- Compared to the general population, they are more likely to be:
- Early retirees or older workers
- Nonelderly spouses of Medicare enrollees
- Self-employed
- Live in rural areas
- Compared to people with employer coverage, they are:
- Lower-income
- Older

**Notes:**
For the most part, the average person in the individual market looks like the average person in the population overall.  Most are adults of child-bearing age who are employed full time all year, and live in urban areas.  Compared to the general population, they are more likely to be early retirees or older workers, non-elderly spouses of Medicare enrollees, self-employed, and living in rural areas.  Those in the individual market are usually lower income and older than those with employer sponsored coverage.

## Source: March 2001 Current Population Survey (Mathematica Policy Research, Inc.).

**Source: March 2001 Current Population Survey (Mathematica Policy Research, Inc.).**

**Notes:**
Generally, the population purchasing individual health coverage is of lower income than those who obtain coverage in the employer group market.  Sixteen percent of the employer group market have income between zero and one hundred ninety-nine percent of the Federal Poverty Level, forty-four percent have income between two hundred and three hundred ninety-nine percent of Federal Poverty, and fifty percent have income four hundred percent or more of Federal Poverty Level.  Twenty five percent of the individual market have income between zero and one hundred ninety nine percent of Federal Poverty Level, thirty two percent have income between two hundred and three hundred ninety nine percent of Federal Poverty Level, and forty three percent have income of four hundred percent or more of the Federal Poverty Level.

## 17%

**17%**

**Source:March 2001 Current Population Survey (Mathematica Policy Research, Inc.).**

**10%**

**Notes:**
The individual health insurance market is, in general, older than the population in the employer group market.  Fewer than thirty percent of the employer group market is less than eighteen years of age, ten percent are between the ages of eighteen and twenty four, between thirty and forty percent are between twenty five and forty four years of age, fifteen to twenty percent are between forty five and fifty four years of age, and ten percent are between fifty five and sixty four years of age.  In the individual market, twenty five percent are less than eighteen years of age, ten percent are between nineteen and twenty four years of age, thirty percent are twenty five to forty four years of age, approximately twenty percent are between the ages of forty five and fifty four, and approximately eighteen percent are between the ages of fifty five and sixty four.

## Who sells individual coverage?

- 690 insurers (counted by state), compared to  about 2,400 group insurers
- Blue Cross Blue Shield and commercial insurers dominate and are more prevalent in the individual market than in the group market.

**Notes:**
The question of who is selling individual policies is another important aspect to understanding the dynamics of the individual health insurance market.  Counted by state, there are six hundred ninety carriers selling individual coverage.  This number compares to about two thousand four hundred carriers selling in the group market. The individual market is dominated by Blue Cross Blue Shield and commercial insurers.

## Source:  “Mapping State Health Insurance: Structure and Change in the States’ Group and Individual Health Insurance Markets, 1995-1997”, 2000. Available at Available on State Coverage Initiative website. 

**Notes:**
In the individual market, Blue Cross Blue Shield holds fifty percent of the market share, commercial insurers hold twenty four percent of the market share, and twenty eight percent of the market share is held by health maintenance organizations.  This contrasts to the group insurance market in which Blue Cross Blue Shield holds thirty six percent of the market share, nineteen percent of the market share is held by commercial insurers, and health maintenance organizations hold forty five percent of the market share.

## What does the market look like?

- Compared to the group market:
- Fewer insurers, but many more insurers per covered life
- Much  lower premium volume per insurer

**Notes:**
In comparison to the group market, the individual market has fewer insurers overall.  There are more insurers per covered life in the individual market, however.  There is also a much lower premium volume per insurer in the individual market as compared to the group market.

## Source:  Source:  “Mapping State Health Insurance: Structure and Change in the States’ Group and Individual Health Insurance Markets, 1995-1997”, 2000. Available at Available on State Coverage Initiative website.

**Notes:**
In 1997, the average number of insurers per state selling individual health insurance policies was fourteen.  The average earned premiums per insurer was eleven point nine million dollars.  In contrast, there was an average of forty nine insurers per state in the group market.  These insurers had average earned premiums of fifty nine point two million dollars.

## What does the market look like? (cont’d)

- In every state, the market is very concentrated
- 1-3 large insurers hold 50% to 97% of the market
- Smallest 50% of insurers account for about 8% of the market
- Small-population states have fewer insurers, but many more insurers per capita
- 17 insurers per million population in Wyoming
- 2 insurers per million population in California

**Notes:**
In every state, the individual health insurance market is very concentrated with between one and three insurers holding fifty to ninety-seven percent of the market share.  The smallest fifty percent of insurers have only about eight percent of the market share.  States with small populations have fewer insurers but have more insurers on a per capita basis.  For example, there are seventeen insurers per million population in Wyoming and two insurers per million population in California.

## Major challenges

- Small market fragmented among “many” insurers
- Small risk pools
- Low average premium volume encourages aggressive “cherry picking”
- High administrative and marketing costs
- High turnover; many consumers stay < 1 year
- Individual sales
- Adverse selection
- People who need health care are more likely to buy than people who do not.
- Adequate coverage *and* an affordable price

**Notes:**
The individual health insurance market faces four major challenges.  First, as a small and fragmented market, the individual insurance market is plagued by small risk pools, and aggressive “cherry picking”, in which the insurer chooses to offer coverage to the lower risk applicants.  Second, this market is dominated by individual sales and high rates of turnover with many consumers staying enrolled for less than one year.  Therefore, the individual market is characterized by high administrative and marketing costs.  Third, people who need health care are more likely to buy than those who do not.  This leads to a phenomenon termed “adverse selection”.  Adverse selection means that healthy people – who are less likely to use health care – opt out of purchasing health insurance, leaving the less healthy people – who cost more to the insurer – with higher priced plans.  The fourth challenge in the individual market is offering adequate coverage at an affordable price.

## Individual Health Insurance:Are You Ready for Change?

- Karen Pollitz, M.P.P.
- Project Director
- Institute for Health Care Research and Policy
- Georgetown University

- A Web-assisted Audio Conference

- April 24, 2002

**Notes:**
The second panelist for the web-assisted audio conference is Karen Pollitz, M.P.P., Project Director for the Institute for Health Care Research and Policy at Georgetown University.  Karen will talk about some of the challenges consumers face when looking for health insurance in the individual market.

## Individual Health Insurance Market Characterized by Medical Underwriting

- Medical underwriting is a process for assessing the health and risk status of an applicant in order to decide whether to issue coverage and, if so, at what price and under what terms
- Insurers medically underwrite coverage because sick people are more expensive to insure than healthy people
- By excluding expensive risks, carriers can keep the cost of coverage lower for those they insure

**Notes:**
The concept of “medical underwriting” is characteristic of the individual health insurance market.  Medical underwriting is a process for assessing the health and risk status of an applicant in order to decide whether to issue coverage and, if so, at what price and under what terms.  Carriers use medical underwriting as a tool to exclude expensive risks and keep the cost of coverage lower for those they do choose to insure.  Medical underwriting contributes to the difficulty many face in obtaining an affordable health insurance policy that offers adequate coverage.

## How Medical Underwriting Works

- Carriers use a variety of “underwriting tools”
- Deny coverage
- Limit coverage
- Exclude conditions via “riders”
- Otherwise reduce covered benefits (e.g., $1,000 prescription drug deductible)
- Charge additional premiums
- Little consistency between carriers on which tools to apply and when; so impossible for consumers to predict outcome of medical underwriting
- Process usually takes 2 weeks to 2 months to complete

**Notes:**
Insurers have three main options once they have determined an applicant to be a sub-standard risk.  One of these is to simply deny coverage.  Another option is to limit coverage either by excluding certain health conditions from the policy – via “ exclusion riders” – or by otherwise reducing benefits.  In other words, a carrier can “rider out” a certain condition or area of the body that is thought to be a health risk. A third options insurers have is to charge additional premiums to those they deem an unwanted risk.  Insurers are not consistent in terms of which of these underwriting tools they use, making it virtually impossible for applicants to predict the outcome of underwriting.  The underwriting process can take anywhere between two weeks and two months.

## Results of 60 applications for “Alice,” 24, hay fever

- Average Annual Premium  $1,656
- Ratio Highest:Lowest         11.4

**Source: “How Accessible is Individual Health Insurance for Consumers in Less-Than-Perfect-Health?”, 2001. Available on the Kaiser Family Foundation website.**

**Notes:**
When a hypothetical applicant for individual health insurance, a twenty four year old with hay fever named Alice, sent out sixty applications for health insurance policies, her offers had an average annual premium of one thousand six hundred and fifty six dollars.  She received a “clean offer” five percent of the time, an offer with benefit limits seventy percent of the time, an offer with a premium increase ten percent of the time, an offer with a premium increase and benefit limits seven percent of the time, and was rejected eight percent of the time.

## Results of 60 applications by “Crane Family,”son “Colin” has asthma

- Average Annual Premium  $5,460
- Ratio Highest:Lowest          9.1

**Source: “How Accessible is Individual Health Insurance for Consumers in Less-Than-Perfect-Health?”, 2001. Available on the Kaiser Family Foundation website.**

**Notes:**
When the hypothetical Crane Family, whose son, Colin, has asthma, sent out sixty applications for insurance in the individual market, they were offered coverage with an annual premium that averaged five thousand four hundred and sixty dollars.  They were received a clean offer five percent of the time, a clean offer that excluded Colin fifteen percent of the time, an offer with benefit limits fifty two percent of the time, an offer with premium increase eight percent of the time, and an were offered insurance with a premium increase and benefit limits twenty percent of the time.

## Results of 60 applications for “Frank” 62, overweight smoker with high blood pressure

- Average Annual Premium  $9,936
- Ratio Highest:Lowest         10.3

**Source: “How Accessible is Individual Health Insurance for Consumers in Less-Than-Perfect-Health?”, 2001. Available on the Kaiser Family Foundation website.**

**Notes:**
When sixty hypothetical applications for health insurance were made by a sixty two year old overweight smoker named Frank, he was offered an average annual premium of nine thousand nine hundred and thirty six dollars.  He received a clean offer three percent of the time, an offer with a premium increase thirty seven percent of the time, an offer with a premium increase and benefit limits five percent of the time, and was rejected for insurance fifty five percent of the time.

## Results of 60 applications for “Greg,” 36, HIV-positive

**Source: “How Accessible is Individual Health Insurance for Consumers in Less-Than-Perfect-Health?”, 2001. Available on the Kaiser Family Foundation website.**

**Notes:**
Sixty hypothetical applications for health insurance made by Greg, a thirty six year old who is HIV positive resulted in rejection for coverage one hundred percent of the time.

## Other “Uninsurable” Conditions

- Anorexia
- Arthritis
- Brain or spinal cord injury
- Cancer
- Chemical dependency
- Cystic fibrosis
- Diabetes
- Epilepsy
- Heart disease
- Hemophilia

- Hepatitis C
- Kidney disease
- Lupus
- Multiple sclerosis
- Muscular dystrophy
- Organ transplant
- Osteoporosis
- Paraplegia or quadriplegia
- Parkinson’s disease
- Pregnancy
- Stroke

**Notes:**
Conditions other than HIV that are considered “uninsurable” in the individual insurance market include: anorexia, arthritis, brain or spinal cord injury, cancer, chemical dependency, cystic fibrosis, diabetes, epilepsy, heart disease, hemophilia, hepatitis C, kidney disease, lupus, multiple sclerosis, muscular dystrophy, organ transplant, osteoporosis, paraplegia or quadriplegia, Parkinson’s disease, pregnancy, and stroke.

## Even for people in “perfect” health...

- Covered benefits are often less comprehensive than in group health plans
- Maternity
- Mental health
- Prescription drugs
- High cost sharing
- Age rating
- Stability/durability of coverage over time

**Notes:**
Even people in “perfect” health face a less-than-ideal situation when in the individual health insurance market.  Typically, coverage is not as comprehensive in an individual plan than in a group plan.  In particular, it is very difficult to buy coverage for maternity care, mental health care and prescription drugs.  The individual market is also characterized by higher cost sharing and more age rating strategies than in the group market.  Stability of coverage over time is another challenge for those who buy policies in this market.

## Individual Health Insurance:Are You Ready for Change?

- A Web-assisted Audio Conference

- Steven Larsen, M.P.P., J.D.
- Insurance Commissioner
- Maryland Insurance Commission
- State of Maryland

- April 24, 2002

**Notes:**
The third panelist for the web-assisted audio conference is Steve Larsen, M.P.P., J.D. Steve is the Insurance Commissioner for the State of Maryland.

## Impact of HIPAA*

- Guaranteed renewal
- If coming from significant period of group coverage:
- Guaranteed issue
- Portability
- But:
- No constraints on price when policies are issued or renewed
- No guaranteed issue or portability within the individual market

- * The Federal Health Insurance Portability and Accountability Act, enacted in 1996.

**Notes:**
The Federal Health Insurance Portability and Accountability Act, enacted in 1996, had an impact on the individual insurance market.  First, this Act mandates guaranteed renewal of coverage in the individual market.  Second, this law mandates guaranteed issue and portability of health insurance for those coming into the individual market from the group market.  This law did not, however, place constraints on price when policies are issued or renewed and did not guarantee issue or portability when moving within the individual market.

## State policies to improve access

- Guaranteed issue
- All or only “qualified resident”
- Some or all products or carriers
- Some or all of the time
- Limits on rate variation (“rate bands”)
- For specific rate factors (e.g., health, age) and/or overall
- Coverage for preexisting conditions
- Look-back and waiting periods
- Exclusion riders
- High risk pools

**Notes:**
States have policy tools to improve access in the individual health insurance market.  The first of these is guaranteed issue which can apply to all residents of the state or only “qualified residents”, to some or all insurance products and carriers, some or all of the time.  The second policy lever is “rate bands”, or limits on rate variation.  Third, states can regulate how carriers treat coverage for pre-existing conditions by regulating look-back and waiting periods and exclusion riders.  A fourth policy tool state’s have is to open a subsidized high risk pool.

## Source:  Mathematica Policy Research, Inc., 2001.

**Source:  Mathematica Policy Research, Inc., 2001.**

**Notes:**
Seven states have guaranteed issue for all products while eight states have guaranteed issue on only some products.  Sixteen states limit the extent to which carriers can use health rating while twelve states have limits on age rating and ten states limit composite rating.  Thirty four states limit the amount of time carriers can “look back” for  pre-existing conditions and thirty five states limit the waiting period for pre-existing conditions.  Thirteen states prohibit exclusion riders and twenty eight states have a high risk pool.  Nine states have no regulations for issuing individual health insurance and five states have no provisions for either issue or rating.

## Other State policy options

- Standardized benefit packages
- Encourage comparison shopping and competition
- Discourage insurer “gaming” of risk selection through benefit design
- Mandated inclusion of benefits
- Mandated offer of benefits

**Notes:**
States also have policy options for bolstering the benefit packages available on the individual health insurance market.  One option is to standardize benefit packages, which is meant to encourage comparison shopping and competition among products while discouraging carriers “gaming” of risk selection through benefit design.  A second option is to mandate certain benefits to be included in all products that are offered.  A third policy option for States is to mandate the offer of benefits.

## State Strategies:

- High-Risk Pool Only
- Portability
- Comprehensive Limits on
-    Medical Underwriting
- Other

**Notes:**
States combine policy options in a variety of ways to create their strategy for regulating the individual insurance market.  These strategies address different aspects of the individual market.  Some use high risk pool only, some focus on portability, some address comprehensive limits on medical underwriting.  Some states have strategies that do not fall into any of these three broad categories.

## High Risk Pool Only

- Few limits on medical underwriting by insurers
- Instead, public pool sells coverage to “uninsurables”
- Pool losses subsidized by tax on insurers/general revenues
- Premiums > standard rates
- Benefit limits, pre-ex exclusions, enrollment caps
**22 states (AK, AR, CO, CT, IL, IN, KS, KY, LA, MS, MO, NE, NH, NM, ND, OK, SC, TX, UT, WA, WI, WY)**

**Source: Health Insurance Info website.**

**Notes:**
States whose use only a high risk pool to regulate their individual insurance market place few limits on underwriting, but instead use a public pool to sell coverage to those deemed “uninsurable”.  This pool is subsidized by taxes – either on insurers or on general revenues.  Generally, premiums are higher than standard rates in this scenario.  Twenty two states employ this strategy: Alaska, Arkansas, Colorado, Connecticut, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, South Carolina, Texas, Utah, Washington, Wisconsin, and Wyoming). 

## Portability

- Limits on medical underwriting for residents with qualified prior coverage
- Guaranteed issue some/all products
- Community rating or rate bands
- No exclusion riders
- Credit for prior coverage
- Minimum benefit standards
- 11 states (CA*, FL, GA, ID*, IA*, MN*, MT*, NV, OH, OR*, SD)
-     * 6 with high risk pool hybrid

**Source: Health Insurance Info website.**

**Notes:**
Some states employ strategies to augment insurance portability in the individual insurance market. Florida, Georgia, Nevada, California, Minnesota, Montana, Ohio, Oregon, South Dakota, Idaho, and Iowa have chosen to use this strategy.  These regulations include limits on medical underwriting for residents with qualified prior coverage and guaranteed issue on some or all products.  Rates are set using community rating or rate bands, and carriers are not allowed to use exclusion riders when offering policies.  Applicants are given credit for having prior coverage and there is a minimum set of benefits that must be offered.  Six states (California, Idaho, Iowa, Minnesota, Montana and Oregon) combine portability regulations with high risk pools.

## Comprehensive Limits on Medical Underwriting

- Prohibition on medical underwriting for all residents/all the time
- Guaranteed issue all products
- Community rating
- No exclusion riders
- Credit for prior coverage
- Standardized benefits
- 5 states (NY, NJ, ME, MA, VT)

**Source: Health Insurance Info website.**

**Notes:**
Five states - New York, New Jersey, Maine, Massachusetts, and Vermont – place limits on medical underwriting.  This strategy includes prohibitions on medical underwriting for all residents, all the time.  All products are guaranteed issue, community rating is used to set rates, and applicants get credit for prior coverage. There are mandated standard benefits and carriers cannot use exclusion riders when offering policies to applicants.

## Other Individual Market Strategies

- Carrier of last resort (HI, MI, PA, NC, VA)
- Open enrollment period (DC, MD, MN, OH, WV)

**Source: Health Insurance Info website.**

**Notes:**
Other strategies employed by states are carrier of last resort - found in Hawaii, Michigan, Pennsylvania, North Carolina, and Virginia – and mandated open enrollment periods – found in the District of Columbia, Maryland, Minnesota, Ohio, and West Virginia.

## Individual Market Alternatives

- Self-employed/Group-of-one access to small group coverage (13 states)
- COBRA*-like continuation rights for small group enrollees (38 states)
- Individual access to small group purchasing cooperative (1 state)
- *COBRA - Consolidated Omnibus Budget Reconciliation Act of 1985 which allows employees who would otherwise lose their coverage due to resignation or dismissal to continue under the employer’s group health insurance plan for up to eighteen months if they pay for the coverage themselves.

**Notes:**
Some states have designed alternative approaches to the individual health insurance market.  Thirteen states have allowed for self-employed or group-of-one access to small group coverage.  Thirty-eight states have continuation rights for small group employees that mock the Consolidated Omnibus Budged Reconciliation Act of 1985.  This act allows employees who would otherwise lose their coverage due to resignation or dismissal to continue under the employer’s group health insurance plan for up to eighteen months if they pay for the coverage themselves.  One state allows for individual access to small group purchasing cooperatives.

## Maryland’s Strategy for Regulating the Individual Health Insurance Market

- Substantial, Available and Affordable Coverage (SAAC) Program
- 	- For carriers that participate in the SAAC program: Semi-	annual open enrollment, standard benefit package, no pre-	existing condition exclusion period, guaranteed renewability.
- Limits on pre-existing condition exclusions
- 	- HMO’s cannot impose pre-existing condition exclusions
- 	-In non-HMO plans, pre-existing exclusion periods cannot 	exceed two years.
- Guaranteed renewability

**Notes:**
Currently, Maryland’s strategy for regulating the individual insurance market has a “Substantial, Available and Affordable Coverage Program, limits on pre-existing condition exclusions, and guaranteed renewability.  Carriers that participate in the Substantial, Available and Affordable Coverage program must hold semi-annual open enrollment, offer a standard benefit package, cannot have a pre-existing condition exclusion period, and must guarantee renewability.  Maryland also regulates pre-existing condition exclusions.  Health maintenance organizations cannot impose pre-existing condition exclusions.  Non health maintenance organization place cannot have pre-existing exclusion periods that exceed two years.

## Maryland’s Future

- Maryland legislature passed 	legislation:
- To repeal semi-annual open enrollment for SAAC
- To open High Risk Pool
- To become effective July 2003

**Notes:**
Maryland recently passed legislature that repeals the semi-annual open enrollment requirement for carriers in the Substantial, Available, and Affordable Coverage program and opens a high risk pool for the state.  This legislation is scheduled to become effective in July of 2003.

## National Association of Insurance Commissioners 

- National Association of Insurance Commissioners
- Model Laws

- Individual Health Insurance Market
- High Risk Pools

- To obtain copies, contact Mary Beth Senkewicz
- msenkewi@naic.org

**Notes:**
The National Association of Insurance Commissioners have created “model laws” on the individual health insurance market and on high risk pools as a resource for state legislators.  Copies are available from Mary Beth Senkewicz at msenkewi@naic.org

## On the Webcast?  	Type in the messaging field and hit EnterOn the Phone?  	Press “14” to indicate you have a question. Ready to E-Mail?  	Send a message to ulp@ahrq.gov. 			Due to the high volume of messages, we may not be able to answer all questions during this session.	

- Question and Answer Period

## New ideas/issues

- Regional vs. state individual markets
- Shore up “guaranteed renewability” especially renewal rates
- Improved high risk pools
- Federal tax credit to subsidize individual policies

**Notes:**
There are a few new ideas for addressing the individual insurance market on the horizon.  One idea is to create regional markets as opposed to state individual markets, which in some cases are too small to adequately pool risk.  Another option is to augment guaranteed renewability.  Improving high risk pools is another mechanism being considered.  On the Federal level, issuing a tax credit to subsidize individual health insurance policies is being discussed as a policy option.

## On the Webcast?  	Type in the messaging field and hit EnterOn the Phone?  	Press “14” to indicate you have a question. Ready to E-Mail?  	Send a message to ulp@ahrq.gov. 			Due to the high volume of messages, we may not be able to answer all questions during this session.	

- Question and Answer Period

## Individual Health Insurance:Are You Ready for Change? A Web-assisted Audio Conference

- _Interested in free access to the archive of this Event?_
- On the internet, visit the AHRQ/ULP Web Site
- www.ahrq.gov/news/ulpix.htm
- _Interested in purchasing audio tapes of this Event?_
- To order:	Contact the AHRQ Publications
- 			Clearinghouse at 1-800-358-9295
- 			Ask for AHRQ02-AV06A,
- 		“Individual Health Insurance: Are You Ready for Change?”
- 			The cost is $10.00 for the tape.

**Notes:**
Free access to the archive of the web-assisted audio conference “Individual Health Insurance: Are You Ready for Change” is available at www.ahrq.gov/news/ulpix.htm.  Audio tapes are available for ten dollars through the Agency for Healthcare Research and Quality’s Publications Clearing House at 1-800-358-9295.  The code for ordering the tapes is AHRQ01-AV06A.

## A Series of three Web-Assisted Audio Conferences for State and Local Health Policymakers April 29 - May 1, 2002   2:00-3:30 p.m. EDT each day

- To register, go to
**http://www.hsrnet.com/meeting/bioterrorism**
**For more information, e-mail ULP at ulp@ahrq.gov**

- Bioterrorism and Health System Preparedness: Emerging Tools, Methods and Strategies