In some states, this is prohibited. In others where this might be allowed, most insurers and agents do not aggressively seek business through purchasing cooperatives and so a strong competitive dynamic has not taken hold. This resistance is due to a number of factors, but the most prominent among agents is the sense that the purpose or eventual effect of purchasing cooperatives is to make agents superfluous. Insurers are also concerned that some purchasing cooperatives tend to attract higher risk groups. Administration and Enforcement Health insurance market reforms have been relatively easy to administer.
Insurers are well-motivated, and basic compliance within the industry is widespread.
These laws have not required a large investment of enforcement or oversight resources by state regulators. Insurers, however, complain that it consumes a substantial amount of their administrative resources to keep up with the multitude of differences across 50 states and the numerous and rapid amendments to these laws. Most states do not conduct detailed audits of insurers' practices under these laws. Therefore, some misinterpretation or circumvention may be going undetected. For instance, compliance with complex rating rules is typically determined only through an actuarial certification filed by each insurer, which contains only a broad and general assurance that actuarial and underwriting practices meet the legal requirements.