title: Self-insurance and the potential effects of health reform on the small-group market.
abstract: The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.
authors.affiliation: National Health Policy Forum, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Linehan
mesh_terms: D006264:Health Benefit Plans, Employee / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008389:Marketing of Health Services / Q000331:legislation & jurisprudence; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D017149:Private Sector / Q000331:legislation & jurisprudence*; D012306:Risk; D014481:United States