State health insurance market reforms and access to insurance for high-risk employees

A specific focus for state regulations of the small group insurance market was to increase offers and stabilize premiums for firms with high-risk workers. We examine the effect of reforms implemented from 1993 through 1996 on the likelihood of employer sponsored insurance coverage. We find that packages of reforms that included both guaranteed issue of some products and some form of rate variance restriction had significant positive effects (4.5 percentage points) on ESI coverage for high-risk compared with low-risk workers within small firms and a small negative effect (−1.7 percentage points) on low-risk workers in small compared with large firms. The mechanism for these effects was an increase in take-up, rather than offer. Reform packages that included both guaranteed issue of all products and rate variance restrictions had similar effects overall, although they did not meet criteria for significance. These effects seemed to act through increased offer rather than take-up.