Editor's Note: The Individual Health Insurance Market

The United States may rarely be noted for its bold policy strokes, but we are unquestionably a nation of tinkerers. Perhaps no policy area illustrates such predilections as much as federal and state policy making in the health care domain. Where there is a gap in access, considerable energy is expended by policy specialists and policy makers trying to fill it, if only a little at a time. When public or private institutions are not performing as efficiently or equitably as one would like, more time and resources are devoted to tweaking them, if only a bit at the margins. Because incremental adjustments in existing products, markets, and programs may at times be the only avenue available for improving the health of our society--or are at least advertised as such--these ventures "under the hood" deserve both our attention and careful evaluation.

The individual health insurance market falls into this realm of health policy and politics. Although most people obtain their insurance coverage outside of this particular market, and few would suggest that individual health insurance is the model upon which to build a system of universal coverage, in fact there is a lively market for such insurance, and state policy makers across the country have actively engaged it in their efforts to enhance the lives of their constituents. Indeed, state policy making may have been as intensively focused on this health care issue as any other. It is appropriate to now ask whether the individual insurance market and the interventions into it by various states have yielded lessons worth pursuing. That can only be determined by careful examination and on-site evaluation.

Fortunately, the Changes in Health Care Financing and Organization (HCFO) program supported by the Robert Wood Johnson Foundation has provided the basis for a thoughtful assessment of the individual health insurance market and policy initiatives designed to improve it in a number of states. This issue of the Journal of Health Politics, Policy and Law presents the results of this evaluation, offered as a series of articles that explore both the conceptual issues associated with this kind of insurance market and the empirical experience in six states: Kentucky, Massachusetts, New York, New Jersey, Vermont, and Washington. These essays were extensively reviewed, and the authors worked hard to be responsive to the predicates for passing judgment on the policy opportunities and politics tied to this part of the insurance market. Commentaries from insurers, regulators, and political scientists well versed on the topic help to put this overall assessment into perspective.

I am grateful to Anne Gauthier and Deborah Rogal of the Alpha Center for organizing the conference that stimulated this evaluation of the individual health insurance market and for playing such a pivotal role in shepherding the articles to publication. Working intensely under enormous time pressures, Robert Hackey and Thomas Oliver were instrumental in the success of this special issue of the journal, for which I am most appreciative. As with so many analytic ventures in this field, the Robert Wood Johnson Foundation made the whole exercise possible. As a result of these efforts by individuals and institutions, we have as firm a grasp as is possible on just what can--and cannot--be achieved through the individual health insurance market and state oversight of it.

Mark A. Peterson

...