Health Insurers Pursue Growth Potential of Individual Market

Most Insurer Growth Strategies at Odds with Proposals to Reform Individual Market

News Release
Nov. 5, 2009

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—Insurers are pursuing strategies to tap the growth potential of the individual health insurance market, including entering less-regulated markets and developing lower-cost, less-comprehensive products targeting younger, healthy consumers, according to a study released today by the Center for Studying Health System Change (HSC).

As the only source of health coverage for people without access to employer-sponsored insurance or public insurance, the individual insurance market has traditionally attracted older, sicker individuals who perceive the need for insurance more than younger, healthier people. The attraction of a sicker population to the individual market creates adverse selection, leading insurers to employ medical underwriting-which most states allow-to either avoid people with the greatest health needs or set premiums more reflective of their expected medical use.

Recently, however, several factors have prompted insurers to recognize the growth potential of the individual market-a declining proportion of people with employer-sponsored insurance, a sizeable population of younger, healthier people forgoing insurance, and the likelihood that many people receiving subsidies to buy insurance under proposed health reforms would buy individual coverage, according to the study funded by the Robert Wood Johnson Foundation (RWJF).

"The current strategies insurers are pursuing in the individual market are unlikely to meet the needs of less-than-healthy people seeking affordable, comprehensive coverage," said HSC President Paul B. Ginsburg, Ph.D., coauthor of the study with HSC Health Research Analyst Elizabeth A. November, J.D., M.P.H.; HSC Health Research Assistant Genna R. Cohen; and RWJF Program Officer Brian C. Quinn, Ph.D.

"If enacted, current health reform proposals, which envision a larger role for the individual market under a sharply different regulatory framework, would likely supersede insurers’ current strategies," Ginsburg said.

To examine insurers’ strategies in the individual market, information was collected from the 12 communities followed by HSC since 1996-Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Between August and December 2008, researchers conducted 72 interviews, including one to three insurance executives and an insurance broker in each community, along with a representative from the state insurance commissioner’s office. Additional interviews were conducted with representatives of state health plan associations, consumer advocacy organizations, national health plans and national associations representing the insurance industry and insurance brokers.

The study’s findings are detailed in a new HSC Research Brief—Individual Insurance: Health Insurers Try to Tap Potential Market Growthavailable here. Other key study findings include:

### ###

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.