Evolution of Self-Insurance in an Era of Managed Care

What is the relationship between increased state and federal managed care insurance regulations and employers’ decisions to self-insure their managed care offerings? The researchers at Wayne State University will test the degree to which the decline in the percentage of employees who were offered self-insured managed care plans may be related to the passage of HIPAA and other federal mandates that could be applied to self-insured plans despite ERISA. In order to better understand the effects of federal and state policies on self-insured market between 1993 and 1999, the researchers will: 1) describe the evolution of self-insurance among large (over 200 workers) and smaller firms, including trends related to type of firm and type of health plan; 2) assess whether there is a causal relationship between federal and state-level insurance regulations on employers’ self-insurance decisions, and on the type of self-insured plan chosen; and 3) compare effects of state regulations pre- and post-1996 on self-insured and purchased plans, within the context of the 1996 federal reforms. Their objective is to inform policymakers on the interrelationships between self-insured employer plans, state and federal regulations, ERISA, and the market.