Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996

Kala Ladenheim

Publius: The Journal of Federalism, vol. 27, issue 2, 33-51

Abstract: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (PL. 104-191) brings the federal government fully into insurance regulation for the first time. Despite the Republican majority's rhetoric about state control, election-year politics trumped federalism. HIPAA's immediate impact oncoverage may be modest, but its ultimate significance is great because it creates a template for more farreaching federal involvement in regulating insurance. HIPAA amends the Employee Retirement Income Security Act (ERISA), the Public Health Service Act, and the Internal Revenue Code, creating a complicatedstructure dictated by efforts to avoid an unfunded mandate. The history of insurance regulation and the activity surrounding the enactment of PL. 104-191 suggest that HIPAA continues an incremental process of transition between state insurance regulation and federal oversight driven by recent and accelerating changes in the structure of the health-care marketplace. Copyright , Oxford University Press.

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