Introduction to the 2010 Special Issue of Jri on Health Insurance

We are pleased to publish this special issue on health insurance, which coincides with a wave of health care reform in the United States. The debate over health care reform is much broader than the insurance coverage of health services, although health insurance is an important financing tool that affects many market participants. In fact, health insurance introduces, among other things, distortions in resource allocation by increasing access to health, by modifying the demand for and the supply of health care services, by changing individuals' incentives for health prevention, by affecting worker absenteeism and productivity, by increasing the financial obligations of firms, and by smoothing consumption over time. Scott Harrington proposes a comprehensive overview of the U.S. health care reform (as of early December 2009) with a focus on health insurance. His article presents the three main motivations for the reform: (1) high and rising annual growth of per capita expenditures in health expenditures not necessarily leading to a higher average quality of health for the population, (2) lack of access to insurance coverage of about 48 million residents, and (3) Medicare deficit and Medicaid cost growth. The author outlines the health care reform bills in the U.S. House and Senate, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article also discusses other issues related to the reform: (1) the potential effects of mandated health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan, and (3) provisions that would modify permissible grounds for health policy rescission and that would repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and an outlook on future developments.