ABSTRACT
Insurance market reform laws and regulations were passed in response to the small-business community’s virtually universal plea for relief from repeated double-digit premium increases and insurers’ refusals to renew disruptions in the small-group market (USGAO 1992). Insurance market regulatory power had rested with the states for some time (Nichols and Blumberg 1998), but the premium inflation of the late 1980s and early 1990s pushed many local systems to crisis point, and, along with the recession of 1991-1992, arguably contributed to the environment in which national discussions of health system reform were possible.1
