HEALTH-INSURANCE IN TRANSITION - THE HEALTH-INSURANCE PORTABILITY ANDACCOUNTABILITY ACT OF 1996

The Health Insurance Portability and Accountability Act (HIPAA) of 199 6 (PL. 104-191) brings the federal government fully into insurance reg ulation for the first time. Despite the Republican majority's rhetoric about stale control, election-year politics trumped federalism. HIPAA 's immediate impact on coverage may be modest, but its ultimate signif icance is great because it creates a template for more far-reaching fe deral involvement in regulating insurance. HIPAA amends the Employee R etirement Income Security Act (ERISA), the Public Health Service Act, and the Internal Revenue Code, creating a complicated structure dictat ed by efforts to avoid an unfunded mandate. The history of insurance r egulation and the activity surrounding the enactment of P.L. 104-191 s uggest that HIPAA continues an incremental process of transition betwe en stale insurance regulation and federal oversight driven by recent a nd accelerating changes in the structure of the health-care marketplac e.