Early experience with 'new federalism' in health insurance regulation - HIPAA, the 1996 federal health insurance reform law, changed the way states can regulate health plans; its implementation remains a work in progress.

The authors monitored the implementation of the Health Insurance Portabilit y and Accountability Act (HIPAA) from 1997 to 1999. Regulators in all state s and relevant federal agencies were interviewed and applicable laws and re gulations studied. The authors found that HIPAA changed legal protections f or consumers' health coverage in several ways. They examine how the process of regulating such coverage was affected at the state and federal levels a nd under an emerging partnership of the two. Despite some early implementat ion challenges, HIPAA's successes have been significant, although limited b y the law's incremental nature.