Last Updated 7/2/2026

Background: Health insurance is product designed to help people pay for medical care. Consumers pay a monthly premium to an insurance company and in return, the insurer helps cover the cost of doctor visits, hospital stays, prescriptions, and other health services. Most health insurance plans also require people to pay part of their healthcare costs through deductibles, copays, or other out-of-pocket expenses.

Health insurance in the United States can be complicated because there are many types of plans and coverage options. Most insured people under the age of 65 get health coverage through their employer, but consumers can also buy coverage on their own or receive it through government programs. Understanding what a plan covers and what costs a person is responsible for can help consumers make informed healthcare decisions.

The health insurance market continues to deal with challenges in the areas of affordability and access to care. The costs of health care continue to rise faster than other goods and services. According to the Centers for Medicare & Medicaid Services, national health care expenditures represent 18% of the gross domestic product, reflecting growth of 7.2% in 2023. While Medicare broadly protects seniors and can be supplemented through private coverage options known as Medicare Supplement (Medigap), costly long-term care (LTC) services remain outside Medicare and Medigap benefits. 

Unlike other types of insurance, health insurance regulation is done both at the federal and state levels depending on the plan. The Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA) are two federal laws that have significantly impacted health insurance and employee benefits regulation in the United States. The primary regulator of any given health plan depends on the type of plan (e.g. employer-sponsored, marketplace, Medicare, supplemental, etc.). 

Enacted in 2010, the ACA aimed to expand health insurance coverage, improve its value through market reforms, and control healthcare costs by promoting competition among insurers. Provisions such as guaranteed issue, community rating, and the prohibition on preexisting condition exclusions have allowed millions of previously uninsured Americans to enroll, increasing access to healthcare. However, challenges related to ACA compliance, limited competition in certain areas, and insurer exits have led to higher premiums and cost-sharing, making coverage unaffordable for some without subsidies or alternative options. Enrollment in the health insurance marketplaces created by the ACA surged in 2021-2025 when enhanced tax credits were available. Enrollment has declined since the expiration of the enhanced credits.  
 
ERISA, enacted in 1974, sets minimum standards for most private sector pension and health plans to protect plan participants. It requires plans to provide participants with essential information about plan features and funding, and sets standards for participation, vesting, benefit accrual, and funding. One notable aspect of ERISA is its preemption of state law, which limits the authority of state insurance regulators over employer-sponsored self-insured health plans. This preemption creates a distinct regulatory environment for ERISA-covered plans, setting them apart from plans that are subject to state regulation. 

Actions: The NAIC continues to provide nonpartisan expertise to state regulators as well as the U.S. Congress and the federal government on health insurance regulation, particularly with respect to plans that are subject to shared state and federal regulation. The NAIC's committees continue their work to develop model policies and highlight best practices on healthcare cost control, market regulation, and consumer protection. NAIC’s work includes monitoring changes to prior authorization, assessing mental health parity compliance efforts, reviewing long-term care insurance (LTCI), supporting regulation of pharmacy benefit managers, and educating consumers on health insurance and their coverage options. 

The Health Insurance and Managed Care (B) Committee addresses issues relating to all aspects of health insurance, including affordability, access to care, consumer protection, market conduct, managed care, and the interaction between federal and state health insurance regulation. For example, the Committee examines rising healthcare costs and insurance premiums and reviews state initiatives to address cost drivers as well as monitoring the impact of healthcare and health insurance-related federal regulation on state insurance regulation. The Committee’s Task Forces and Working Groups allow regulators to collaborate on health coverage for seniors, actuarial issues in health insurance, and in the production of papers on topics like prior authorization and state flexibility under the Affordable Care Act.

The NAIC's Improper Marketing of Health Insurance (D) Working Group focuses on addressing the improper marketing of health plans and health insurance products, including coordination with state insurance regulators at the state and federal levels to support monitoring, provide assistance and guidance, and coordinate appropriate enforcement actions as needed.  The group works closely with the (B) Committee to ensure consumer protection. Their efforts align with the broader NAIC strategy to develop model policies, enhance transparency, and improve consumer understanding of health insurance options, especially in light of rising healthcare costs and the complexities of health insurance regulation.