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Should State Consolidate Health Plan Regulation? How, When?

As California implements early provisions in the federal health reform law and positions itself for major changes in 2014, an old question is resurfacing: Should California consolidate health insurance regulation in one agency?

California, the only state with two agencies overseeing health insurers, is looking for ways to reduce state spending, and proponents of merging the two agencies say consolidation could save money.

The Department of Managed Health Care oversees health plans — primarily HMOs — that cover more than 21 million state residents. The California Department of Insurance regulates most PPOs and traditional indemnity plans, which cover about 2.4 million Californians.

Although no legislation or formal proposal to combine the departments is in the works, stakeholders have proposed shifting all health insurance regulation to one agency or the other. Last year, during his campaign for office, Insurance Commissioner Dave Jones (D) called for the two departments to better collaborate and possibly merge.

The consolidation debate was brought to the forefront this summer by the release of a new California HealthCare Foundation report examining how the state might best handle health insurance regulation under the Affordable Care Act. CHCF publishes California Healthline.

We asked stakeholders and experts three questions:

  • Should California consolidate health care regulation in one agency?
  • If so, how?
  • When?

The two agencies involved — CDI and DMHC — declined to contribute.

We got responses from:

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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