Abstract
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (PL. 104-191) brings the federal governmentfully into insurance regulation for thefirst time. Despite the Republican majority's rhetoric about state control, election-year politics trumped federalism. HIPAA's immediate impact on coverage may be modest, but its ultimate significance is great because it creates a template for more farreachingfederal involvement in regulating insurance. HIPAA amends the Employee Retirement Income Security Act (ERISA), the Public Health Service Act, and the Internal Revenue Code, creating a complicated structure dictated by efforts to avoid an unfunded mandate. The history of insurance regulation and the activity surrounding the enactment ofPEL. 104-191 suggest that HIPAA continues an incremental process of transition between state insurance regulation and federal oversight driven by recent and accelerating changes in the structure of the health-care marketplace.
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