Association for Public Policy Analysis & Management

State legislatures have extensively regulated their insurance markets since the late 1800s.  Despite the importance of this topic, scholars have paid little attention to how states regulate their insurance markets. As a result, valuable insights have been lost and our understanding is heavily skewed toward the role of federal government. Of particular interest are the more than 2,200 health insurance mandates enacted by state legislatures. Health insurance mandates have both direct impacts on coverage as well as indirect impacts through the premium changes they induce. Moreover, mandates exhibit tremendous persistence as less than 1 percent of all mandates have ever been repealed.  Mandates remain important under the Affordable Care Act (ACA) because of their implications for affordability.  Not surprisingly, many states have sought to gain a better understanding of the effects of insurance mandates by requiring a review of the potential effects of the mandate under legislative consideration. From a policy perspective, the efforts by states to bring this expertise to the legislative process are laudable. However, the rigor and utility of these reviews differs significantly across the states; while some rely on their state university systems to draft extensive reports, others use two-page templates with only limited information that legislators can act upon. This paper assesses the interplay between expertise and politics at multiple levels using over one-hundred mandate analyses conducted for the California legislature by the California Health Benefits Review Program. First, it considers the effects at the macro level, i.e. outcomes at the aggregate/legislative level. Second, we assess the interplay at the micro level, i.e. decision-making at the level of the individual legislator using more than 12,000 individual votes.