State Health Insurance Regulation and Self-Employment Rates After the Great Recession: The Role of Guaranteed Issue Mandates.

Individual-level research has found self-employment positively linked to regulations that facilitate health insurance access outside the large group market. Since self-employment can aid regional economies, if such a relationship holds at the state level, insurance regulation may bolster state economic development. Yet such regulations may spawn high insurance premiums, which can depress self-employment. This study tested whether state self-employment rates from 2009 to 2011 related positively to states’ use of “guaranteed issue” mandates in the individual and small group markets from 2008 to 2010. These mandates require insurers to offer coverage to all applicants. Self-employment rates are measured as the share of the nonagricultural labor force self-employed, and alternately as the number of individual proprietorships per 1,000 population. Both measures are statistically higher in states that mandate guaranteed issue for groups of one in the small-group market than in states that do not; however, they are insensitive to individual market-guaranteed issue and inversely related to premiums. [ABSTRACT FROM AUTHOR]