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Key Findings

• To date, there is no evidence that either state health-insurance mandates or consumer-directed health plans (CDHPs) have improved access to or the affordability of health insurance for small businesses.
• Small-group insurance reforms appear to have had unintended effects, leading some firms to adjust their size to avoid the more highly regulated market.
• New policy solutions, such as small-business purchasing pools, should be explored and monitored.
• The changing marketplace for CDHP-related products and services should also be monitored to track CDHPs' effects on insurance offered to small businesses.