document_title: Health insurance in the United States

question_text: which act established provisions that require u.s. citizens to obtain health insurance

question_tokens: which act established provisions that require u.s. citizens to obtain health insurance

text: Health insurance in the United States

text: Enrollment and the uninsured[edit]

text: Trends in private coverage[edit]

text: The proportion of non-elderly individuals with employer-sponsored cover fell from 66% in 2000 to 56% in 2010, then stabilized following the passage of the Affordable Care Act. Employees who worked part time (less than 30 hours a week) were less likely to be offered coverage by their employer than were employees who worked full time (21% vs. 72%).[5]

text: A major trend in employer sponsored cover has been increasing premiums, deductibles, and co-payments for medical services, and increasing the costs of using out-of-network health providers rather than in-network providers.[6]

text: Trends in public coverage[edit]

text: Public insurance cover increased from 2000–2010 in part because of an aging population and an economic downturn in the latter part of the decade. Funding for Medicaid and CHIP expanded significantly under the 2010 health reform bill.[7] The proportion of individuals covered by Medicaid increased from 10.5% in 2000 to 14.5% in 2010 and 20% in 2015. The proportion covered by Medicare increased from 13.5% in 2000 to 15.9% in 2010, then decreased to 14% in 2015.[3][8]

text: Status of the uninsured[edit]

text: The uninsured proportion was stable at 14–15% from 1990 to 2008, then rose to a peak of 18% in Q3 2013 and rapidly fell to 11% in 2015.[9] The proportion without insurance has stabilized at 9%.[4]

text: A 2011 study found that there were 2.1 million hospital stays for uninsured patients, accounting for 4.4% ($17.1 billion) of total aggregate inpatient hospital costs in the United States.[10] The costs of treating the uninsured must often be absorbed by providers as charity care, passed on to the insured via cost-shifting and higher health insurance premiums, or paid by taxpayers through higher taxes.[11]

text: Death[edit]

text: Since people who lack health insurance are unable to obtain timely medical care, they have a 40% higher risk of death in any given year than those with health insurance, according to a study published in the American Journal of Public Health. The study estimated that in 2005 in the United States, there were 45,000 deaths associated with lack of health insurance.[12] A 2008 systematic review found consistent evidence that health insurance increased utilization of services and improved health.[13]

text: A Johns Hopkins Hospital study found that heart transplant complications occurred most often amongst the uninsured, and that patients who had private health plans fared better than those covered by Medicaid or Medicare.[14] Gallup issued a report in July 2014 stating that the uninsured rate for adults 18 and over declined from 18% in 2013 to 13.4% by in 2014, largely because there were new coverage options and market reforms under the Affordable Care Act.[15] Rand Corporation had similar findings.[16]

text: Reform[edit]

text: The Affordable Care Act of 2010 was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created health insurance exchanges. The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive coverage because of the act by 2022.[17]

text: History[edit]

text: Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, sickness coverage in the US effectively dates from 1890. The first employer-sponsored group disability policy was issued in 1911, but this plan's primary purpose was replacing wages lost because the worker was unable to work, not medical expenses.[18]

text: Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case. The rise of private insurance was accompanied by the gradual expansion of public insurance programs for those who could not acquire coverage through the market.

text: Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations in the 1930s.[18] The first employer-sponsored hospitalization plan was created by teachers in Dallas, Texas in 1929.[19] Because the plan only covered members' expenses at a single hospital, it is also the forerunner of today's health maintenance organizations (HMOs).[19][20][21]

text: In 1935 the decision was made by the Roosevelt Administration not to include a large-scale health insurance program as part of the new Social Security program. The problem was not an attack by any organized opposition, such as the opposition from the American Medical Association that derailed Truman's proposals in 1949. Instead, there was a lack of active popular, congressional, or interest group support. Roosevelt's strategy was to wait for a demand and a program to materialize, and then if he thought it popular enough to throw his support behind it. His Committee on Economic Security (CES) deliberately limited the health segment of Social Security to the expansion of medical care and facilities. It considered unemployment insurance to be the major priority. Roosevelt assured the medical community that medicine would be kept out of politics. Jaap Kooijman says he succeeded in "pacifying the opponents without discouraging the reformers." The right moment never came for him to reintroduce the topic.[22][23]

text: The rise of employer-sponsored coverage[edit]

text: Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II.[19] The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.[19]

text: President Harry S. Truman proposed a system of public health insurance in his November 19, 1945, address. He envisioned a national system that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give cash to the policy holder to replace wages lost because of illness or injury. The proposal was quite popular with the public, but it was fiercely opposed by the Chamber of Commerce, the American Hospital Association, and the AMA, which denounced it as "socialism".[24]

text: Foreseeing a long and costly political battle, many labor unions chose to campaign for employer-sponsored coverage, which they saw as a less desirable but more achievable goal, and as coverage expanded the national insurance system lost political momentum and ultimately failed to pass. Using health care and other fringe benefits to attract the best employees, private sector, white-collar employers nationwide expanded the U.S. health care system. Public sector employers followed suit in an effort to compete. Between 1940 and 1960, the total number of people enrolled in health insurance plans grew seven-fold, from 20,662,000 to 142,334,000,[25] and by 1958, 75% of Americans had some form of health coverage.[26]

text: Kerr-Mills Act[edit]

text: Still, private insurance remained unaffordable or simply unavailable to many, including the poor, the unemployed, and the elderly. Before 1965, only half of seniors had health care coverage, and they paid three times as much as younger adults, while having lower incomes.[27] Consequently, interest persisted in creating public health insurance for those left out of the private marketplace.

text: The 1960 Kerr-Mills Act provided matching funds to states assisting patients with their medical bills. In the early 1960s, Congress rejected a plan to subsidize private coverage for people with Social Security as unworkable, and an amendment to the Social Security Act creating a publicly run alternative was proposed. Finally, President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965, creating publicly run insurance for the elderly and the poor.[28] Medicare was later expanded to cover people with disabilities, end-stage renal disease, and ALS.

text: Towards universal coverage[edit]

text: Persistent lack of insurance among many working Americans continued to create pressure for a comprehensive national health insurance system. In the early 1970s, there was fierce debate between two alternative models for universal coverage. Senator Ted Kennedy proposed a universal single-payer system, while President Nixon countered with his own proposal based on mandates and incentives for employers to provide coverage while expanding publicly run coverage for low-wage workers and the unemployed. Compromise was never reached, and Nixon's resignation and a series of economic problems later in the decade diverted Congress's attention away from health reform.

text: Shortly after his inauguration, President Clinton offered a new proposal for a universal health insurance system. Like Nixon's plan, Clinton's relied on mandates, both for individuals and for insurers, along with subsidies for people who could not afford insurance. The bill would have also created "health-purchasing alliances" to pool risk among multiple businesses and large groups of individuals. The plan was staunchly opposed by the insurance industry and employers' groups and received only mild support from liberal groups, particularly unions, which preferred a single payer system. Ultimately it failed after the Republican takeover of Congress in 1994.[29]

text: Finally achieving universal health coverage remained a top priority among Democrats, and passing a health reform bill was one of the Obama Administration's top priorities. The Patient Protection and Affordable Care Act was similar to the Nixon and Clinton plans, mandating coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively.[7] Earlier versions of the bill included a publicly run insurer that could compete to cover those without employer sponsored coverage (the so-called public option), but this was ultimately stripped to secure the support of moderates. The bill passed the Senate in December 2009 with all Democrats voting in favor and the House in March 2010 with the support of most Democrats. Not a single Republican voted in favor of it either time.

text: Public health care coverage[edit]

text: Public programs provide the primary source of coverage for most seniors and also low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income individuals.[30] In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid—up from 52 percent in 1997.[31]

text: Medicare[edit]

text: In the United States, Medicare is a federal social insurance program that provides health insurance to people over the age of 65, individuals who become totally and permanently disabled, end stage renal disease (ESRD) patients, and people with ALS. Recent research has found that the health trends of previously uninsured adults, especially those with chronic health problems, improves once they enter the Medicare program.[32] Traditional Medicare requires considerable cost-sharing, but ninety percent of Medicare enrollees have some kind of supplemental insurance—either employer-sponsored or retiree coverage, Medicaid, or a private Medigap plan—that covers some or all of their cost-sharing.[33] With supplemental insurance, Medicare ensures that its enrollees have predictable, affordable health care costs regardless of unforeseen illness or injury.

text: As the population covered by Medicare grows, its costs are projected to rise from slightly over 3 percent of GDP to over 6 percent, contributing substantially to the federal budget deficit.[34] In 2011, Medicare was the primary payer for an estimated 15.3 million inpatient stays, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States.[10] The Affordable Care Act took some steps to reduce Medicare spending, and various other proposals are circulating to reduce it further.

text: Medicare Advantage[edit]

text: Medicare Advantage plans expand the health insurance options for people with Medicare. Medicare Advantage was created under the Balanced Budget Act of 1997, with the intent to better control the rapid growth in Medicare spending, as well as to provide Medicare beneficiaries more choices. But on average, Medicare Advantage plans cost 12% more than traditional Medicare.[35] The ACA took steps to align payments to Medicare Advantage plans with the cost of traditional Medicare.

text: There is some evidence that Medicare Advantage plans select patients with low risk of incurring major medical expenses to maximize profits at the expense of traditional Medicare.[36]

text: Medicare Part D[edit]

text: Medicare Part D provides a private insurance option to allow Medicare beneficiaries to purchase subsidized coverage for the costs of prescription drugs. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and went into effect on January 1, 2006.[37]

text: Medicaid[edit]

text: Medicaid was instituted for the very poor in 1965. Since enrollees must pass a means test, Medicaid is a social welfare or social protection program rather than a social insurance program. Despite its establishment, the percentage of US residents who lack any form of health insurance has increased since 1994.[38] It has been reported that the number of physicians accepting Medicaid has decreased in recent years because of lower reimbursement rates.[39]

text: The Affordable Care Act dramatically expanded Medicaid. The program will now cover everyone with incomes under 133% of the federal poverty level who does not qualify for Medicare, provided this expansion of coverage has been accepted by the state where the person resides. Meanwhile, Medicaid benefits must be the same as the essential benefit in the newly created state exchanges. The federal government will fully fund the expansion of Medicaid initially, with some of the financial responsibility gradually devolving back to the states by 2020.

text: In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States.[10]

text: Children's Health Insurance Program (SCHIP)[edit]

text: The Children's Health Insurance Program (CHIP) is a joint state/federal program to provide health insurance to children in families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance. The statutory authority for CHIP is under title XXI of the Social Security Act. CHIP programs are run by the individual states according to requirements set by the federal Centers for Medicare and Medicaid Services, and may be structured as independent programs separate from Medicaid (separate child health programs), as expansions of their Medicaid programs (CHIP Medicaid expansion programs), or combine these approaches (CHIP combination programs). States receive enhanced federal funds for their CHIP programs at a rate above the regular Medicaid match.

text: Military health benefits[edit]

text: Health benefits are provided to active duty service members, retired service members and their dependents by the Department of Defense Military Health System (MHS). The MHS consists of a direct care network of Military Treatment Facilities and a purchased care network known as TRICARE. Additionally, veterans may also be eligible for benefits through the Veterans Health Administration.

text: Indian health service[edit]

text: The Indian Health Service (IHS) provides medical assistance to eligible American Indians at IHS facilities, and helps pay the cost of some services provided by non-IHS health care providers.[30]

text: State risk pools[edit]

text: In 1976, some states began providing guaranteed-issuance risk pools, which enable individuals who are medically uninsurable through private health insurance to purchase a state-sponsored health insurance plan, usually at higher cost. Minnesota was the first to offer such a plan; 34 states (Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, Wyoming) now offer them. Plans vary greatly from state to state, both in their costs and benefits to consumers and in their methods of funding and operations. They serve a very small portion of the uninsurable market—about 182,000 people in the U.S. as of 2004,[40] and about 200,000 in 2008.[41]

text: These risk pools allow people with pre-existing conditions such as cancer, diabetes, heart disease or other chronic illnesses to be able to switch jobs or seek self-employment without fear of being without health care benefits.[42] However, the plans are expensive, with premiums that can be double the average policy, and the pools currently cover only 1 in 25 of the so-called "uninsurable" population.[43] Additionally, even plans which are not expensive can leave those enrolled with little real health insurance beyond "catastrophic" insurance; for example, one insurance plan through Minnesota's high-risk pool, while costing only $215 per quarter, includes a $10,000 deductible with no preventative or other health care covered unless and until the enrollee has spent $10,000 of their own money during the year on health care.[44] Very sick people can accumulate large medical bills during mandatory waiting periods before their medical expenses are covered, and there are often lifetime expenditure caps (maximums), after which the risk pool no longer pays for any medical expenses.[45]

text: Efforts to pass a national pool have been unsuccessful, but some federal tax money has been awarded to states to innovate and improve their plans. With the Patient Protection and Affordable Care Act, effective by 2014, it will be easier for people with pre-existing conditions to afford regular insurance, since all insurers will be fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.[46][47]

text: Pre-existing Condition Insurance Plan[edit]

text: The Pre-existing Condition Insurance Plan, or PCIP, is a transitional program created in the Patient Protection and Affordable Care Act (PPACA). Those eligible for PCIP are citizens of the United States or those legally residing in the U.S., who have been uninsured for the last 6 months and "have a pre-existing condition or have been denied health coverage because of their health condition." However, if one has health insurance or is enrolled in a state high risk pool, they are not eligible for PCIP, even if that coverage does not cover their medical condition. PCIP is run by the individual states or through the U.S. Department of Health and Human Services, which has a contract with the Government Employees Health Association, or GEHA, to administer benefits. Both will be funded by the federal government and provide three plan options. These options are the standard, extended, and the Health Savings Account option. PCIP only covers the individual enrollee and does not include family members or dependents. In 2014, the Affordable Care Act provision banning discrimination based on pre-existing conditions will be implemented and PCIP enrollees will be transitioned into new state-based health care exchanges.[48][49][50]

text: Private health care coverage[edit]

text: Private health insurance may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. Most Americans with private health insurance receive it through an employer-sponsored program. According to the United States Census Bureau, some 60% of Americans are covered through an employer, while about 9% purchase health insurance directly.[51] Private insurance was billed for 12.2 million inpatient hospital stays in 2011, incurring approximately 29% ($112.5 billion) of the total aggregate inpatient hospital costs in the United States.[10]

text: The US has a joint federal and state system for regulating insurance, with the federal government ceding primary responsibility to the states under the McCarran-Ferguson Act. States regulate the content of health insurance policies and often require coverage of specific types of medical services or health care providers.[52][53] State mandates generally do not apply to the health plans offered by large employers, because of the preemption clause of the Employee Retirement Income Security Act.

text: Employer sponsored[edit]

text: Employer-sponsored health insurance is paid for by businesses on behalf of their employees as part of an employee benefit package. Most private (non-government) health coverage in the US is employment-based. Nearly all large employers in America offer group health insurance to their employees.[54] The typical large-employer PPO plan is typically more generous than either Medicare or the Federal Employees Health Benefits Program Standard Option.[55]

text: The employer typically makes a substantial contribution towards the cost of coverage. Typically, employers pay about 85% of the insurance premium for their employees, and about 75% of the premium for their employees' dependents. The employee pays the remaining fraction of the premium, usually with pre-tax/tax-exempt earnings. These percentages have been stable since 1999.[56] Health benefits provided by employers are also tax-favored: Employee contributions can be made on a pre-tax basis if the employer offers the benefits through a section 125 cafeteria plan.

text: Workers who receive employer-sponsored health insurance tend to be paid less in cash wages than they would be without the benefit, because of the cost of insurance premiums to the employer and the value of the benefit to the worker. The value to workers is generally greater than the wage reduction because of economies of scale, a reduction in adverse selection pressures on the insurance pool (premiums are lower when all employees participate rather than just the sickest), and reduced income taxes.[19] Disadvantages to workers include disruptions related to changing jobs, the regressive tax effect (high-income workers benefit far more from the tax exemption for premiums than low-income workers), and increased spending on healthcare.[19]

text: Costs for employer-paid health insurance are rising rapidly: between 2001 and 2007, premiums for family coverage have increased 78%, while wages have risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation.[57] Employer costs have risen noticeably per hour worked, and vary significantly. In particular, average employer costs for health benefits vary by firm size and occupation. The cost per hour of health benefits is generally higher for workers in higher-wage occupations, but represent a smaller percentage of payroll.[58] The percentage of total compensation devoted to health benefits has been rising since the 1960s.[59] Average premiums, including both the employer and employee portions, were $4,704 for single coverage and $12,680 for family coverage in 2008.[56][60]

text: However, in a 2007 analysis, the Employee Benefit Research Institute concluded that the availability of employment-based health benefits for active workers in the US is stable. The "take-up rate," or percentage of eligible workers participating in employer-sponsored plans, has fallen somewhat, but not sharply. EBRI interviewed employers for the study, and found that others might follow if a major employer discontinued health benefits. Effective by January 1, 2014, the Patient Protection and Affordable Care Act will impose a $2000 per employee tax penalty on employers with over 50 employees who do not offer health insurance to their full-time workers. (In 2008, over 95% of employers with at least 50 employees offered health insurance.[61])[62] On the other hand, public policy changes could also result in a reduction in employer support for employment-based health benefits.[63]

text: Although much more likely to offer retiree health benefits than small firms, the percentage of large firms offering these benefits fell from 66% in 1988 to 34% in 2002.[54]

text: Small employer group coverage[edit]

text: According to a 2007 study, about 59% of employers at small firms (3–199 workers) in the US provide employee health insurance. The percentage of small firms offering coverage has been dropping steadily since 1999. The study notes that cost remains the main reason cited by small firms who do not offer health benefits.[64] Small firms that are new are less likely to offer coverage than ones that have been in existence for a number of years. For example, using 2005 data for firms with fewer than 10 employees, 43% of those that had been in existence at least 20 years offered coverage, but only 24% of those that had been in existence less than 5 years did. The volatility of offer rates from year to year also appears to be higher for newer small businesses.[65]

text: The types of coverage available to small employers are similar to those offered by large firms, but small businesses do not have the same options for financing their benefit plans. In particular, self-funded health care (whereby an employer provides health or disability benefits to employees with its own funds rather than contracting an insurance company[66]) is not a practical option for most small employers.[67] A RAND Corporation study published in April 2008 found that the cost of health care coverage places a greater burden on small firms, as a percentage of payroll, than on larger firms.[68] A study published by the American Enterprise Institute in August 2008 examined the effect of state benefit mandates on self-employed individuals, and found that "the larger the number of mandates in a state, the lower the probability that a self-employed person will be a significant employment generator."[69] Beneficiary cost sharing is, on average, higher among small firms than large firms.[70]

text: When small group plans are medically underwritten, employees are asked to provide health information about themselves and their covered family members when they apply for coverage. When determining rates, insurance companies use the medical information on these applications. Sometimes they will request additional information from an applicant's physician or ask the applicants for clarification.[71]

text: States regulate small group premium rates, typically by placing limits on the premium variation allowable between groups (rate bands). Insurers price to recover their costs over their entire book of small group business while abiding by state rating rules.[72] Over time, the effect of initial underwriting "wears off" as the cost of a group regresses towards the mean. Recent claim experience—whether better or worse than average—is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to regress over time towards that of an average group.[73] The process used to price small group coverage changes when a state enacts small group reform laws.[74]

text: Insurance brokers play a significant role in helping small employers find health insurance, particularly in more competitive markets. Average small group commissions range from 2 percent to 8 percent of premiums. Brokers provide services beyond insurance sales, such as assisting with employee enrollment and helping to resolve benefits issues.[75]

text: College-sponsored health insurance for students[edit]

text: Many colleges, universities, graduate schools, professional schools and trade schools offer a school-sponsored health insurance plan. Many schools require that you enroll in the school-sponsored plan unless you are able to show that you have comparable coverage from another source.

text: Effective group health plan years beginning after September 23, 2010, if an employer-sponsored health plan allows employees' children to enroll in coverage, then the health plan must allow employees' adult children to enroll as well as long as the adult child is not yet age 26. Some group health insurance plans may also require that the adult child not be eligible for other group health insurance coverage, but only before 2014.[76]

text: This extension of coverage will help cover one in three young adults, according to White House documents.

text: Federal employees health benefit plan (FEHBP)[edit]

text: In addition to such public plans as Medicare and Medicaid, the federal government also sponsors a health benefit plan for federal employees—the Federal Employees Health Benefits Program (FEHBP). FEHBP provides health benefits to full-time civilian employees. Active-duty service members, retired service members and their dependents are covered through the Department of Defense Military Health System (MHS). FEHBP is managed by the federal Office of Personnel Management.

text: "Portability" of group coverage[edit]

text: Two federal laws address the ability of individuals with employment-based health insurance coverage to maintain coverage.

text: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) enables certain individuals with employer-sponsored coverage to extend their coverage if certain "qualifying events" would otherwise cause them to lose it. Employers may require COBRA-qualified individuals to pay the full cost of coverage, and coverage cannot be extended indefinitely. COBRA only applies to firms with 20 or more employees, although some states also have "mini-COBRA" laws that apply to small employers.

text: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides for forms of both "group-to-group" and "group-to-individual" portability. When an individual moves from one employer's benefit plan to another's, the new plan must count coverage under the old plan against any waiting period for pre-existing conditions, as long as there is not a break in coverage of more than 63 days between the two plans. When certain qualified individuals lose group coverage altogether, they must be guaranteed access to some form of individual coverage. To qualify, they must have at least 18 months of prior continuous coverage. The details of access and the price of coverage are determined on a state-by-state basis.

text: Association Health Plan (AHP)[edit]

text: In the late 1990s federal legislation had been proposed to "create federally-recognized Association Health Plans which was then "referred to in some bills as 'Small Business Health Plans.'[77] The National Association of Insurance Commissioners (NAIC), which is the "standard-setting and regulatory of chief insurance regulators from all states, the District of Columbia and territories, cautioned against implementing AHPs citing "plan failures like we saw The Multiple Employer Welfare Arrangements (MEWAs) in the 1990s."[78] "[S]mall businesses in California such as dairy farmers, car dealers, and accountants created AHPs "to buy health insurance on the premise that a bigger pool of enrollees would get them a better deal."[79] A November 2017 article in the Los Angeles Times described how there were only 4 remaining AHPs in California. Many of the AHPs filed for bankruptcy, "sometimes in the wake of fraud." State legislators were forced to pass "sweeping changes in the 1990s" that almost made AHPs extinct.[79]

text: According to a 2000 Congressional Budget Office (CBO) report, Congress passed legislation creating "two new vehicles Association Health Plans (AHPs) and HealthMarts, to facilitate the sale of health insurance coverage to employees of small firms" in response to concerns about the "large and growing number of uninsured people in the United States."[80]

text: In 2003, according to the Heartland Institute's Merrill Matthews, association group health insurance plans offered affordable health insurance to "some 6 million Americans." Matthews responded to the criticism that said that some associations work too closely with their insurance providers. He said, "You would expect the head of AARP to have a good working relationship with the CEO of Prudential, which sells policies to AARP’s seniors."[81]

text: In March 2017, the U.S. House of Representatives passed The Small Business Health Fairness Act (H.R. 1101), which established "requirements for creating a federally-certified AHP, including for certification itself, sponsors and boards of trustees, participation and coverage, nondiscrimination, contribution rates, and voluntary termination."[77][82]

text: AHPs would be "exempt from most state regulation and oversight, subject only to Employee Retirement Income Security Act (ERISA) and oversight by the U.S. Department of Labor, and most proposals would also allow for interstate plans."[77]

text: Critics said that "Exemptions would lead to market instability and higher premiums in the traditional small-group market. AHPs exempt from state regulation and oversight would enable them to be more selective about who they cover. They will be less likely to cover higher-risk populations, which would cause an imbalance in the risk pool for other small business health plans that are part of the state small group risk pool. Adverse selection would likely abound and Association Health Plans would be selling an unregulated product alongside small group plans, which creates an unlevel playing field."[77] According to the Congressional Budget Office (CBO), "[p]remiums would go up for those buying in the traditional small-group market." competing against AHPs that offer less expensive and less comprehensive plans.[77][80]

text: The National Association of Insurance Commissioners (NAIC), the National Governors’ Association and "several insurance and consumer groups" opposed the AHP legislation.[78] The NAIC issued a Consumer Alert regarding AHPs, as proposed in Developing the Next Generation of Small Businesses Act of 2017. H.R. 1774.[78] Their statement said that AHP's "[t]hreaten the stability of the small group market" and provide "inadequate benefits and insufficient protection to consumers."[78] Under AHPs, "[f]ewer consumers would have their rights protected, "AHPs would also be exempt from state solvency requirements, putting consumers at serious risk of incurring medical claims that cannot be paid by their Association Health Plan."[77]

text: In November 2017, President Trump directed "the Department of Labor to investigate ways that would "allow more small businesses to avoid many of the [Affordable Care Act’s] costly requirements."[79] Under the ACA, small-employer and individual markets had "gained important consumer protections under the ACA and state health laws — including minimum benefit levels."[79] In a December 28, 2017 interview with the New York Times, Trump explained that, "We’ve created associations, millions of people are joining associations. ...That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. ...It could be as high as 50 percent of the people. So now you have associations, and people don’t even talk about the associations. That could be half the people are going to be joining up...So now you have associations and the individual mandate. I believe that because of the individual mandate and the association".[83]

text: Individually purchased[edit]

text: According to the US Census Bureau, about 9% of Americans are covered under health insurance purchased directly.[51] The range of products available is similar to those provided through employers. However, average out-of-pocket spending is higher in the individual market, with higher deductibles, co-payments and other cost-sharing provisions.[70][84] Major medical is the most commonly purchased form of individual health insurance. Although a major medical health insurance policy is primarily a catastrophic plan, qualified preventive benefits are still covered at 100% without any waiting period or copay.[85]

text: In the individual market, the consumer pays the entire premium without benefit of an employer contribution.[84][86] While self-employed individuals receive a tax deduction for their health insurance and can buy health insurance with additional tax benefits, most consumers in the individual market do not receive any tax benefit.[87]

text: Premiums vary significantly by age.[84][88][89] In states that allow individual medical plan underwriting, premiums also vary by health status.[84] However, with the Patient Protection and Affordable Care Act, effective since 2014, insurers are prohibited from discriminating against or charging higher rates for individuals based on pre-existing medical conditions.[46][47]

text: In August 2008, the Hartford Courant reported that competition was increasing in the individual health insurance market, with more insurers entering the market, an increased variety of products, and a broader spread of prices.[90]

text: Individual health insurance is primarily regulated at the state level, consistent with the McCarran-Ferguson Act. Model acts and regulations promulgated by the National Association of Insurance Commissioners (NAIC) provide some degree of uniformity state to state. These models do not have the force of law and have no effect unless they are adopted by a state. They are, however, used as guides by most states, and some states adopt them with little or no change.

text: Types of medical insurance[edit]

text: Traditional indemnity or fee-for-service[edit]

text: Early hospital and medical plans offered by insurance companies paid either a fixed amount for specific diseases or medical procedures (schedule benefits) or a percentage of the provider's fee. The relationship between the patient and the medical provider was not changed. The patient received medical care and was responsible for paying the provider. If the service was covered by the policy, the insurance company was responsible for reimbursing or indemnifying the patient based on the provisions of the insurance contract ("reimbursement benefits"). Health insurance plans that are not based on a network of contracted providers, or that base payments on a percentage of provider charges, are still described as indemnity or fee-for-service plans.[18]

text: Blue Cross Blue Shield Association[edit]

text: The Blue Cross Blue Shield Association (BCBSA) is a federation of 38 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans.[91] BCBSA insurance companies are franchisees, independent of the association (and traditionally each other), offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state, and also act as administrators of Medicare in many states or regions of the United States, and provide coverage to state government employees as well as to federal government employees under a nationwide option of the Federal Employees Health Benefit Plan.[92]

text: Health Maintenance Organizations[edit]

text: A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options.[93] Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. Benefits are provided through a network of providers. Providers may be employees of the HMO ("staff model"), employees of a provider group that has contracted with the HMO ("group model"), or members of an independent practice association ("IPA model"). HMOs may also use a combination of these approaches ("network model").[18][94]

text: Managed care[edit]

text: The term managed care is used to describe a variety of techniques intended to reduce the cost of health benefits and improve the quality of care. It is also used to describe organizations that use these techniques ("managed care organization").[95] Many of these techniques were pioneered by HMOs, but they are now used in a wide variety of private health insurance programs. Through the 1990s, managed care grew from about 25% US employees with employer-sponsored coverage to the vast majority.[96]

text:
Rise of managed care in the US[97][clarification needed]

Year
Conventional
plans
HMOs
PPOs
POS
plans
HDHP/SOs

1998
14%
27%
35%
24%
—

1999
10%
28%
39%
24%
—

2000
8%
29%
42%
21%
—

2001
7%
24%
46%
23%
—

2002
4%
27%
52%
18%
—

2003
5%
24%
54%
17%
—

2004
5%
25%
55%
15%
—

2005
3%
21%
61%
15%
—

2006
3%
20%
60%
13%
4%

2007
3%
21%
57%
15%
5%

2008
2%
20%
58%
12%
8%

2009
1%
20%
60%
10%
8%

2010
1%
19%
58%
8%
13%

2011
1%
17%
55%
10%
17%

2012
<1%
16%
56%
9%
19%

2013
<1%
14%
57%
9%
20%

2014
<1%
13%
55%
23%
27%

2015
1%
17%
50%
26%
26%

2016
2%
23%
35%
32%
28%

text: Network-based managed care[edit]

text: Many managed care programs are based on a panel or network of contracted health care providers. Such programs typically include:

text:
A set of selected providers that furnish a comprehensive array of health care services to enrollees;
Explicit standards for selecting providers;
Formal utilization review and quality improvement programs;
An emphasis on preventive care; and
Financial incentives to encourage enrollees to use care efficiently.

tag: ul

text: Provider networks can be used to reduce costs by negotiating favorable fees from providers, selecting cost effective providers, and creating financial incentives for providers to practice more efficiently.[21] A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees.[98][99]

text: Network-based plans may be either closed or open. With a closed network, enrollees' expenses are generally only covered when they go to network providers. Only limited services are covered outside the network—typically only emergency and out-of-area care. Most traditional HMOs were closed network plans. Open network plans provide some coverage when an enrollee uses non-network provider, generally at a lower benefit level to encourage the use of network providers. Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans.

text: The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan. In a "closed panel" HMO, the network providers are either HMO employees (staff model) or members of large group practices with which the HMO has a contract. In an "open panel" plan the HMO or PPO contracts with independent practitioners, opening participation in the network to any provider in the community that meets the plan's credential requirements and is willing to accept the terms of the plan's contract.

text: Other managed care techniques[edit]

text: Other managed care techniques include such elements as disease management, case management, wellness incentives, patient education, utilization management and utilization review. These techniques can be applied to both network-based benefit programs and benefit programs that are not based on a provider network. The use of managed care techniques without a provider network is sometimes described as "managed indemnity."

text: Blurring lines[edit]

text: Over time, the operations of many Blue Cross and Blue Shield operations have become more similar to those of commercial health insurance companies.[100] However, some Blue Cross and Blue Shield plans continue to serve as insurers of last resort.[101] Similarly, the benefits offered by Blues plans, commercial insurers, and HMOs are converging in many respects because of market pressures. One example is the convergence of preferred provider organization (PPO) plans offered by Blues and commercial insurers and the point of service plans offered by HMOs. Historically, commercial insurers, Blue Cross and Blue Shield plans, and HMOs might be subject to different regulatory oversight in a state (e.g., the Department of Insurance for insurance companies, versus the Department of Health for HMOs). Today, it is common for commercial insurance companies to have HMOs as subsidiaries, and for HMOs to have insurers as subsidiaries (the state license for an HMO is typically different from that for an insurance company).[18][94][102] At one time the distinctions between traditional indemnity insurance, HMOs and PPOs were very clear; today, it can be difficult to distinguish between the products offered by the various types of organization operating in the market.[103]

text: The blurring of distinctions between the different types of health care coverage can be seen in the history of the industry's trade associations. The two primary HMO trade associations were the Group Health Association of America and the American Managed Care and Review Association. After merging, they were known as American Association of Health Plans (AAHP). The primary trade association for commercial health insurers was the Health Insurance Association of America (HIAA). These two have now merged, and are known as America's Health Insurance Plans (AHIP).

text: New types of medical plans[edit]

text: In recent years,[when?] various new types of medical plans have been introduced.

text: Health care markets and pricing[edit]

text: The US health insurance market is highly concentrated, as leading insurers have carried out over 400 mergers from the mid-1990s to the mid-2000s (decade). In 2000, the two largest health insurers (Aetna and UnitedHealth Group) had total membership of 32 million. By 2006 the top two insurers, WellPoint and UnitedHealth, had total membership of 67 million. The two companies together had more than 36% of the national market for commercial health insurance. The AMA has said that it "has long been concerned about the impact of consolidated markets on patient care." A 2007 AMA study found that in 299 of the 313 markets surveyed, one health plan accounted for at least 30% of the combined health maintenance organization (HMO)/preferred provider organization (PPO) market. In 90% of markets, the largest insurer controls at least 30% of the market, and the largest insurer controls more than 50% of the market in 54% of metropolitan areas.[115] The US Department of Justice has recognized this percentage of market control as conferring substantial monopsony power in the relations between insurer and physicians.[116]

text: Most provider markets (especially hospitals) are also highly concentrated—roughly 80%, according to criteria established by the FTC and Department of Justice[117]—so insurers usually have little choice about which providers to include in their networks, and consequently little leverage to control the prices they pay. Large insurers frequently negotiate most-favored nation clauses with providers, agreeing to raise rates significantly while guaranteeing that providers will charge other insurers higher rates.[118]

text: According to some experts, such as Uwe Reinhardt,[119] Sherry Glied, Megan Laugensen,[120] Michael Porter, and Elizabeth Teisberg,[121] this pricing system is highly inefficient and is a major cause of rising health care costs. Health care costs in the United States vary enormously between plans and geographical regions, even when input costs are fairly similar, and rise very quickly. Health care costs have risen faster than economic growth at least since the 1970s. Public health insurance programs typically have more bargaining power as a result of their greater size and typically pay less for medical services than private plans, leading to slower cost growth, but the overall trend in health care prices have led public programs' costs to grow at a rapid pace as well.

text: Other types of health insurance (non-medical)[edit]

text: While the term "health insurance" is most commonly used by the public to describe coverage for medical expenses, the insurance industry uses the term more broadly to include other related forms of coverage, such as disability income and long-term care insurance.

text: Disability income insurance[edit]

text: Disability income (DI) insurance pays benefits to individuals who become unable to work because of injury or illness. DI insurance replaces income lost while the policyholder is unable to work during a period of disability (in contrast to medical expense insurance, which pays for the cost of medical care).[122] For most working age adults, the risk of disability is greater than the risk of premature death, and the resulting reduction in lifetime earnings can be significant. Private disability insurance is sold on both a group and an individual basis. Policies may be designed to cover long-term disabilities (LTD coverage) or short-term disabilities (STD coverage).[123] Business owners can also purchase disability overhead insurance to cover the overhead expenses of their business while they are unable to work.[124]

text: A basic level of disability income protection is provided through the Social Security Disability Insurance (SSDI) program for qualified workers who are totally and permanently disabled (the worker is incapable of engaging in any "substantial gainful work" and the disability is expected to last at least 12 months or result in death).

text: Long-term care insurance[edit]

text: Long-term care (LTC) insurance reimburses the policyholder for the cost of long-term or custodial care services designed to minimize or compensate for the loss of functioning due to age, disability or chronic illness.[125] LTC has many surface similarities to long-term disability insurance. There are at least two fundamental differences, however. LTC policies cover the cost of certain types of chronic care, while long-term-disability policies replace income lost while the policyholder is unable to work. For LTC, the event triggering benefits is the need for chronic care, while the triggering event for disability insurance is the inability to work.[122]

text: Private LTC insurance is growing in popularity in the US. Premiums have remained relatively stable in recent years. However, the coverage is quite expensive, especially when consumers wait until retirement age to purchase it. The average age of new purchasers was 61 in 2005, and has been dropping.[126]

text: Supplemental coverage[edit]

text: Private insurers offer a variety of supplemental coverages in both the group and individual markets. These are not designed to provide the primary source of medical or disability protection for an individual, but can assist with unexpected expenses and provide additional peace of mind for insureds. Supplemental coverages include Medicare supplement insurance, hospital indemnity insurance, dental insurance, vision insurance, accidental death and dismemberment insurance and specified disease insurance.[18]

text: Supplemental coverages are intended to:

text:
Supplement a primary medical expense plan by paying for expenses that are excluded or subject to the primary plan's cost-sharing requirements (e.g., co-payments, deductibles, etc.);
Cover related expenses such as dental or vision care;
Assist with additional expenses that may be associated with a serious illness or injury.[18]

text: Medicare Supplement Coverage (Medigap)[edit]

text: Medicare Supplement policies are designed to cover expenses not covered (or only partially covered) by the "original Medicare" (Parts A & B) fee-for-service benefits. They are only available to individuals enrolled in Medicare Parts A & B. Medigap plans may be purchased on a guaranteed issue basis (no health questions asked) during a six-month open enrollment period when an individual first becomes eligible for Medicare.[127] The benefits offered by Medigap plans are standardized.

text: Hospital indemnity insurance[edit]

text: Hospital indemnity insurance provides a fixed daily, weekly or monthly benefit while the insured is confined in a hospital. The payment is not dependent on actual hospital charges, and is most commonly expressed as a flat dollar amount. Hospital indemnity benefits are paid in addition to any other benefits that may be available, and are typically used to pay out-of-pocket and non-covered expenses associated with the primary medical plan, and to help with additional expenses (e.g., child care) incurred while in the hospital.[18][94]

text: Scheduled health insurance plans[edit]

text: Scheduled health insurance plans are an expanded form of Hospital Indemnity plans. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization, surgical, and physician services. However, they are not meant to replace a traditional comprehensive health insurance plan. Scheduled health insurance plans are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug, but these benefits will be limited and are not meant to be effective for catastrophic events. Payments are based upon the plan's "schedule of benefits" and are usually paid directly to the service provider. These plans cost much less than comprehensive health insurance. Annual benefit maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.[128]

text: Dental insurance[edit]

text: Dental insurance helps pay for the cost of necessary dental care. Few medical expense plans include coverage for dental expenses. About 97% of dental benefits in the United States is provided through separate policies from carriers—both stand-alone and medical affiliates—that specialize in this coverage. Typically, these dental plans offer comprehensive preventive benefits. However, major dental expenses, such as crowns and root canals, are just partially covered. Also, most carriers offer a lower rate if you select a plan that utilizes their Network providers. Discount dental programs are also available. These do not constitute insurance, but provide participants with access to discounted fees for dental work.

text: Vision care insurance[edit]

text: Vision care insurance provides coverage for routine eye care and is typically written to complement other medical benefits. Vision benefits are designed to encourage routine eye examinations and ensure that appropriate treatment is provided.[18]

text: Specified disease[edit]

text: Specified disease provides benefits for one or more specifically identified conditions. Benefits can be used to fill gaps in a primary medical plan, such as co-payments and deductibles, or to assist with additional expenses such as transportation and child care costs.[18]

text: Accidental death and dismemberment insurance[edit]

text: AD&D insurance is offered by group insurers and provides benefits in the event of accidental death. It also provides benefits for certain specified types of bodily injuries (e.g., loss of a limb or loss of sight) when they are the direct result of an accident.[18]

text:
Insurance companies have high administrative costs.[129] Private health insurers are a significant portion of the U.S. economy directly employing (in 2004) almost 470,000 people at an average salary of $61,409.[130]
Health insurance companies are not actually providing traditional insurance, which involves the pooling of risk, because the vast majority of purchasers actually do face the harms that they are "insuring" against. Instead, as Edward Beiser and Jacob Appel have separately argued, health insurers are better thought of as low-risk money managers who pocket the interest on what are really long-term healthcare savings accounts.[131][132]
According to a study by a pro-health reform group published February 11, the nation's largest five health insurance companies posted a 56 percent gain in 2009 profits over 2008. The insurers (Wellpoint, UnitedHealth, Cigna, Aetna and Humana) cover the majority of Americans with health insurance.[133]


document_title: List of Law & Order characters

question_text: who played the district attorney in law and order

root

text: List of Law & Order characters

text: Main characters[edit]

text:
Name
Portrayed by
Occupation
Seasons

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Max Greevey
George Dzundza
Senior Detective (Sergeant)
Main

Mike Logan
Chris Noth
Junior Detective
Main

Donald Cragen
Dann Florek
Captain
Main

Guest

Guest

Guest

Ben Stone
Michael Moriarty
Executive Assistant District Attorney
Main

Paul Robinette
Richard Brooks
Assistant District Attorney
Main

Guest

Guest

Adam Schiff
Steven Hill
District Attorney
Main

Phil Cerreta
Paul Sorvino
Senior Detective (Sergeant)

Main

Elizabeth Olivet
Carolyn McCormick
Psychologist

Guest
Also Starring
Guest

Guest

Guest

Lennie Briscoe
Jerry Orbach
Senior Detective

Main

Anita Van Buren
S. Epatha Merkerson
Lieutenant

Main

Claire Kincaid
Jill Hennessy
Assistant District Attorney

Main

Jack McCoy
Sam Waterston
Executive Assistant District Attorney,
District Attorney

Main

Rey Curtis
Benjamin Bratt
Junior Detective

Main

Guest

Jamie Ross
Carey Lowell
Assistant District Attorney

Main

Guest

Abbie Carmichael
Angie Harmon
Assistant District Attorney

Main

Ed Green
Jesse L. Martin
Junior Detective,
Senior Detective

Main

Nora Lewin
Dianne Wiest
Interim District Attorney

Main

Serena Southerlyn
Elisabeth Röhm
Assistant District Attorney

Main

Arthur Branch
Fred Thompson
District Attorney

Main

Joe Fontana
Dennis Farina
Senior Detective

Main

Nick Falco
Michael Imperioli
Junior Detective

Main
Guest

Alexandra Borgia
Annie Parisse
Assistant District Attorney

Main

Nina Cassady
Milena Govich
Junior Detective

Main

Connie Rubirosa
Alana de la Garza
Assistant District Attorney

Main

Cyrus Lupo
Jeremy Sisto
Junior Detective,
Senior Detective

Main

Michael Cutter
Linus Roache
Executive Assistant District Attorney

Main

Kevin Bernard
Anthony Anderson
Junior Detective

Main

tag: table

tag: p

text: Police officers[edit]

text: Sergeants[edit]

text:
Name
Portrayed by
Year
Episodes
Junior Partners
Notes

Maxwell "Max" Greeevy
George Dzundza
1990–1991
23
Mike Logan
* Murdered in 1991.

Philip "Phil" Cerreta
Paul Sorvino
1991–1992
31
Mike Logan
* Transferred to a desk job at the 110th Precinct after being shot on the job.

text: Senior Detectives[edit]

text:
Name
Portrayed by
Year
Episodes
Junior Partners
Notes

Leonard "Lennie" Wilbur Briscoe
Jerry Orbach
1992–2004
273
Mike Logan (1992–1995)
Rey Curtis (1995–1999)
Ed Green (1999–2004)
* Retired (2004)
* Deceased (2005) (Due to Jerry Orbach's death).

Joseph "Joe" Fontana
Dennis Farina
2004–2006
46
Ed Green (2004–2006)
Nick Falco (2005)
* Retired (2006).

Edward "Ed" Green
Jesse L. Martin
2006–2008
198
Nina Cassady (2006–2007)
Cyrus Lupo (2008)
* Promoted to Senior Detective (2006).
* Retired following his absolution during
an Internal Affairs investigation (2008).

Cyrus Lupo
Jeremy Sisto
2008–2010
63
Kevin Bernard (2008–2010)
* Transferred from Intelligence Division (2008).
* Promoted to Senior Detective (2008).

text: Junior Detectives[edit]

text:
Name
Portrayed by
Year
Episodes
Senior Partners
Notes

Michael "Mike" Logan
Chris Noth
1990–1995
111
Max Greevey (1990–1991)
Phil Cerreta (1991–1992)
Lennie Briscoe (1992–1995)
* Assigned to Staten Island from 1995–2005
after punching a homophobic politician.
* Solved a major murder & police corruption case
in Exiled: A Law & Order Movie.
* Joined One Police Plaza's Major Case Squad 2005-2008.
* Retired after solving a cold case (CI:Last Rites).

Reynaldo "Rey" Curtis
Benjamin Bratt
1995–1999
94
Lennie Briscoe
* Took early retirement so he could care for his ill wife (1999).
* Returned in 2009 to bury his deceased wife in New York.

Edward "Ed" Green
Jesse L. Martin
1999–2006
198
Lennie Briscoe (1999–2004)
Joe Fontana (2004–2006)
* Promoted to senior detective (2006).
* Retired following his absolution during
an Internal Affairs investigation (2008).

Nicolas "Nick" Falco
Michael Imperioli
2005
5
Joe Fontana
* Temporary replacement from Brooklyn for Ed Green,
while Green was recovering from a gunshot wound.
* Appears again in 2006 as a murder suspect,
but was later cleared.

Nina Cassady
Milena Govich
2006–2007
22
Ed Green
* Nicknamed 'Detective Beauty Queen' after her involvement
in a shooting that led to her promotion.
* Dismissed in 2007, although no reason is given on the show
(However, it was most likely due to her lack of detective experience).

Cyrus Lupo
Jeremy Sisto
2008
63
Ed Green (2008)
* Transferred from Intelligence Division (2008).
* Promoted to Senior Detective (2008).

Kevin Bernard
Anthony Anderson
2008–2010
49
Cyrus Lupo
* Transferred from Internal Affairs (2008).

text: Supervising Officers[edit]

text:
Name
Portrayed by
Rank
Year
Episodes
Notes

Donald "Don" Cragen
Dann Florek
Captain
1990–1993
66
* Transferred to the Anti-Corruption Task Force and later to the Manhattan
Special Victims Unit.
* Left the NYPD in 2014, taking a six-month vacation that brought him up to the
mandatory retirement age.
* Returned briefly in 2015 to help the SVU re-examine a decades-old rape case.

Anita Van Buren
S. Epatha Merkerson
Lieutenant
1993–2010
390

text: Prosecutors[edit]

text: Executive Assistant District Attorneys[edit]

text:
Name
Portrayed by
Year
Partners
Episodes
Notes

Ben Stone
Michael Moriarty
1990–1994
Paul Robinette
& Claire Kincaid
88
* Resigns due to his feelings of guilt over the death of a witness whose safety he tried to guarantee.
* In 1996, Adam Schiff informs Jack McCoy that Stone is travelling in Europe

Jack McCoy
Sam Waterston
1994–2007
Claire Kincaid,
Jamie Ross,
Abbie Carmichael,
Serena Southerlyn,
Alexandra Borgia &
Connie Rubirosa
368
* Promoted to interim D.A. (2008)
* Begins his campaign to be elected as New York County District Attorney in 2009, with support from Adam Schiff.
* Later episodes of Law & Order: Special Victims Unit references a "new District Attorney," implying McCoy is no longer in office.

Michael Cutter
Linus Roache
2008–2010
Connie Rubirosa
63
* Promoted to Bureau Chief of the Sex Crimes Unit of the DA's office. (2011)

text: Assistant District Attorneys[edit]

text:
Name
Portrayed by
Year
Partners
Episodes
Notes

Paul Robinette
Richard Brooks
1990–1993
Ben Stone
66
* Resigns to pursue private practice in 1993.
*Appears in three subsequent episodes as a defense attorney between 1996 and 2005.

Claire Kincaid
Jill Hennessy
1993–1996
Ben Stone &
Jack McCoy
68
* Dies in a car crash in 1996.

Jamie Ross
Carey Lowell
1996–1998
Jack McCoy
47
* Resigns to pursue private practice and to spend more time with her daughter (1998).
* Reappears as a defense attorney in 1999 and 2001.
* Reappears as a judge in Law & Order: Trial By Jury (2005).

Abbie Carmichael
Angie Harmon
1998–2001
Jack McCoy
72
* Resigns to accept a job at the United States Attorney General's Office (2001).

Serena Southerlyn
Elisabeth Röhm
2001–2005
Jack McCoy
85
* Fired by Arthur Branch for being inappropriately sympathetic towards a defendant she was prosecuting (2005).

Alexandra Borgia
Annie Parisse
2005–2006
Jack McCoy
34
* Dies after being kidnapped and beaten during a murder trial (2006).

Connie Rubirosa
Alana de la Garza
2006–2010
Jack McCoy & Michael Cutter
85
* Moves to Los Angeles and joins the DA's office there as a DDA (2011).
* Later appears in Law & Order: SVU as a federal prosecutor leading an investigation into an underage sex trafficking operation (2014).

text: In the 1997 season 7 episode "We Like Mike", Caleb Duff is listed as Assistant District Attorney beneath Adam Schiff as District Attorney and John J McCoy as Executive Assistant District Attorney at the New York County District Attorney's Office, though he never appears on screen.

text: Manhattan District Attorneys[edit]

text:
Name
Portrayed by
Terms
Episodes
Notes

Alfred Wentworth
Roy Thinnes
1990
1
* Only appears in "Everybody's Favorite Bagman"

Adam Schiff
Steven Hill
1990–2000
228
* Leaves office to work overseas for The Holocaust Project with Simon Wiesenthal and to investigate Swiss Banks during WWII,
went with former President Jimmy Carter as part of a delegation to Zimbabwe in 2008.

Nora Lewin
Dianne Wiest
2000–2002
48
* Prior to her appointment as interim DA by the Governor of New York, she was a law professor
Chooses not to run for election following her interim term.

Arthur Branch
Fred Thompson
2002–2007
116
Branch's departure, the reason for which was never specified on the series, occurred after Thompson announced his campaign for the Republican Party's 2008 nomination for President.

Jack McCoy
Sam Waterston
2007–2010
368
* Appointed interim DA after Branch's departure in 2007.
* Begins his election campaign to become New York County District Attorney in 2009.
* Episode count includes those as Executive Assistant DA (62 as DA).

text: Other main characters[edit]

text:
Name
Portrayed by
Years
Episodes

Psychologist Dr. Elizabeth Olivet
Carolyn McCormick
1991–1997; 1999; 2002-2009
87

Medical Examiner Dr. Elizabeth Rodgers
Leslie Hendrix
1992–2010
139

Psychiatrist Dr. Emil Skoda
J.K. Simmons
1997-2004; 2010
44

text: Recurring characters[edit]

text: NYPD Personnel[edit]

text: NYPD Officials[edit]

text:
Name
Portrayed by
Year
Episodes

Chief of Detectives Laird
James Biberi
2008-2010
3

Borough Detective Commander James Dietz
Michael Cullen
1998-1999
3

Borough Detective Commander Joseph Strudevant
Dan Lauria
2000-2001
2

text: 27th Precinct Support Detectives[edit]

text:
Name
Portrayed by
Year
Episodes

Detective Tony Profaci
John Fiore
1990–1998
53

Detective Morris LeMotte
Larry Clarke
1998–2000
20

Detective Reina Perez
Nancy Ticotin
2001
6

Detective Ana Cordova
Andrea Navedo
2001–2004
24

Sergeant Martinez
Joe Gonzalez
2002–2004
7

Detective Mariluz Rivera
Selenis Leyva
2004–2006
18

Detective Joe Cormack
Joe Forbrich
2008–2009
17

text: Crime Scene Unit Investigators / Crime Laboratory Technicians[edit]

text:
Name
Portrayed by
Year
Episodes

CSU Technician Julian Beck
John Cariani
2002–2006
26

CSU Technician Jessica Reed
Liz Larsen
1998–2006
12

CSU Technician Lisa Santoro
Abigail Lopez
2004–2005
3

Forensic Technician Medill
Donald Corren
1992–1999
17

Forensic Technician Arlene Shrier
Christine Farrell
1992–1999
16

Computer Forensic Technician Myra Camp
Megan Byrne
2003–2004
6

text: Medical Examiners[edit]

text:
Name
Portrayed by
Year
Episodes

Borak
Josh Pais
1990–2002
15

Brody
Richard Hirschfeld
2002–2006
12

text: Defense Attorneys[edit]

text:
Name
Portrayed by
Year
# of Eps

Danielle Melnick
Tovah Feldshuh
1991–2007
13

Professor Norman Rothenberg
Jeffrey DeMunn
1993–2008
8

Shambala Green
Lorraine Toussaint
1990–1994, 2003
7

Lawrence "Larry" Weaver
Bob Dishy
1994–2002
7

Nick Margolis
Ben Shenkman
1999-2009
6

Bill Patton
Bill Moor
1991–2000
6

Helen Brolin
Maria Tucci
1993–2003
6

Peter Behrens
Tom O'Rourke
1996–2001
6

Arthur Gold
George Grizzard
1992–2000
6

Al Archer
Dennis Boutsikaris
1996–2004
5

Charles Garnett
James Rebhorn
1995–2001
5

James Granick
Ned Eisenberg
1997–2008
5

Douglas Greer
Richard Venture
1991–2000
5

Anne Paulsen
Glynnis O'Connor
1998–2004
5

Sally Bell
Edie Falco
1993–1998
4

Aaron Solomon
John Benjamin Hickey
2002–2006
4

Daniel Metzler
John Cunningham
1997–2008
4

Mr. Axtell
Jack Gilpin
1997–2001
4

Barry Kaufer
Lee Shepherd
1998–2002
4

Charlotte Swan
Helen Carey
1999–2005
4

Leon Chiles
Joe Morton
2000–2005
4

Paul Robinette
Richard Brooks
1996, 2005, 2006
3

Gordon Schell
Philip Bosco
1990–1994
3

Deirdre Powell
Joanna Merlin
1994–1998
3

Max Hellman
Ron Orbach
1994, 2002
3

James Linde
Joe Grifasi
1996–2001
3

Stephen Olson
Spencer Garrett
2000–2004
3

Erica Gardner
Kate Burton
2001–2004
3

Jessica Sheets
Susan Floyd
2002–2006
3

Randolph J. 'Randy' Dworkin, Esq.
Peter Jacobson
2003–2006
3

Vanessa Galiano
Roma Maffia
2003–2006
3

Rodney Fallon
Giancarlo Esposito
2004–2005
3

Sanford Remz
Dylan Baker
2004–2006
3

Gary Lowenthal
Eric Bogosian
1992–1993
2

Lanie Stieglitz
Elaine Stritch
1992, 1997
2

Ruth Miller
Patti LuPone
1996, 1997
2

Stan Shatenstein
Sig Libowitz
1997, 2005
2

Bernie Adler
Ron Silver
2004–2007
2

Marcus Woll
Jonathan Cake
2009
2

text: Judges[edit]

text: Arraignment Judges[edit]

text:
Name
Portrayed by
Year
Episodes

Arraignment Judge Morris Torledsky
David Lipman
1992–2005
26

Arraignment Judge Colin Fraser
Larry Sherman
1994–2004
12

Arraignment Judge Harriet Doremus
Barbara Spiegel
1991–2003
12

Arraignment Judge Janice Goldberg
Fran Lebowitz
2001–2007
12

Arraignment Judge Ian Feist
Merwin Goldsmith
1991–2005
11

Arraignment Judge William Koehler
Mark Kenneth Smaltz
1998–2007
11

Arraignment Judge Antonia Mellon
Mary Lou Mellaces
1999–2006
9

Arraignment Judge Joseph Flint
Doug Stender
1999–2005
9

Arraignment Judge Anna Shiro
Karen Shallo
2000–2005
8

Arraignment Judge David Venturelli
Vince Pacimeo
1998–2000
4

Arraignment Judge Lisa Cutler
Kathleen Chalfant
2001-2009
3

Arraignment Judge Harper
Brian Smiar
1990
2

text: Trial Judges[edit]

text:
Name
Portrayed by
Year
Episodes

Trial Judge Alan Berman
David Rosenbaum
1992–2004
14

Trial Judge Walter Bradley
Peter McRobbie
2001–2009
13

Trial Judge Lisa Pongracic
Charlotte Colavin
1992–2006
13

Trial Judge Elizabeth Mizener
Lynn Cohen
1993–2006
12

Trial Judge Walter Schreiber
John Ramsey
1991–2001
11

Trial Judge Margaret Barry
Doris Belack
1990–2001
10

Trial Judge Herman Mooney
Ben Hammer
1991–2002
9

Trial Judge Harrison Taylor
Michael Mulheren
1999–2006
9

Trial Judge Andrew Barsky
Fred J. Scollay
1992–1999
8

Trial Judge Donald Karan
Jordan Charney
2000–2006
8

Trial Judge Grace Larkin
Rochelle Oliver
1990–2003
8

Trial Judge Rebecca Stein
Joan Copeland
1991–2001
8

Trial Judge Rebecca Steinman
Susan Blommaert
1991–2004
8

Trial Judge Deborah Burke
Donna Hanover
1997–2004
7

Trial Judge Michael Callahan
Bernie McInerney
1991–1999
7

Trial Judge Henry Fillmore
William Severs
1991-2004
7

Trial Judge Rosalyn Lenz
Tanya Berezin
1991–2001
7

Trial Judge Barbara Lusky
Iris Little Thomas
1999–2009
7

Trial Judge Rochelle Desmond
Patricia R. Floyd
2006–2009
6

Trial Judge Eric Caffey
John Newton
1991–1998
6

Trial Judge Nathan Murphy
Mark Zimmerman
1997–2008
6

Trial Judge Robert Quinn
Roger Serbagi
1992–1999
6

Trial Judge Joseph Rivera
Shawn Elliott
1994–2002
6

Trial Judge Carla Solomon
Lauren Klein
1999–2005
6

Trial Judge William Wright
Ron McLarty
1991–2008
6

Trial Judge Hugo Bright
Robert J. Hogan
2003–2006
4

Trial Judge Delano Burns
Mike Hodge
1991–2006
4

Trial Judge Manuel Leon
Sam Gray
1990–1994
4

Trial Judge Michael Schneider
David Little
2004–2006
4

Trial Judge Norman Barclay
Wayne Duvall
2004–2010
3

Trial Judge Gary Feldman
Cliff Gorman
1998
3

Trial Judge Derek Hafner
David Wolos-Fonteno
2001–2009
3

Trial Judge Elayne Link
Maggie Burke
1993–2003
3

Trial Judge Ida Zeller
Polly Adams
2009
3

Trial Judge Linda Taft
Jenna Stern
2009-2010
2

text: Appellate Judges[edit]

text:
Name
Portrayed by
Year
Episodes

Appellate Judge Pamela Jensen
Norma Fire
1993–1997, 2000–2003
7

Appellate Judge Shawn McNamara
George Bartenieff
1993, 1995 & 1999
4

Appellate Judge Bloom
Ira Wheeler
1991, 1993
2

Appellate Judge Lewis Getman
Leslie Barrett
1991, 1993
2

Appellate Judge Wayne Humphrey
Chester A. Sims II
1993, 1995
2

Appellate Judge Barry Marton
Graham Brown
1991, 1993
2