Health Insurance Fundamentals: How the U.S. System Really Works

August 12, 2026

1:00 pm-

2:30 pm

Virtual Event

Health insurance touches nearly every American, yet it remains one of the most misunderstood areas of health policy. The U.S. health insurance system is not a single, unified structure; it is a collection of distinct markets, each operating under its own rules, regulators, and incentives. Alliance audience research shows demand for accessible, foundational content that builds practical understanding of how policy actually works.

Experts will ground participants in what health insurance is, how it differs from other forms of insurance, and how it functions across the markets that make up the U.S. system. The session is designed as a foundational primer, accessible to those newer to health insurance policy and useful for those seeking a refresher on first principles. It will also include an interactive Q&A to address common questions and clarify persistent misconceptions.

By the end of the webinar, participants will be able to:

Explain the historical context and foundational purpose of health insurance and how health insurance differs from other forms of insurance Americans encounter.
Identify the core concepts and terminology used in health insurance policy discussions.
Distinguish between the major health insurance markets – including commercial self-insured, commercial fully insured (both individual and group), Medicare, and Medicaid – and understand how shared core concepts drive unique products and dynamics within each.

Speakers:

Cynthia Cox, MPH, Senior Vice President and Director of the Program on the ACA and Director of the Peterson-KFF Health System Tracker, KFF (Moderator)
Brian Webb, MPA, Director of Health Policy, NAIC
Frederick (Fritz) Busch, FSA, MAAA, Principal and Consulting Actuary, Milliman
Mila Kofman, J.D., Executive Director, DC Health Benefit Exchange Authority
Paul Fronstin, Ph.D., Director, Health Benefits Research, Employee Benefit Research Institute

Speakers

Cynthia Cox, MPH

Senior Vice President and Director of the Program on the ACA and Director of the Peterson-KFF Health System Tracker, KFF

Cynthia Cox is senior vice president and director of the Program on the ACA, where she conducts economic and policy research on the Affordable Care Act and its effects on private insurers and enrollees. Her work focuses on enrollment, pricing and competition in the ACA’s exchange markets. Cox also directs the Peterson-KFF Health System Tracker, a partnership of the Peterson Center on Healthcare and KFF aimed at monitoring the performance of the U.S. health system over time and in relation to other large, high-income countries. Her work on this project focuses on trends in health care costs, access and affordability, as well as measures of health care quality and outcomes. Prior to joining KFF, she held research and advocacy positions at Columbia University Medical Center and the American Cancer Society. She also served on the board of directors of the Berkeley Free Clinic in California. Cox holds a bachelor’s degree from the University of California, Berkeley, and a Master of Public Health degree from Columbia University.

Brian Webb, MPA

Director of Health Policy, NAIC

Brian Webb is the Director of Health and Life Policy for the National Association Insurance Commissioners (NAIC). The NAIC represents the insurance regulators in all 50 states, the District of Columbia, and 5 U.S. territories. Before joining the NAIC, Brian worked on Medicare and Medicaid policy for the BlueCross BlueShield Association and, prior to that, was the Assistant Vice President for Legislation for the then-Federation of American Health Systems (FAHS). Brian began working in Washington, D.C. on health care policy in 1988 as a legislative aide for Congressman Bill Thomas. After six years with Congressman Thomas, Brian worked five years in California Governor Pete Wilson’s Washington, D.C., office as health and welfare aide and Deputy Director.

Frederick (Fritz) Busch, FSA, MAAA

Principal and Consulting Actuary, Milliman

Fritz Busch is a principal and consulting actuary with the Milwaukee office of Milliman. He joined the firm in 2015. Fritz's experience includes over 30 years as an actuary and business leader in the insurance industry. Prior to Milliman, he was with multiple Blue plans, as well as consulting roles with McKinsey & Co. His commercial carrier experience includes a wide array of actuarial plan management functions, including reserving and annual statement work, trend analysis, large group pricing, ACA individual and small group pricing, forecasting, benefit plan design, and health product development. In addition to carriers and payers, he has advised state regulators on health care reform initiatives, including 1332 waiver certifications, state public option programs, Basic Health Plan (BHP) analysis, and coverage for the uninsured. Engagement deliverables in these complex initiatives included strategic and creative thinking on model frameworks, ensuring that modeled program parameters are consistent with laws and regulations, and actuarial modeling of enrollment, costs, and revenue sources for these health care reform proposals. He is a leader in the Direct Primary Care space, advising employers, health systems, and DPC organizations on costs, ROI, product design, and utilization benchmarks. He has worked with third-party vendors in designing and evaluating appropriate methodologies to estimate savings from various delivery system model improvements. He has successfully worked with a wide variety of clients, including regulators, insurance company executives, and other non-actuarial clients. He is a frequent speaker at industry and public policy meetings.

Mila Kofman, J.D.

Executive Director, DC Health Benefit Exchange Authority

Mila Kofman, J.D., is executive director of the DC Health Benefit Exchange Authority. She is a nationally recognized expert on the private health insurance market — regulation, consumer protections, new products, state and federal reforms, and market failures like fraud and insolvency. Prior to joining DCHBX, she was a research professor at Georgetown University's Health Policy Institute, and before that was superintendent of insurance for the state of Maine. Ms. Kofman received her law degree from Georgetown University Law Center.

Paul Fronstin, Ph.D.

Director, Health Benefits Research, Employee Benefit Research Institute

Paul Fronstin is Director of Health Benefits Research at the Employee Benefit Research Institute (EBRI), a private, nonprofit, nonpartisan organization committed to original public policy research and education on economic security and employee benefits. He also oversees the Center for Research on Health Benefits Innovation. He has been with EBRI since 1993. Dr. Fronstin's research interests include trends in employment-based health benefits, employee benefits and public policy, health plan design, HSAs, workplace wellness programs, retiree health benefits, and public opinion about health benefits and health care. He currently serves on the board of trustees for Emeriti Retirement Health Solutions and the Mid-Atlantic Business Group on Health. He also serves on the National Advisory Board for the University of Michigan Center for Value-Based Insurance Design. Dr. Fronstin earned his Bachelor of Science degree from SUNY Binghamton and his Ph.D. in economics from the University of Miami.

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