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PREFACEThe cost of health insurance has been the primary concern of small business owners for several decades. State small group health insurance reforms, implemented in the 1990s, aimed to control the variability of health insurance premiums and to improve access to health insurance.These small group reforms only affected firms within a specific size range, and the definition of the upper size threshold for small firms varied by state and over time. The primary intended result of these reforms was to increase the propensity of small firms to offer health insurance. However, because of the way these regulations were crafted, an unintended consequence of the reforms may have been to affect the size of small firms around the legislative threshold. Several studies have examined the effect of health insurance mandates on the propensity of small firms to offer health insurance. These studies generally find little to no effect of the mandates. In this paper, we examine the effect of small group reforms on small business size and find some evidence that firms that were near the threshold adjusted their size.By providing a more complete picture of the intended and unintended effects of policy reforms in which the implementation is based upon a specific firm size threshold, the research should help inform the development effective policies to assist small businesses. The research should be of interest to policymakers at both the state and federal level as well as businesses and others interested in the role of regulation in expanding access to health insurance and the effect of size thresholds in policy implementation. The work was completed under the auspices of the Kauffman-RAND Center for the Study of Small Business and Regulation and was funded by the Kauffman Foundation.The RAND Institute for Justice is an independent research program within the RAND Corporation. The mission of the RAND Institute for Civil Justice (ICJ), a division of the RAND Corporation, is to improve private and public decisionmaking on civil legal issues by supplying policymakers and the public with the results of objective, empirically based, analytic research.The ICJ facilitates change in the civil justice system by analyzing trends and outcomes, identifying and evaluating policy options, and bringing together representatives of different interests to debate alternative solutions to policy problems. The Institute builds on a long tradition of RAND research characterized by an interdisciplinary, empirical approach to public policy issues and rigorous standards of quality, objectivity, and independence. ICJ research is supported by pooled grants from corporations, trade and professional associations, and individuals; by government grants and contracts; and by private foundations.The Institute disseminates its work widely to the legal, business, and research communities, and to the general public. In accordance with RAND policy, all Institute research products are subject -ivto peer review before publication. ICJ publications do not necess...