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en-wikipedia-org-1559		Health insurance in the United States - Wikipedia			.html	text/html	15517	1515	59	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.[55][56] 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. As of 2018, there were 5,965 health insurance companies in the United States,[57] although the top 10 account for about 53% of revenue and the top 100 account for 95% of revenue.[58]:70 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."[85] Under the ACA, small-employer and individual markets had "gained important consumer protections under the ACA and state health laws — including minimum benefit levels."[85] In a December 28, 2017 interview with the New York Times, Trump explained that, "We've created associations, millions of people are joining associations.	./cache/en-wikipedia-org-1559.html	./txt/en-wikipedia-org-1559.txt