The issue of how to regulate self-funded insurance plans is affecting medical practices and patients across the country, and one that will likely become more prominent in the coming years as more employers choose this approach, says St. Louis Post-Dispatch columnist Mary Jo Feldstein. Between 1999 and 2007, the percentage of workers covered under a self-funded plan rose to 55% from 44%, she says. She adds that for years, courts have debated how the Employee Retirement Income Security Act intersects with state laws regulating other health plans. The debate will have a big impact on the regulations of self-funded plans in the future, Feldstein says.