Pennsylvania's commercial insurance market suffered in 2009 as employment losses and the rising cost of employer-based health insurance forced many to drop coverage. The state's major communities all saw declines, which ranged from minor enrollment losses in economically stable regions to more severe losses in manufacturing communities. Carriers fought over market share in individual communities and insurers have responded with new products in hopes of attracting new customers. In comparison, the Mid-Atlantic region remained stable in 2009, helped by a strong labor market that is tied to the federal government. As a result, carriers in this region kept their enrollment rolls intact, but worries over healthcare reform rules may prompt signficant changes to benefit design. Meanwhile, Medicaid enrollment continues to grow and health plans are looking for ways to limit their prescription drug costs with many showing success.