States steer away from broad health benefit mandates

Lawmakers view the cost of new coverage requirements as a drawback at a time when rising insurance rates are fueling complaints from employers.

By Joel B. Finkelstein, AMNews staff. Sept. 1, 2003.

Washington -- In the face of rising insurance premiums, many states are pulling back from health benefit mandates long opposed by managed care companies. But at least one bucked state and national trends by passing a universal health care law.

Over the past few years, states have passed hundreds of requirements aimed at ensuring that patients receive coverage for a variety of medical services. However, it is becoming less and less clear to state lawmakers what services are truly necessary.

According to policy experts, the impetus for bills establishing state benefit mandates often is complaints from a small group of people.

"You see individual legislators going to bat for an individual constituent," said Jeffrey L. Gabardi, senior vice president of state affairs for the Health Insurance Assn. of America.

In recent years, state legislators seem to be shying away from broad measures, instead favoring more narrowly defined mandates. This type of legislation is more likely to address a single medical condition or circumstance than a group of conditions, said Richard Cauchi, senior health care policy specialist with the National Conference of State Legislatures. Small measures are easier to push through than large bills that contain multiple mandates.

Still, insurers almost categorically oppose mandates of any size or kind.

While coverage requirements may help a few patients, they raise premiums for everyone, Gabardi said.