In the recent public discussion of the autism bill and health insurance mandates, a recurring question has emerged: can a particular mandate be worth the costs — or, at least, be more worthy than most? If we follow that logic, though, where do we draw the line?
As of 2009, Missouri had 41 mandates for health insurance. Considered singly, no individual mandate had a large impact on premium costs, but they each had a marginal impact. Every incremental increase in the cost of health insurance premiums leads to the possibility that some unknown number of individuals and businesses are no longer able to afford their previous coverage.
Here is a look at mandates in Missouri (data compiled from the Council for Affordable Health Insurance):
| Mandated benefits: | States with mandate | Influence on premium |
| Alcoholism/Substance Abuse | 45 | 1% to 3% |
| Ambulatory Surgery | 11 | 1% to 3% |
| Blood Lead Poisoning Screening | 9 | <1% |
| Bone Marrow Transplant | 11 | <1% |
| Bone Mass Measurement | 16 | <1% |
| Breast Reconstruction | 50 | <1% |
| Cervical Cancer/HPV Screening | 31 | <1% |
| Clinical Trial | 23 | <1% |
| Colorectal Cancer Screening | 33 | <1% |
| Contraceptive | 29 | 1% to 3% |
| Dental Anesthesia | 30 | <1% |
| Diabetic Supplies | 47 | <1% |
| Drug Abuse Treatment | 35 | <1% |
| Emergency Service | 47 | <1% |
| Hair Prothesis | 11 | <1% |
| Mammography | 50 | <1% |
| Mastectomy | 23 | <1% |
| Mastectomy Minimum Stay | 25 | <1% |
| Maternity | 23 | 1% to 3% |
| Maternity Minimum Stay | 50 | <1% |
| Mental Health General | 39 | 1% to 3% |
| Mental Health Parity | 47 | 5% to 10% |
| Newborn Hearing Screening | 18 | <1% |
| Off Label Drug Use | 36 | <1% |
| PKU/Metabolic Disorders | 34 | <1% |
| Port Wine Stain Elimination | 2 | <1% |
| Prostate Cancer Screening | 36 | <1% |
| Second Surgical Opinion | 11 | <1% |
| Well Child Care | 34 | 1% to 3% |
| Mandated providers: | States with mandate | Influence on premium |
| Chiropractor | 46 | 1% to 3% |
| Dentist | 34 | 3% to 5% |
| Nurse Practitioner | 31 | <1% |
| Optometrist | 44 | <1% |
| Podiatrist | 33 | <1% |
| Psychologist | 44 | 1% to 3% |
| Speech/Hearing Therapist | 21 | <1% |
| Mandated coverage: | States with mandate | Influence on premium |
| Continuation Dependent | 43 | <1% |
| Continuation Employee | 45 | <1% |
| Conversion to Non Group | 42 | 1% to 3% |
| Dependent Student/Adult | 34 | <1% |
| Disabled Dependent | 42 | 1% to 3% |
| Newborn | 51 | 1% to 3% |
As we’ve discussed before here at Show-Me Daily, injecting competition into the insurance market is really the only long-term solution that will both increase coverage and lower health care costs. Sarah Brodsky has also suggested tuition tax credits for autistic children as another alternative to insurance mandates.
Regardless of how one looks at the issue, mandates do not serve as a solution. The list provided by CAHI contained 130 different mandates throughout all of the states and Washington, D.C. Health insurance would be prohibitively expensive for far more people if every policy had to cover all 130 items, and there will still be many other conditions or diseases that are not covered. Does every 20-year-old want insurance against Alzheimer’s disease? Does every 60-year-old want insurance against autism?
With more choice in the insurance market, people can better choose for which illnesses or conditions they wish to be insured. Eliminating the way in which insurance is tied to employment and encouraging health savings accounts would allow individuals to purchase portable, cost-effective policies, saving for foreseeable health-related expenses while hedging against unknown future risk.
