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Sunday, June 5, 2011

Mandates and Costs

Jennifer Robison writes at The Las Vegas Review-Journal:

J.P. Wieske, executive director of the Council for Affordable Health Insurance, said research shows mandates are behind 10 percent to 25 percent of those premiums, depending on the state and the mix of requirements. Nevada health insurers privately say the state's average-size mandates account for 10 percent to 20 percent of policy premiums for small businesses and as much as 15 percent for individuals.

Most individual mandates contribute less than 1 percent to premiums, but they add up, Wieske said.

By the council's estimate, Nevada's 44 mandates are behind at least 19 percent of the cost of Silver State comprehensive health insurance premiums. Topping the expense list at 5 percent to 10 percent is mandatory mental health care coverage, which must be offered on par with physical therapy for an injury.


But health-care affordability is already a big problem for society's neediest patients, and that's why coverage requirements are so important, mandate supporters say.

"The cost of health care, especially coverage of certain conditions such as autism, can be extraordinary, so health insurance companies decide to deny coverage," said Mark Olson, a local publicist who advocates for continued coverage for autism. "But people can't get treatment because the providers won't accept them as patients without insurance, and the cost of treatment is often more than people have available in cash."

A 2006 study from the Harvard School of Public Health found that autism care for one patient can cost $72,000 a year. The Centers for Disease Control and Prevention estimates that just less than 1 percent of the country grapples with an autism-spectrum disorder.


Politics also affects insurance markets by dictating who will pay for specific treatments, and how those therapies will be covered.

Consider autism. Some of the blame for mandates comes from state budget crunches, which have encouraged legislators to slowly shift therapies away from public schools, where they've typically been funded, and onto private insurers, Wieske said.

"The question isn't whether those children need or deserve society's help. They do," Wieske said. "There's no question about that. But autism is an example of the states abdicating their responsibilities because of budget issues, and putting those responsibilities on insurance companies. It's a balancing act that we have to figure out. Is it fair for an individual to be priced out of insurance markets because of autism mandates?"

Wieske and Murphy both suggested reducing or eliminating some mandates by handling some coverage as riders to basic insurance plans, or letting consumers decide whether they want to pay to cover some specific illnesses. In some situations, though, riders are as impractical as mandates: Autism riders, for example, can cost as much as the $36,000 annual benefit itself.