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State Health Benefit Mandates Come with New Costs

Margaret Dick Tocknell, for HealthLeaders Media, March 14, 2012

Insurance coverage requirements enacted by state legislatures across the country have always been a sore point among insurers in the individual and small group market. Now it's understood that under healthcare reform, they may carry new costs.

Insurers contend that mandates for treatments such as chiropractic care or autism services accomplish very little and actually make health insurance more expensive. Supporters assert that coverage mandates ensure access to important care.

There are in total, 2,262 state health mandates, according to the Council for Affordable Health Insurance. Idaho has the fewest—13, while Rhode Island and Virginia boast the most—70 each. The most popular include mammography screening, maternity minimum stay, breast reconstruction, mental health parity, and alcohol and substance abuse. The least popular mandates include breast implant removal, cardiovascular disease screening, circumcision, gastric electrical stimulation and organ transplant donor coverage.

Until now, legislators have usually been happy to appease constituents and risk the anger of insurers by approving mandates. But healthcare reform, especially essential health benefits and health insurance exchanges, adds a wrinkle that has some states rethinking that approach.

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