Especially when you examine state differences.
For the last few decdes, special interest groups have influenced state legislators in passing health insurance mandates.
Examples of mandates include coverage for the following.
- Treatment by a specific type of provider – e.g. chiropractor
- Specific treatment coverage – e.g., bone density test
- Dependent children with specified age limit
A report released by the Council for Affordable Health Insurance (CAHI) examines Health Insurance Mandates in the States 2012.
The number of health insurance mandates range from a low of 13 (Idaho) to a high of 69 (Rhode Island).
Each state can have different health insurance mandates. Insurers conducting business in the state are required to offer policies that include mandated coverage.
There are exceptions, but I won’t confuse the discussion with all those points. Generally, if a state mandate is more restrictive than federal legislation, the state mandate takes precedence.
However, provisions of health reform’s Patient Protection and Affordable Care Act (PPACA) have more than a few of its own mandates that states and insurers must follow, including ~
- Setting prices that are not based on claim history or health status – (modified community rating)
- Requirements to accept all who apply for coverage (guaranteed issue)
- Covering specified treatment (essential health benefits)
Report on States
The state I reside in (Idaho) has the least number of mandated benefits.
Depending on your perspective, a low number of mandates could mean different things.
- Is a lower number a sign of greater freedom?
- Or a lack of oversight of the insurance industry?
You be the judge.
The following charts illustrate some of the report’s findings.
The top five most popular state health insurance mandates are the following.
- Mammography screening – all 50 states mandate coverage
- Specified minimum hospital stay for maternity–all 50 states
- Coverage for breast reconstruction – following mastectomy – 49 states
- Mental health parity – specifies minimum coverage – 48 states
- Alcohol and substance abuse – specifies minimum coverage – 46 states
For the complete list of states and the number of mandates per state, download CAHI’s Executive Summary of the report.
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.