Accumulating Mandates

The number of required provisions in health insurance has increased 40-fold since 1970 among states, which are beginning to become much more scrupulous about adding to the lists of mandated coverage. While Maine has only a small number of the 1,400 total required benefits, it has followed this national mandate trend and is thinking of adding three more. But while it debates these three, it should also look to other states for ways to ensure the breadth of the coverage doesn’t exceed the depth of the payers’ pockets.

Maine began adding insurance mandates later than other states, but caught up quickly and now requires coverage for mental health, substance abuse, mammography, chiropractic and diabetic services, Pap smears, prostate cancer, hospice care, dental anesthesia and many more. All of them can be justified medically and many of them can be justified because they encourage good preventative medicine, saving money overall.

Cumulatively, however, they add to the price of health insurance in Maine, limiting the number of people and employers who can afford coverage.

By adding to the cost of coverage, according to a 1999 study, they also lead to lower wages.

The three proposed mandates to be considered by the Legislature this year would require coverage for infertility treatment up to a lifetime maximum of $20,000 (LD 213), hearing aids for people 21 and younger (LD 1087) and that insurance mandates apply when issued by an out-of-state group health plan (LD 1353). There are good arguments for all three, and though the Insurance and Financial Services Committee voted “ought not to pass” on each of them, enough members of that committee supported the ideas so that the full Legislature will vote on them.

Before they do, the committee should spend more time looking at various ways other states have tired to hold down costs. The most popular method is to allow for a more basic product, free of most mandates, but the problem with that idea is immediately apparent. An alternative to mandates means the mandates then become options for some people and the mandated benefits fall to a smaller and smaller group, at some point defeating the idea of insurance.

Another way to hold down costs is to limit the amount of money that mandates require, so that if one essential area of coverage is lacking it could be added only if an equally costly mandate is dropped. This idea, too, has its drawbacks – confusion about what’s covered and what isn’t, for one thing – but it would be a more honest approach to limiting coverage than the current method of simply making it unaffordable for many people.

Whether the three proposed mandates pass, Maine has a huge challenge in finding many ways to reduce the cost of health insurance. The governor’s Dirigo Health plan provides opportunities for looking more deeply at this issue; the Legislature can help by making sure mandates are part of the discussion.