Nearly One Out Of Four Are Uninsured Due To State Mandates: Do You Agr

[Guest Lori Senter]

I don't know about the 1 in 4 not having coverage, but I do agree wholeheartedly that mandate increase premiums. How can they not? Usually the mandates are for high-dollar coverage (if they weren't expensive, they'd be in plans already). Also, many carriers have left states with certain mandates (Kentucky and Washington are two I know of personally), so the competition is reduced which drives up premiums even more. I know mandates are supposed to help, but KY's was such a fiasco they had a special session of the legislature to try to fix the fix. Without mandates, small companies could provide basic coverage at reasonable rates. Isn't some coverage better than none?

[Dave Baker]

The Health Insurance Association of America says, in a press release: .

• The full report (click), in Adobe Acrobat Reader (pdf) format.
  

Do you agree with the conclusions?

[KIP KRAUS]

I don't know how you can prove the 1 out of 4 theory, but I'm sure that the mandated benftis provision of each state increase the cost of health care insurance.

Insurance companies have to employee attornies to keep up with the different laws and how they apply to contracts. Some laws apply to cvontracts issued in a state, while some apply to contracts issued in the state and to employees covered by such in-state contracts even if they reside outside of the contract sited state.

The majority of the coverage laws are no doubt politically motivated by special interest groups. This is not to say that a majority of them don't make since. I think most of them do. However, I would think it would be to the advantage to all concerned to establish a national acceted standard of mandated coverage items and qualified health care professionals. But then, special interest groups would lose their foothold, and become unnecessary. Wouldn't that be a shame????

[Guest kchristy]

Poppycock. I'll agree with my two colleagues and fully recognize that state mandates increase the cost of coverage, but to hang all the uninsured on the cost of state mandates is totally absurd, and economists should know better. The decision to provide health coverage or not provide it isn't one that's made at the margins, where a 10% or 20% difference in the rates can determine whether or not employers offer coverage to their employees. I have never in my career seen or heard of an employer group dropping health coverage due to cost increases. Rather, those groups pursue some combination of reduced benefits, increased cost sharing, and increased managed care. In other words, those employer groups who didn't offer insurance when it was cheaper can't blame subsequent state mandates for making it unaffordable.

Another disingenous point that HIAA makes is that employers are fleeing to self-insured plans to avoid state mandates and get cheaper coverage. That certainly isn't the case in California, where it's pretty difficult to design a self-insured, fee-for-service plan that is competitive with exisiting HMO rates. In this state (admittedly only *one* state, but it is the most populous one in the Union), companies self-insure largely because of personal philosophy (such as to exclude abortions and/or fertility treatments) and a desire to reduce the degree of management of their employees' care.

There is a phenomenon in some low-paid industries, such as agriculture, of self-insured "minimal benefit" plans and plans that require employees to go to Mexico for medical care. These plans are dramatically cheaper than even the most affordable comprehensive HMO. However, is it fair to say that state mandates have "driven" them to these plans? Questionable, in my opinion, given that most employers, when offered such plans, choose not to buy them in favor of more comprehensive plans.