More Mandates, More Costs

Les Masterson, for HCPro, Inc., March 12, 2008

The three candidates who remain in the race for the White House have presented healthcare plans that include mandates, quality measures, and tax credits, but there is another option that more than 10 states have implemented, which could help reduce costs while removing barriers to care for the 47 million uninsured Americans.

The idea is mandate-lite legislation, which allows health insurers to offer plans that are not as mandate-heavy. It is quite a departure from the mandated health insurance movement.

Mandated health insurance is a relatively new phenomenon. Over the past 40 years, well-meaning leaders have implemented mandates that they believe will improve care, but these mandates have resulted in increased healthcare costs.

It's interesting that the trend toward mandates mirrors government's added influence over individuals' lives. Combine a growing number of Americans' support of greater governmental influence with the fact that many see themselves as non-stakeholders in their own healthcare, and you have a big brother system that mandates services and frowns upon choice.

According to the Council for Affordable Health Insurance, a research and advocacy association of insurance carriers, in its "Health Insurance Mandates in the States 2008," there are 1,961 mandated healthcare benefits and providers throughout the country. Those mandates are increasing healthcare costs (in some states, more than 50%), according to the study.

Some of the state mandates are:

  • Hair and limb prostheses, bone mass measurement, and care for TMJ disorders
  • Providers like dentists, optometrists, and marriage therapists
  • Covered persons such as non-custodial children, dependent students (some as old as 30), and adopted children

Then there are the states that mandate services like athletic trainers (Arkansas), and cover persons like legal non-residents living in the U.S. (Maine). The vast majority of mandates barely increase costs on their own, but when hundreds of mandates are piled on top of one another, costs rise resulting in lower-middle-class Americans being priced out.

There is good news though. There has been state legislation to loosen those healthcare mandates and require a mandate's economic impact be considered when a bill is presented. Mandate-lite gives smaller businesses a chance to offer health insurance that isn't weighed down by the requirements that many health plans have, allowing companies to offer lower-cost options to such under-covered groups as recent college graduates. Health plans with fewer mandates allow the 20s-set to purchase basic health insurance without being forced to pay fees for coverage they will probably not use, such as chronic disease, grandchildren, or cleft palate coverage.

Some states have found mandate-lite legislation as a way to cut healthcare costs, but the idea isn't part of the president hopefuls' healthcare plans. Instead, there is talk of more mandates, tax credits, and retail clinics.

Les Masterson is senior editor of managed care with HCPro, Inc. He may be reached at
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