Oklahoman OP/Ed - Cost benefit Analysis needed

Cost-benefit analysis needed to examine issue
OUR VIEWS: Insurance mandates

Published: December 10, 2008

With two months to go before the start of the next legislative session, one of the loudest issues that will come before lawmakers is already making noise.

It’s the issue of forcing health insurance policies to cover autism treatments. Taking a larger view, it’s the issue of adding mandates to policies that make them more expensive and thus harder to afford by those already struggling to get coverage.

Battle lines on this issue were drawn in the 2008 session, in a tussle between the forces of emotion and the forces of reason. Back then we termed it a classic case of the irresistible force meeting the immovable object.

Parents of children with autism have a champion in state Sen. Jay Paul Gumm, D-Durant, who approaches the issue with almost evangelistic fervor. If he’s the good guy in this deal (and we don’t necessarily believe he is), then the men in black hats are Republican House members who believe the mandate train must be held up if not derailed.

Gumm says momentum is building for "Nick’s Law,” the mandate bill named for an Edmond boy who is autistic. Last year, Gumm couldn’t get a hearing for the bill in the Republican-controlled House, despite intense lobbying from the parent group and Gumm’s emotion-choked arguments.

A possible compromise — passing this mandate in exchange for a bill restricting future mandates — went nowhere. This reasonable approach may face just as much opposition as before. Gumm now has the burden of getting his bill through a Senate that will be controlled by Republicans for the first time in history.

The autism mandate would be the 37th the state forces on policyholders. Estimates on what the autism mandate would cost vary wildly — so much so that it’s difficult to believe either side’s numbers.

Nevertheless, mandates do add to the cost of insurance, and that reduces the number of people who can afford insurance in a state with a chronic uninsured problem.

Rep. Doug Cox, R-Grove, is a physician who initially supported Nick’s Law. He now opposes it on the basis of not wishing to worsen the uninsured problem.

We believe the first thing the Legislature should do vis-a-vis mandates is to pass a law requiring a cost-benefit analysis for all future mandates. That analysis should not be funded by the state. Absent a consensus on the cost of any particular mandate, it’s folly to keep adding dollars to policy premiums.

Lawmaker proposed mandate waiver

Lawmaker proposes mandate waiver

The Edmond Sun

December 06, 2008 01:02 am

— OKLAHOMA CITY (AP) — Legislation that would waive state health insurance mandates and permit insurers to create inexpensive “bare-bones” health insurance policies could significantly reduce the number of uninsured Oklahomans, a physician and state lawmaker said Friday.

Rep. Doug Cox, R-Grove, an emergency medicine physician at Integris Grove General Hospital, said he is drafting a measure that would waive a variety of mandated coverage for people in their 20s and 30s whose major health expense is accidental injuries.

Cox said he believes mandates drive up the cost of health insurance and make it unaffordable for many Oklahomans. Oklahoma has an estimated 600,000 uninsured residents, including 85,000 under the age of 18.

“Younger people are for the most part healthy,” Cox said. “It’s also the age range where they don’t really have the excess cash to use to buy things like insurance policies. So, let’s offer them a bare-bones policy.”

Cox’s proposal received the support of Insurance Commission Kim Holland, who said she endorses the plan to evaluate the state’s mandated coverage and develop affordable health insurance policies.

“I think it’s appropriate to take a second look and say, ‘Wow, do people really need all this,’” Holland said. “Affordability is the No. 1 reason that people say they don’t have insurance. We have to come up with more affordable health insurance options.”
Every state imposes health insurance mandates on insurers. Minnesota has the most with 64 and Idaho the least with just 15.

Oklahoma has 36 health insurance mandates for such procedures as immunizations for children, mammograms, breast reconstruction and prostate cancer screening. Some mandates, such as maternal health, are imposed by federal law and cannot be waived, Holland said.

Lawmakers plan to consider another mandate to cover the diagnosis and treatment of autism when the Legislature convenes in February.

Cox said waiving state mandates would allow health insurers to create high-deductible accident policies for young people. State-mandated coverage would still apply to people 40 and over, he said.

“As you get older, preventative tests become more important,” he said. “I think it will have some impact. Young people just don’t see the value of insurance. Young people don’t see the value until they need it — and then it’s too late.”

Holland said 70 percent of young adults aged 19-34 in Oklahoma do not have health insurance. “They’re young. They’re invincible. They’re looking at the immediate. They’re not thinking long-term,” she said. Holland said her agency is interested in developing insurance products to help people manage their health from a young age.
“There are ways that we can construct low-cost plans for them,” she said.

A health insurance mandate is a requirement that an insurer or health plan cover or offer coverage for health care providers, benefits and patient populations.

The Council for Affordable Health Insurance, a research and advocacy association of insurance carriers based in Alexandria, Va., says mandates make health insurance more comprehensive as well as more expensive by requiring insurers to pay for care consumers previously paid for out of their own pockets.

CAHI estimates that mandated benefits increase the cost of basic health coverage from a little less than 20 percent to more than 50 percent, depending on the state and its mandates.