Senate candidate (and current state senator) Scott Brown stuck his foot in the mandated benefits issue yesterday with legislation and a statement that shows his serious misunderstanding of the cause of high insurance premiums and how to cut health care costs. Brown filed legislation concerning health insurance mandated benefits – the state laws that require insurers to cover specified benefits.
This has been a long-time bugaboo for us (see our take-downs of Jeff Jacoby, Charlie Baker, and MAHP, among others). We’ve explained at length that while we don’t defend every existing mandated benefit, and we rarely take a position on proposed new ones, mandated benefits make sense by setting a common floor so that all insurers provide adequate coverage. Otherwise, insurers would decide not to offer treatments for an expensive disease (like diabetes, for example), so they would not attract patients with that disease. The insurers would game the system by avoiding high-cost patients. The result would be a race to the bottom, with all insurers trying to avoid the expensive patients. Ultimately, everyone is worse off.
Even the Boston Herald’s State House blogger takes Brown to task for his proposal. And even Tom Finneran scoffed on the radio this morning, saying the proposal is not a game changer. On the broadcast, Brown admitted that he voted for a lot of these mandates.
Brown’s approach blames coverage mandates for the high cost of health coverage in Massachusetts. But a study done by the Division of Health Care Finance and Policy found that at most, mandates add no more than 3%-4% to the cost of coverage. Eliminating mandates would result in a small 1-time drop in the rate of premium growth, but would do nothing to stop the ongoing rise of premiums.
We know why health costs are climbing. Multiple studies have shown that the rising cost of medical care, both increased utilization of expensive services, and higher prices for all services, is driving premium cost growth in Massachusetts. To get at the cause of the problem will require making comprehenisve changes in how care is delivered and paid for. That’s why all the stakeholders and experts on the Payment Reform Commission and the Quality and Cost Council agree that a fundamental approach is required to reduce costs.
Looking at the actual text of Brown’s bill (pdf) leads one to wonder if he understands Massachusetts health policy. The first section authorizes the Connector to eliminate state mandated health benefits. It’s very curious that Brown, a state senator, would propose to take power away from the legislature and give it to a board where 3 out of 10 votes are appointed by the Governor, and another 3 out of 10 are appointed by his current opponent, the Attorney General. It was the Connector, in any case, that added prescription drug coverage that he opposes to the minimum creditable coverage requirement, which fits on top of mandated benefits for people seeking to comply with the coverage mandate.
The bill’s second section authorizes DHCFP to study coverage mandates. However, current law already has DHCFP studying mandates, and new mandates cannot be considered without a DHCFP analysis.
Finally, Section 3 of Brown’s bill declares it to be the policy of the General Court that a moratorium on new mandates be observed. This provision, which has no legal authority whatsoever, mirrors a similar declaration that was part of the 2006 health reform law (section 127 of chapter 58). That provision was quickly ignored when, less than 5 months later, the legislature passed a mandate for coverage of prosthetic arms and legs. The bill passed through the Senate during informal sessions when any Senator could have held it up; did Senator Brown support or oppose this bill?
Many medical reports show obesity as a leading cause of illnesses in this country, through diabetes, high blood pressure, renal disease, etc.
Now that we have mandatory health insurance, and fatso’s health (or lack thereof) is affecting my insurance rates, I think it’s time to get after those who are obese: Either lose weight, sign up for a weight reduction program, or pay a penalty.
After all, our politicians (Mitten Romney, Hussein Obama) couldn’t wait to compare auto insurance with health insurance. Ergo, a penalty on obesity is akin to the seat belt law. People used to defend the seat belt laws with “What I do inside my car is my business”, only to be reminded that everyone pays if a driver is injured. Same thing with obesity.
This should make the liberals happy, with another way of intruding into their lives with a law “for their own good”.
It’s very curious that Brown would propose to take power away from the legislature?
Isn’t it even more curious that HCFA won’t say where it is in the Constitution that the people have delegated any power for the alleged mandate? Just where is this mandatory health insurance you’re talking about, Joe?
And, as for comparing health insurance to auto insurance, what about those that don’t drive?
“And, as for comparing health insurance to auto insurance, what about those that don’t drive?”
Exactly, “?”.
One can opt out of driving. Driving is , after all, a privelage. Last time I checked, existing is not. Ergo, the mandate (which exists in MA, and the other 49 states if Mr. Hussein Obama has his way) should be considered unlawful.
First, I agree that this bill is not the answer to our health care cost woes. However, I really think some honesty on your part about why you think it makes sense that mandated benefits that apply only to fully insured businesses (mostly smaller companies)is fair? Now that we have an individual mandate, wouldn’t it be better to discuss these benefits in the open and have a full dialog about the costs and benefits of each? If they make so much sense,everyone in MA should have them and they should be imbedded in creditable coverage language not hidden in obscure legislation. And, let’s be honest about diabetes coverage. People who work for large self-insured firms have diabetes coverage and the firms are not “mandated” to cover it. I wish we could all meet in the middle on this issue once and for all. A good New Year’s resolution would be to end rhetoric on both sides.
Amy,
I wish Massachusetts could impose uniform benefits for people who have health coverage in the state but it cannot because of ERISA. The individual mandate is, of course, very tricky because of this. While I support most of the mandates, I don’t think including them all in MCC would be very wise, from a policy or political pespective. Maybe federal reform will create a uniform system of regulating health plans (although I fear we’ll sink to the lowest common denominator if it does). Until then, we’ll have to live with inconsistency and balance carefully the scope of the MCC benefits with a world in which the state cannot reach self-funded plans, and so needs to be very careful about imposing requirements on individuals for benefit designs that the state cannot enforce on employers that have self-funded plans. It creates a messy and unfair configuration of plans, for sure.
I think we’ve had more transparency about the cost of the mandates in the last year than ever before because of the analyses done by the Division of Health Care Finance and Policy. We now have pretty clear evidence, as the initial post suggests, that the mandates, despite all the arguments to the contrary are not a major reason why health insurance is expensive. (They account for about 3-4 months of the currernt trend in health insurance premiums….so we could eliminate them all and not get much relief from cost pressures…) We know that just a handful of the mandates account for most of the cost of mandates. The top four mandates–maternity, mental health, home health, and preventive care for children– account for 75% of the total cost of the mandated benefits (about 9% of premiums). My question to Senator Brown and other opponents of the mandates is: which of these mandates do we want to abolish?(Federal law requires maternity coverage, so that’s not an option.) And if we did eliminate them all, what’s your plan for cost control 3-4 months later?
As a public health person, I don’t find the fact that some mandated benefits would be voluntarily offered by some employers in the absence of state or federal mandates, to be a compelling reason to eliminate them. Most of the mandates are for services that insurers–and purchasers– have historically undervalued or which have positive effects on the health of people in the Commonwealth. I’d note, in particular, that at least half of the mandates, and maybe more, target services for women and children. To me, the mandates are an extremely important issue for the health of women and families, ensuring access to important services–at least within the insured plans that the state can legally reach.
These mandates include:
For women: maternity health care ; contraceptive services; hormone replacement therapy; scalp hair prostheses for cancer patients; cytologic screening; and mammography. Mandates that are primarily for children: preventive care for children up to age six (including specific newborn testing); early intervention services; low protein food products for inherited amino acid and organic acid diseases; nonprescription enteral formulas; speech, hearing, and language disorders; hearing screening for newborns; and lead poisoning screening.
While I might personally quibble with a few of the mandates, I think most of them reflect sound decisions by the legislature to require coverage for services that have positive externalities for all of us, and so promote the health of the public (with a strong focus on the health of women and children). The total cost of doing so is very low, and well worth it, in my opinion. And experience suggests that we cannot rely on the market to make sound public policy or public health decisions in these important areas.
The biggest cost of the mandates, to me, is that our endless discussion about them distracts us from the real work that needs to be done to contain health care costs.
Nancy
Both of you ladies forgot to mention invitro as a Mass mandated benefit. Only 15 states cover invitro and this benefit has a larger impact on premiums than maternity coverage according to CAHI.
Hi MCC is a tax,
According to the DHCFP report, infertility services is ranked #5 in total cost (including medical and administrative costs) among all the mandates, at $2.68 per member per month (0.9% of premium), which is far less than maternity, #1 at $11.18 pmpm (3.7% of premium). I think it’s fair to assume that this is one of the mandates that would be less likely to be offered were it not mandated, although before the mandate many providers and patients received coverage for some infertility-related services by unbundling them and billing them with other types of diagnosis codes. I suspect this would happen again (and probably does happen now in many self-funded plans that don’t provide infertility coverage) so I doubt premiums would decline by the full estimated cost of the mandate.
The infertility mandate generates lots of discussion, but not really that much cost. My daughter was conceived with the help of infertility services, so I’m not a neutral commentator on the value of these services. Ironically, because my family was covered under a self-funded plan at the time, we didn’t have health plan coverage for any of the services. So I understand fully the inequities between insured and self-insured plans that Amy is talking about in her post. And I also understand that employers will not necessarily voluntarily decide to cover certain services without mandated coverage (BTW, that self funded plan also didn’t cover diabetes supplies or quite a few of the other mandates).
Nancy
Stop the dems craziness on Jan 19th and help get Scott Brown elected. His vote in the senate is #41 and blocks this legislation from ever getting to the senate floor.
STOP Obamacare NOW!
Scott Brown (R) is leading 48-47 in Massachusetts!!!! http://publicpolicypolling.blogspot.com/2010/01/toss-up-in-massachu...
This is the special US senate race on Jan 19th. Scott says he will vote to KILL Obamacare if he is elected. He is Republican vote #41 and blocks cloture and KILLS the healthcare bill. We have made up 30 points in the last month and are ahead by one!
Organizing for America just sent out info for a phone bank for Coakley (D) yesterday. MoveOn.org and SEIU are pouring money into the race to get Coakley elected. Bill Clinton and Kerry are going to Massachusetts to help We NEED to win this one.
Scott Brown needs our help and the national phone bank is the key. Please join today
People across the country are calling, and Tea Party and 912 groups everywhere are getting involved as well. If all of us make calls for the next 8 days with a HUGE get out the vote calls on Jan 19th then we CAN win. Scott’s vote is #41 in the Senate and KILLS Obamacare, Cap and Trade and anything else the Dems throw at us. Do NOT allow another progressive backed by SEIU into the senate!
To join the national phone bank go to:
https://spreadsheets.google.com/viewform?formkey=dDFVMGxFamFFbkFMcE...
OR
http://www.brownforussenate.com/
OR
Tea Party Phone Bank for Brown site at:
http://brownbrigade.ning.com/group/teapartyphonebankbrownbrigade
Scott was just on Hannity’s TV show and said he will vote NO which will KILL the healthcare bill.
Make this the VOTE HEARD ROUND THE WORLD!
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According to the DHCFP report, infertility services is ranked #5 in total cost (including medical and administrative costs) among all the mandates, at $2.68 per member per month (0.9% of premium), which is far less than maternity, #1 at $11.18 pmpm (3.7% of premium).
Umm, doesn’t IVF coverage result in people needing maternity care? And from what I understand, IVF is far more likely to result in high risk and expensive pregnancies, while natural pregnancies tend to result in natural births of healthier babies. And we don’t need to spend so much money on trying to save premature babies. We could spend an infinite amount on incubators and the like and still not save every baby.
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