A bill pending in the House Corporations Committee, dubbed “Duncan’s Law,” would require every health insurance policy in Rhode Island to cover treatment for fanconi anemia, including up to six cycles of in-vitro fertilization.
A trio of bills before the House Health, Education and Welfare Committee would mandate coverage of prosthetic devices, even from providers outside an insurer’s network. Another bill would require insurers to pay up to $400 or 20 percent of the cost of adults’ hearing aids (children’s hearing aids must already be covered up to $1,000).
It’s too early to tell if these bills will become law, but in recent years, similar measures have passed that health insurers say increased costs unnecessarily. Such mandates, they say, are a big part of why health insurance is beyond many small businesses’ reach.
Two bills before House Corporations would test that assertion, requiring that before legislators can consider, say, Duncan’s Law, they subject it to an expert cost-benefit analysis. One, sponsored by state Rep. Rene R. Menard (D-Lincoln), would also apply retroactively.
“We have to weigh the potential health benefits to Rhode Islanders with the potential costs to insurers, which will eventually get passed along to consumers,” Menard said. “These are difficult decisions that must be based on facts on how great the need is, how big the health risk is, how many people it affects, and what the cost of the coverage will be. We can’t make a decision if we have only part of that information, and some emotional stories.”
UnitedHealthcare of New England has been trying to persuade state leaders of that point for years. In a recent interview, CEO Stephen J. Farrell noted that self-insured groups – most large employers – are already exempt from coverage mandates, and their workers are hardly deprived. Small employers, Farrell argues, shouldn’t be at a disadvantage.
At a hearing earlier this month, United testified in favor of Menard’s bill, and so did Blue Cross & Blue Shield of Rhode Island and the National Federation of Independent Business.
In an e-mail reply to a reporter’s query, Scott A. Fraser, lobbyist for Blue Cross, said about 30 states have “some sort of mandate benefit review mechanism to evaluate the medical efficacy, economic impact, social need and cost-effectiveness” of any proposed requirement.
In Rhode Island, by contrast, the only review that goes on is the legislative hearing process, Fraser noted. Having health care experts to review proposed mandates, he said, “would take some of the burden off the Legislature.”
Beyond the cost considerations, one recent experience might bolster the insurers’ arguments: Last year, the General Assembly approved a bill requiring early-childhood intervention coverage and, in the process, unwittingly made it impossible to offer health savings accounts in Rhode Island. Legislators are now considering bills to exempt HSA-compatible plans from the early-childhood mandate or, alternately, from all coverage mandates. Passage of at least the early-childhood bill is considered almost certain.
The concept of a mandates review panel is not new. State Rep. Peter F. Kilmartin (D-Pawtucket) first sponsored a bill to that effect in 2003, and he did so again last year. This year, the bill is being sponsored by state Rep. Raymond C. Church (D-North Smithfield).
Kilmartin, who is co-sponsoring Church’s bill, said through a spokesman that he wants to get Health Insurance Commissioner Christopher F. Koller’s input before going forward.
Church’s bill would create a panel of three senior researchers, two experts in health or biostatistics from local universities, and one senior research associate, all appointed by the state director of health. They would review any new proposed mandates based on:
– the social impact – to what extent the treatment or service is needed by Rhode Islanders;
– the current availability, utilization and demand for the service;
– the extent to which it’s already covered by insurance, and if it’s not, how that affects the adequacy of care and whether it creates a “major financial hardship”;
– the medical efficacy, as documented in clinical research, with comparisons to alternatives, if available;
– the financial impact – increase or decrease in the cost of treatment, administrative expenses, etc., the impact on the total cost of care, and on employers of different sizes.
Menard’s bill would require a similar review of new proposals, though his panel would have five members, appointed by political leaders, and including someone employed by a health insurer and two consumers. Both bills allow the General Assembly to skip the review process if there’s an “immediate public need.”
Church’s bill would apply only to new mandates, but Menard’s would also require the panel to go back and look at an estimated 40 mandates now on the books.
Some of those mandates add very little to the cost of health insurance, Menard said, but several add between 1 percent and 3 percent, and one adds between 5 percent and 10 percent. In an interview, Menard said those figures concern him not only in connection with private insurance costs, but to the extent that they might be fueling the fast-rising cost of RIte Care.
“We don’t know what a mandate truly costs; we do know that our health care is out of sight,” Menard said. He personally sponsored one mandate on the books, for coverage of meningitis immunization, he said, and he’d do it again “in a heartbeat” – but the cost of that and other mandates should be documented.
“To any critic of this bill, I would say, what are you so afraid to learn?” he said.
State Rep. Steven A. Costantino (D-Providence), a leader in health care issues, sees things differently. Insurers complain to no end about the supposed cost of mandates, he said – the one for Lyme disease is particularly controversial – but they never do document their assertions.
“I want to know what the evidence is on mandates increasing premiums versus not having mandates, and whether the premiums would still be increased without the mandates,” Costantino said. “At what point do you decide not to provide coverage?”
