Health Care Commentary | |
Easy Ways To Make Health Insurance More Expensive |
Congress has undermined recent legislation aimed at making health insurance
more accessible and affordable. For the first time the federal government
-- operating under a Republican-led Congress, no less -- is mandating health
insurance benefits, dictating what procedures and therapies health insurance
policies must cover. It's a step Congress considered taking, but wisely rejected, when it passed the Kassebaum-Kennedy health insurance reform bill. Unfortunately, short-term memory loss set in. Three significant health insurance mandates were included in an unrelated appropriations bill signed by President Clinton last week, including a provision requiring insurers to cover a minimum maternity stay of 48 hours and forcing insurers and employers to cover mental health care needs to the same limit they cover traditional health care needs. The House of Representatives voted 392 to 17 in a show of support for mandating insurance benefits, even though it wouldn't even consider the mental health care parity provision of the Kassebaum-Kennedy bill. This development is oozing with irony. Just consider: (1) The passage of the Kassebaum-Kennedy bill was supposed to make health insurance more accessible and more affordable. If the federal government gets in the business of mandating health insurance benefits, just the opposite will occur. It's not like we don't have any experience with government-mandated health insurance benefits. The states have been doing it for years. Though there were only eight state-mandated benefits in 1965, there are well over 1,000 today, requiring insurers to cover providers such as chiropractors and treatments such as drug and alcohol abuse, but they can also require coverage for nonmedical expenses such as hairpieces and pastoral and marriage counseling. Studies in six states have found that mandated coverage accounts for between 7 and 21 percent of all insurance claims, depending on the state. As a result, the cost of health insurance has increased. For example, one study found that mandated coverage increases insurance premiums by 6 to 8 percent for substance abuse, 10 to 13 percent for outpatient mental health care and 21 percent for psychiatric hospital care for employee dependents. Those premium increases drive up costs and the of number of uninsured. By one estimate one out of every four uninsured people has been priced out of the market by state-mandated health insurance laws. (2) There is renewed concern about the uninsured population. A new study by the health policy consultants Lewin-VHI for the American Hospital Association -- which got front-page coverage in many major newspapers -- declares that the number of uninsured is on the rise. While the number of uninsured has actually decreased over the past few years -- from 40.9 million in 1993 to 39.6 million last year -- it will increase to 45.6 million by 2002, according to the study. Yet Congress and the White House, in their election-year attempt to give everyone something, passed those mandates, and they will virtually ensure the accuracy of Lewin's prediction. (3) Once the new mandates are in place, two things will happen. First, every type of health care provider not typically covered by a standard health insurance policy will be knocking at Congress' door wanting its product or profession covered. Members of Congress will be inundated with special-interest pleas claiming that by covering their product or service, the government, insurers and employers will save money. The truth is, of course, that they always cost more money. (4) Once the mandates are in place they are almost impossible to repeal. A few states have tried to go around these mandates once in place so that small employers could have access to a less-expensive, "bare bones" policy, but repealing mandates is politically difficult and most legislators do not want to face the turmoil. (5) A primary purpose behind creating ERISA was to permit employers to escape insurance mandates. The Employee Retirement Income Security Act (1974), among other things, permitted larger employers to self-insure (i.e., pay health care claims themselves rather than going through an insurance company). The act also placed self-insuring plans under federal law rather than state laws, so that states could not regulate the self-insured companies or impose mandates on them. That ability to be free of mandates has made self-funded plans very popular among employers, with about two-thirds of the employers who converted to self-insured plans doing so to avoid state regulations. Furthermore, an estimated one in five small firms that are not offering health benefits would do so in an environment free of state-mandated benefits. Thus, passing federal mandates is going to undermine the expanded coverage that has come about as a result of ERISA. The issue involved is not whether the mandated benefits will benefit some people. Mandated benefits always benefit somebody. The issue is that the federal government has taken the unprecedented step of telling insurers what they must cover. The 104th Congress came in on a pledge to stop imposing unfunded mandates on the states -- requiring them to provide costly services but refusing to provide the money for those services. Unfortunately, it never took such a stand for businesses. Had it done so it would not have considered passing health insurance mandates today. Congress drove the states to the brink of bankruptcy with those unfunded mandates. Is it about to do the same for business? (6) Pressure groups lobbying for contraceptive coverage.Family planning groups are pressuring lawmakers to order employers to cover the costs of contraception as a health benefit. The new demands spring from the decision by some states to mandate health insurance coverage of Viagra, the male impotence drug.
Observers say that opposition to the proposal could build. Dan Danner, of the National Federation of Independent Businesses, says his organization's position is that "we're opposed to mandates of any sort." A spokeswoman for Foundation Health Systems, a large HMO in California, warned that the contraceptives plan is "obviously going to drive up premiums for a standard benefits package." Source: Peter T. Kilborn, "Pressure Growing to Cover the Cost of Birth Control," New York Times, August 2, 1998. |
Health Benefits For Cohabitants And Domestic Partners |
The debate over extending employers' health plans to include unmarried couples has become complicated, says the National Journal, "by the drive for gay rights and by the growing political pressures to bolster the traditional family." In some cases, advocates for both homosexuals and the traditional family have opposed local governments granting family health benefits to the nonemployee in unmarried heterosexual couples -- so-called domestic partners or cohabitants.
The Human Rights Campaign says laws extending benefits to same-sex couples only are appropriate, because homosexuals can't marry. And Massachusetts' acting Governor Paul Cellucci vetoed a bill to allow Boston to extend benefits to city employees' domestic partners because it "undermines strong marriages" -- but would support extending benefits to same-sex couples only. Traditional family advocates say extending benefits takes away an incentive to get married, and that unmarried couples lack the commitment of married ones. Their case is bolstered by sociologists Larry Bumpass, of the University of Wisconsin - Madison, and Linda J. Waite, of the University of Chicago, whose research shows unmarried couples are far less likely to stay involved over the long term, regardless of whether they've become parents. Inclusive plans would likely benefit unmarried heterosexual couples far more than homosexuals. The Census Bureau estimates the number of unmarried cohabitants has growth from 523,000 in 1970 to almost 4 million in 1996. Source: Shawn Zeller, "All in the So-Called Family," National Journal, September 19, 1998. |
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