NCPA - National Center for Policy Analysis


March 28, 2007

A health insurance "mandate" is a requirement that an insurance company or health plan offer coverage for common -- but sometimes not so common -- health care providers, benefits and patient populations.  For almost every health care product or service, there is someone who wants insurance to cover it so that those who sell the products and services get more business and those who use the products and services don't have to pay out of pocket for them, says the Council for Affordable Health Insurance (CAHI).


  • Mandated benefits currently increase the cost of basic health coverage from a little less than 20 percent to more than 50 percent, depending on the state.
  • By the late 1960s, state legislatures had passed only a handful of mandated benefits; today, the CAHI has identified more than 1,900 mandated benefits and providers and more are on their way.

Mandate legislation differs from bill to bill and from state to state, says the CAHI:

  • For example, one state may require insurance to cover a limited number of chiropractor visits per year, while another state may require chiropractors to be covered equally with medical doctors.
  • The second will have a greater impact on the cost of a health insurance policy than the first.

Consider the following mandates and their estimated costs:

  • Drug abuse treatment, 1 percent.
  • Hair prosthesis, 1 percent.
  • In vitro fertilization, 3 percent to 5 percent.
  • Acupuncturists, 1 percent to 3 percent.
  • Massage therapists, 1 percent.

In the aggregate, mandates drive up the cost of health insurance.  But determining the impact in a particular state requires careful analysis of each piece of mandate legislation, as well as other regulations that have been promulgated, says CAHI.

Source: Victoria Craig Bunce and Vlasta Prikazsky, "Health Insurance Mandates in the States 2007," Council for Affordable Health Insurance, 2007.


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