NCPA - National Center for Policy Analysis

New Jersey Enacts Preventive Care Mandate

January 17, 2001

In an attempt to promote preventive care, a new New Jersey law requires insurers to cover a 17-point annual physical for all enrollees.

Health plans must now cover several tests in annual exams in addition to consultations on such things as weight, low-back exercises, smoking and seat belt usage. The law will affect about a quarter of the state's eight million residents. Its requirements include:

  • Blood tests to determine blood pressure, cholesterol levels, hemoglobin levels and blood sugar concentration, beginning at age 20.
  • Pap smears every two years and mammograms annually for women after age 40.
  • Addition items such as screenings for osteoporosis and depression are being considered.

Many observers hope the law may serve as a blueprint for the rest of the nation. However, NCPA experts point out that health insurance in New Jersey is among the nation's costliest -- due to other state-imposed mandates. Moreover, the medical need for some of the screening measures is debatable. For instance:

  • The medical community says colon cancer screening should begin at age 50 -- five years older than the New Jersey law mandates.
  • The new law also requires testing blood sugar levels more aggressively than the American Diabetic Association recommends.

Exemptions were made for self-funded employer plans and insurance policies for individuals or small business. Although the state law put a cap of $220 on what insurers must reimburse for the annual physical, they assume health plans will save money over the long term.

But most health economists agree that, although often desirable, preventive medicine doesn't actually save money. Furthermore, some of New Jersey's requirements are not cost effective: they will cost hundred of thousands of dollars per year of life saved.

Source: Christine Wiebe, "New Jersey Enacts New Preventive Care Law," Medscape Money & Medicine, 2000.


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