Healthcare Mandates: Value Versus Cost
Debates on healthcare coverage can be among the more challenging at the state Capitol.
Public hearings on proposals to add coverage are often heartrending and lawmakers of all stripes tend to have a sympathetic ear.
But each time the legislature votes to add a covered procedure, item, or medication, employers—who want to offer quality benefits to their employees—often see costs rise.
And lawmakers don’t always consider those costs when voting.
The ever-increasing price of healthcare remains one of the top three concerns of CBIA members.
So as lawmakers approach the close of the 2018 session, CBIA is redoubling efforts to shine a light on several proposed laws that include assessments, fees, and increased employer premiums.
Substantial Cost to Business
On the surface, these bills appear laudable, sensitive, and may have the right intentions, but they come at a substantial cost to Connecticut businesses.
As it has in the past, the Insurance and Real Estate Committee this year sent numerous health benefit mandates for consideration to the House and Senate.
Most of these bills sit on the Senate calendar with less than a week left in the 2018 session.
CBIA is among an active coalition working against seven specific healthcare mandates.
Other coalition members include the Connecticut Conference of Municipalities, the Council of Small Towns, the National Federation of Independent Business, America’s Health Insurance Plans, Connecticut Benefit Brokers, the Connecticut Association of Health Plans, and the Pharmaceutical Care Management Association.
Seven Healthcare Mandates
SB 206: Permits certain pregnant individuals to enroll in a health insurance policy or plan no later than 30 days after the pregnancy has been certified by a licensed health care provider.
SB 208: Requires health insurance policies that provide coverage for prescription drugs to provide coverage for intravenously administered drugs on a basis no less favorable than orally administered drugs.
SB 209: Decreases the time frame for certain adverse determination review requests from 72 to 48 hours. Typically, the insurer is delayed in making a determination while awaiting records from the insured/patient physician. Shortening the time allowed for the insurer to act could have the reverse effect and increase denials due to lack of necessary information from any third parties, including the patient’s physician.
SB 376: Requires insurance coverage for certain prosthetic devices. Insurance coverage for a prosthetic device must be at least equivalent to the coverage Medicare provides for such devices. It also requires policies to cover repairs or replacements of prosthetic devices that the patient’s health care provider determines are medically necessary.
SB 379: Limits when insurers can change prescription drug formularies during insurance policy terms.
SB 380: Requires health insurers to cover a prescribed drug during the duration of grievance/review procedures.
SB 384: Requires certain health insurance policies to cover, at an annual physical, screenings for mental or nervous conditions. Also expands reporting requirements for the insurance commissioner, and changes to the data that must be included in the Consumer Report Card.
A Better Way
CBIA believes there is better way—one that’s fair and equitable—to determine whether the cost of any mandate truly reflects its value.
Current law allows the Insurance Committee to petition the Department of Insurance to conduct a cost-benefit review of both current and proposed new mandated benefits.
Legislation was introduced this year to improve that process. However, the committee failed to act on it.
As it did last year, CBIA supports this legislation, which ensures that before lawmakers vote, they understand the full impact of these proposals.
For more information, contact CBIA’s John Blair (860.280.4059).
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