While a major goal of healthcare reform is to trim the rise of medical costs, states continue to sanction new mandates that expand the number of benefits employers must pay for in workers' insurance plans.
Between 1991 and 1993, nearly 100 new benefits were approved by state State reformlegislatures. In the last 30 years, some 1,063 benefit mandates have been passed by state lawmakers, according to a Washington-based newsletter called Health Benefits.
Some of the mandates are the result of medical advances. For example, last year Massachusetts approved coverage for bone marrow transplants to aid in the treatment of breast cancer.
New Hampshire, on the other hand, agreed to pay for toupees to cover unex-plained bald spots on scalps.
State-mandated benefits typically expand coverage by extending coverage to a specific group, reimbursing certain providers or covering a particular procedure or service.
The nation's governors last month called for an overhaul of ERISA, the Employee Retirement Income Security Act of 1974, that would help consolidate even more power among the states by bringing self-insured employers within their grasp. Courts have ruled that ERISA pre-empts state laws governing self-insured health plans.
Healthcare purchasers and payers complain that laws mandating benefits stand in the way of reform because they're expensive and wasteful. Insurers argue that they should be replaced by a national set of standard benefits.
Group Health Association of America, a Washington-based trade group representing more than 350 health maintenance organizations covering some 33 million Americans, on Feb. 15 again called for the abolition of what it termed state-imposed anti-managed-care laws, including so-called "any willing provider" laws. Such laws require managed-care organizations to accept any providers who want to be part of the plans.
The GHAA for years has been battling to outlaw provisions the group says will cripple HMOs' ability to "improve the quality of care and reduce the incidence of unnecessarily performed procedures that lead to higher healthcare costs" (Aug. 9, 1993, p. 100).
The group also has long held that state certification of HMOs could lead to 50 conflicting sets of regulations and has consistently argued for uniform federal standards.