Tuesday, April 24, 2007

The Reality of Health Mandates in Wisconsin

It seems some clarification is necessary when it comes to health coverage mandates in Wisconsin.

When opponents -- usually conservatives -- talk about these mandates, they make them seem like universal mandates that affect every insurance policy in the state. Here's a recent post by Owen that lambastes liberals for sacrificing "other people’s dollars to make themselves feel better about fighting the latest crisis":
Currently in Wisconsin, I count at two dozen mandated coverages. They are everything from HIV infection coverage to lead screening coverage to optometric coverage to breast reconstruction coverage. The problem with mandating coverages is that it forces health insurance plans to cover all sorts of stuff that may not apply to the people in the plan.
Let's take a look at those four coverages Owen mentions: HIV infection coverage, lead screening coverage, optometric coverage, and breast reconstruction coverage.

The way Owen lays them out, it makes it seem like every insurance policy in the state is forced to cover all of these procedures. But when you look at the actual state statutes -- which Owen even cites -- you find that they all come with significant "ifs" attached.

HIV drug coverage is mandated only if the plan includes other prescription drug coverage. Lead screening coverage is mandated only if the participants are under 6 years old. Optometric coverage is mandated only if the plan covers the same vision procedures by another health care provider. Breast reconstruction coverage is mandated only if mastectomy procedures are also covered and the reconstruction coverage only applies to breast tissue that's incidentally affected by the mastectomy procedure.

All of the state mandates have similar restrictions, whether it involves limiting the coverage to specific types of plans, specific age groups, or only in the event that the same procedures are already covered elsewhere in the plan. A more reader-friendly rundown of coverage mandates in Wisconsin can be found here.

And contrary to the line that these mandates significantly increase health costs, the ones that are the most universal are aimed at preventative care -- such as screenings, immunizations, mammograms, etc. -- that most experts agree keeps costs down by catching ailments early in their development.

The mandates that pertain to treatment, as opposed to detection, are intended to ensure that patients are provided complete coverage when any coverage is included; for instance, it's mandated that if policies cover diabetes treatment, they also cover the cost of equipment that's necessary for treatment such as insulin pumps. But policies still have the option to not cover diabetes treatment at all, just like policies can avoid the optometry mandate by not covering vision treatments or the chiropractic mandate by not covering back treatments.

You can certainly still take issue with the mandates, but at the very least they should be discussed and portrayed accurately, and doing so puts a big question mark on the charge that they are a significant driver of health care costs in the state.


Side-Note: Owen definitely isn't the only person to comment on mandates in this way; I just picked his post because it happened to catch my eye this morning.

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