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Provide opportunity to purchase lower benefit/catastrophic coverage by removing mandated benefits

Health Factors: Access to Care
Decision Makers: Government - State
Evidence Rating: Insufficient Evidence
Population Reach: 50-99% of WI's population
Impact on Disparities: Likely to increase disparities

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Expected Beneficial Outcomes

Increased proportion of population with at least some coverage in low cost plans
Reduced premiums for plans that choose to eliminate coverage

Evidence of Effectiveness

OCI-Mandated benefits 2001 examining costs of selected health insurance mandates in Wisconsin for group and individual health insurance policies offered by the largest writers of health insurance in the state indicates that individual mandates have small but variable impacts on overall costs. Of the five mandated services examined, the largest marginal cost of benefit payment was approximately 3% of benefits paid; the smallest cost was less than one half of one percent. Insurers reported no marginal costs of some mandated services, as those services were already covered prior to introduction of a mandate.

Implementation Examples

United States

The number of mandated benefits varies among states. According to a 2009 Council for Affordable Health Insurance (CAHI) brief, the number varies from from 13 in Idaho to 70 in Rhode Island.

Wisconsin

As of 2009, Wisconsin has 34 mandated benefits including coverage for childhood immunizations, diabetic equipment and supplies, lead screening, kidney disease treatment, mammography, newborn infant care, HIV treatment drugs, nervous and mental disorders, AODA, breast reconstruction post-mastectomy, home health care, skilled nursing care, hospital and ambulatory surgery care for some dental treatment, TMJ treatment, services for adopted and handicapped children, and certain services provided by chiropractors, nurse practitioners, and optometrists.

Implementation Resources

CAHI-Bunce 2009 - Bunce V, Wieske JP. Health insurance mandates in the states 2009. Alexandria: Council for Affordable Insurance (CAHI); 2009.
Accessed on June 15, 2012
Webpage: http://cdm16064.contentdm.oclc.org/cdm/singleitem/collection/p266901coll4/id/3761/rec/12

Citations - Evidence

OCI-Mandated benefits 2001 - Office of the Commissioner of Insurance (OCI). Study of costs of certain mandated benefits in insurance policies 2001. Accessed on June 20, 2012
Webpage: http://www.docstoc.com/docs/2391751/Study-of-Costs-of-Certain-Mandated-Benefits-in-Insurance-Policies-2001

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Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

  • Scientifically Supported Numerous studies or systematic review(s) with positive results
  • Some Evidence Research suggests positive impacts; further study may be warranted
  • Expert Opinion Recommended by credible groups*; research evidence limited
  • Insufficient Evidence Evidence limited or unavailable; further study warranted
  • Mixed Evidence Evidence mixed; further study warranted
  • Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

  • Likely to decrease disparities
  • No impact on disparities likely
  • Likely to increase disparities