Linda Sherry, director for the nonprofit consumer advocacy group Consumer Action in Washington, D.C., points out that state mandates are not the only driver of rising health insurance costs.

"I think the fact that there are 45 million uninsured persons who use public assistance and emergency rooms has more to do with rising costs," says Sherry.

Mandates gaining steam

Are you already paying for . . . alcoholism treatment coverage?

Wieske points out that the most popular benefit trend is autism coverage, which has attracted broad interest both from the public and politicians. In addition to autism, he says there has been a great deal of interest in enacting prosthetics coverage mandates.

Wieske points to in vitro fertilization as a problematic mandate.

"I personally have a problem with an in vitro fertilization mandate," he says. "I’m convinced it’s a straight income transfer from the poor to the rich. Poor families are struggling to afford health insurance and are not interested in spending their hard-earned dollar on in vitro fertilization. It’s clearly not something that is treating a medical condition and it’s not threatening to the individual’s health."

Wiekse says since having children is not "medically necessary," the benefit shouldn’t be required.

Although Sherry agrees that mandating coverage for certain procedures (such as in vitro fertilization or prescription drugs) drives up costs more than other types of mandated coverage, she also believes that part of the problem is the unwillingness by health care industries to accept smaller payments.

"Why can consumers buy the same prescription drugs in other countries for much less money? It is difficult not to conclude that the industry is gouging American consumers on drugs and some procedures," notes Sherry.

While evidence is mounting about the financial burden of additional mandates, there are currently eight big mandate trends, according to CAHI:

Autism treatment: This mandate includes the evaluation and treatment of autism. Eleven states already have this mandate.

HPV vaccine screening: HPV is the virus responsible for cervical cancer and genital warts. Sixteen states mandate vaccine coverage.

Dependent-student mandate: This extends coverage from a parent’s health insurance policy to children up to age 30. Also known as the "slacker mandate," it has been enacted in 30 states.

Michelle’s law: This requires the continuation of health insurance coverage for full-time students who are on a 12-month medical leave from college. Normally, this would make them ineligible for dependent-student status under a parent’s health insurance plan.

Domestic partners: This allows a domestic partner as an eligible dependent on a health insurance policy.

Legal aliens: So far only Maine has extended eligibility for health insurance coverage to include a person who isn’t a citizen but is residing legally in the U.S.

Grandchildren: Maryland, Minnesota, New York and Texas have extended "dependent" eligibility to include a grandchild.

U.S. armed forces: If you served in the military and you live in Illinois or Pennsylvania, you can receive medical care from the state for a time that’s equal to the amount of time you spent in the military.

Mandate "lite" policies: There are currently 10 states that allow individuals to purchase special group health policies with fewer state mandates that are customized to their needs and financial means.

Mandate-heavy states

Which states pile on the mandates, and the related costs? The top five mandate-heavy states are Rhode Island (70), Minnesota (68), Maryland (66), Virginia (60) and Washington (57).

Wieske says that many mandates are things that employers would likely include anyway when they purchase health plans for their workers, but making them mandates raises the costs for everyone — and then ultimately pushes people out of the market.

"The key is to balance those costs with a comprehensive plan that provides necessary treatments and services," suggests Wieske.

Sherry believes that the states should take a more conservative role in determining which mandates should be enacted.

"It is an acceptable role for states to attempt to protect their citizens, and to help people who are locked out of traditional coverage because of pre-existing conditions," says Sherry. "Sometimes hard choices have to be made—not being able to get pregnant, for instance, is not a life or death situation, so the fact that it is an elective procedure to go for in vitro should be taken into account when deciding what to mandate and what not to mandate."