States continued to add more rules last year that mandate what health insurance plans must cover, according to a new report from the Council for Affordable Health Insurance in Alexandria, Va.
The number of state health insurance mandates grew by 106 in 2011, reaching a record 2,262 nationwide. Coverage mandates have more than doubled since 1992, when the council began tracking them. Twenty years ago, there were about 850 mandates across all 50 states.
A health insurance mandate requires insurance companies to cover specific health care providers, procedures, treatments or patients. Mandates make health insurance more expensive because they require insurers to pay for care consumers previously funded out of their own pockets, the council says.
"One of the biggest cost drivers in our health care system is the steady proliferation of federal and state-based coverage mandates," Victoria Craig Bunce, the council's research and policy director, said in a press statement. "Based on our annual analysis, mandated benefits currently increase the cost of basic health coverage from slightly less than 10 percent to more than 50 percent, depending on the state, specific legislative language, and type of health insurance policy."
The council says the "most popular" mandates are mammography screening, minimum maternity stay, breast reconstruction, mental health parity, and alcohol and substance abuse.
The "least popular" mandates are for breast implant removal, cardiovascular disease screening, circumcision, gastric electrical stimulation and organ transplant donor coverage.
Rhode Island and Virginia, which each have 70 mandates, have the most of any state. Others topping the list of states with the most health insurance mandates are Maryland (67), Minnesota (65) and Connecticut (63).
Idaho, with 13 mandates, has the least number of coverage mandates. Others with relatively few mandates are Alabama (19), Michigan (23), Hawaii (24) and Utah (26).
State mandates apply to individual and mostly small group health insurance plans. States do not regulate self-insured employer-sponsored health plans. Most large employers self-insure, which means they pay for their workers' health claims rather than paying premiums to an insurance company to cover employees' claims. Self-insured plans are regulated by the federal government.