Tracking NY’s insurance mandates

by Bill Hammond |  | NY Torch

healthYear in and year out, state lawmakers vote to impose new coverage requirements for health plans sold in New York State.

Often, these mandates go beyond the evidence-based guidelines recommended by major national health organizations. Usually, they drive up costs for New York consumers, who already face the highest average premiums in the lower 48 states. Never are they subjected to serious, impartial analysis of cost and benefits.

To raise awareness of this expensive habit, the Empire Center will be identifying new proposed mandates as they are put forward and tracking their progress through the Legislature.

Our scan of current legislation, summarized here, found no fewer than 91 bills that would expand what health plans must pay for.

Some call for incremental changes, such as broadening an existing mammography mandate to include a 3D procedure known as tomosynthesis. Others would take bigger steps, such as requiring insurers to pay for acupuncture, in vitro fertilization, or service animals (including the costs of acquisition, training, feeding, and veterinary care).

Most pending mandates are one-house bills with little chance of becoming law. However, 20 have majority-party sponsorship in both the Assembly and Senate. To date, two of those 20 have been approved by the full Assembly.

In memorandums accompanying these bills, sponsors usually say the fiscal impact on state and local government will be “none,” without further explanation. Others assert that the costs would be minimal, or that their bills would actually save money, without providing hard evidence. The most forthright sponsors admit that the fiscal impact of their proposals is “undetermined.”

A 2007 law called for new insurance mandates to be vetted by a commission of experts – effectively acknowledging that some could do more harm than good. But subsequent governors and legislative leaders failed to follow through with appointments to the panel, so it has never met.

The first mandate approved by the Assembly this year, dubbed the Comprehensive Contraceptive Coverage Act of 2017, passed by a vote of 103-43 on January 17, just six days after it was proposed by Attorney General Eric Schneiderman. Both federal and state law already required coverage of contraceptives, but this bill would expand the mandate in some respects – most notably by ordering plans to provide a 12-month supply when filling prescriptions and banning copayments or coinsurance of any amount.

Three days after that vote – the day of President Donald Trump’s inauguration and the eve a major women’s march in Washington – Governor Andrew Cuomo announced that the state Department of Financial Services would impose similar contraceptive requirements by regulatory action, along with a ban on copayments for abortions.

The second bill passed by the Assembly, which was approved on Thursday, would mandate coverage of a three-dimensional breast-cancer scan known as tomosynthesis, adding the procedure to the state’s existing mandate for mammography. Supporters point to studies that suggest 3D scans are more accurate, especially for women with dense breast tissue, and therefore avoid false positive results and unnecessary follow-ups and biopsies.

However, the U.S. Preventive Services Task Force – an expert panel tasked with evaluating the effectiveness of medical procedures without considering cost – declined last year to take a firm position on tomosynthesis, saying there is “not enough evidence to determine whether it will result in better overall health outcomes for women.”

On Feb. 28, shortly after the Assembly bill was introduced, Cuomo again announced executive action: DFS issued a memo to health plans declaring that tomosynthesis “falls under the definition of ‘mammography screening’ and therefore must be covered when medically necessary.”

The Assembly bill, by contrast, omits the language about medical necessity. It requires health plans to cover tomosynthesis the same way they’re already mandated to cover routine mammography in healthy women – with a baseline as young as 35 and annual screens after 40.

As Health News Review wrote about New York’s policies, “Breast cancer is good politics, and when votes are at stake, inconvenient or nuanced science gets overlooked.”

Another proposal with majority support in both houses calls for mandatory coverage of diagnostic testing for ovarian cancer, including sonograms and the so-called CA 125 blood test. However, the Preventive Services Task Force recommends against sonograms and blood tests to screen otherwise healthy women, saying their use “does not reduce the number of ovarian cancer deaths” and “can lead to important harms, including major surgical interventions in women who do not have cancer.”

The task force said its recommendation does not apply to women with genetic mutations that increase their risk for ovarian cancer. The bill in the Legislature, however, would apply to all “women aged forty and over with one or more relatives with a prior history of ovarian cancer,” whether they have a genetic mutation or not.

Whatever their merits, mandates passed by the Legislature affect only a fraction of New Yorkers. The state has no authority over Medicare, a federal program that covers the elderly 65, or over the self-insured plans operated by most large employers, which are exempt from state regulation under federal law.

Mandates primarily affect health plans sold to small employers and individuals, the two groups most likely to forgo coverage over affordability issues. And of course an insurance mandate is of no use to someone who is uninsured.

In 2003, an actuarial study sponsored by the Employer Alliance for Affordable Health Care found that New York’s insurance mandates added an average of 12.2 percent to health insurance premiums in New York. After 14 years of additional lawmaking without cost-benefit analysis, that number could well have increased.

If you know of other legislation that belongs in Mandate Watch, contact Bill Hammond at billh@empirecenter.org.

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