Effect of commission review on mandated health benefits

Objectives. Mandated Health Benefits are laws that require health insurance companies to provide or offer specific benefits to their insured. Since 1985, state legislatures have increasingly passed laws requiring review of mandated benefits. We sought to identify risk factors for commission adoption and to determine the effect of commission review on the passage of mandated benefits.

Methods. Compilation of state data on years of mandate (n=1737) and commission (n=29) enactment was available from the Blue Cross Blue Shield Association, the Council for Affordable Health Insurance, and other health services research sources. We assessed the association between various factors and commission adoption and determined the effect of commission adoption on mandate enactment. These factors included states' party vote in the 2004 presidential election, geographical region designation as per the Census Bureau, economic status relative to the national mean per capita income, and number of enacted mandates. To determine the relationship between commission adoption and mandate enactment, we calculated by state the rates of mandate passage for intervals of time before and after commission adoption. We also examined the effect of commission existence on passage rates of different types of mandates.

Results. States with larger numbers of mandates were more likely to adopt review commissions. Though western Democrat states had higher rates of commission adoption, no other geographic, political, or economic factors for commission adoption, including time of commission adoption, were found. Following commission adoption, states experienced a reduction in overall passage of mandates (rate ratio: 0.74, 95% CI: 0.59-0.92). However, mandates related to integrative medicine or complementary and alternative therapies were passed at a higher rate following commission adoption. Adoption of commissions was also associated with a shift to higher passage of “benefit” type mandates relative to “provider” and “persons covered” type mandates.

Conclusions. Our assessment is that commissions in general act as a brake that decelerates the rate of passage of legislature-proposed mandates. This hypothesis could be confirmed if there were a positive association between establishment of commissions and decreased passage of new health mandates. Assuming that current commissions act as such a brake, there is complementary need for parallel commissions that function to propose legislation for new mandates that would improve the effectiveness of healthcare.