Since the 1980s, Georgia legislators have added a series of consumer protections to the state’s insurance laws.
They required insurers to pay for mammograms and prostate cancer screenings. They banned “drive-through deliveries” by requiring insurers to pay for a 48-hour hospital stay for new mothers and their babies.
Lawmakers also required that insurers pay chiropractors and optometrists for care.
This year, legislators are debating whether Georgia has gone too far with its slate of mandates for insurance companies. That debate is taking place as the federal government is coming up with its own list of insurance minimums, as part of the national health care law.
“Mandates drive up the cost of health insurance for small business,” said Sen. Tim Golden, R-Valdosta, the sponsor of a bill (SB 17) that would establish a commission to study Georgia’s requirements for health coverage. “I just want a very tough look at mandates.”
The Senate will vote on Golden’s bill today.
While Golden’s bill would create a panel of experts to assess the costs and benefits of Georgia’s insurance mandates, state Rep. Matt Ramsey, R-Peachtree City, wants to offer Georgians who buy individual health insurance policies a way to circumvent the requirements. Under his bill (HB 47), insurance companies doing business in Georgia could offer policies they sell in other states where the list of coverage requirements is shorter.
“The whole point of this bill is to put more power in the hands of consumers,” Ramsey said.
Georgia’s insurance mandates do not apply to everyone with health insurance in Georgia. Most large companies operate self-insured plans that are governed by federal law and not subject to state mandates. About 60 percent of Georgians who get insurance through an employer are covered by a self-insured plan.
The federal law that oversees such plans leaves most decisions about coverage up to employers. However, the self-insured plans are beginning to face some new requirements under the nation’s new health care law.
Ramsey said his bill would allow some Georgians who buy individual insurance coverage to get a better deal, and should prompt some uninsured Georgians to buy coverage. About one in five Georgians has no health insurance.
While Ramsey said his bill would promote choice, some who support mandates say such legislation could actually restrict the options of Georgians who want a policy written under another state’s rules. That’s because Georgia’s mandates go beyond requirements for certain services and also let consumers choose a chiropractor, optometrist or athletic trainer for their care, if they prefer that provider over a medical doctor who specializes in orthopedics or ophthalmology.
“The patient should be able to choose,” said Dr. Tom Spetalnick, a Georgia optometrist. “It shouldn’t be the insurance company choosing who you have to see.”
Others say that Georgians should not let the policy decisions of states that are very different from Georgia trump what is on the books here, especially after Georgia lawmakers have debated each mandate before approving it.
“They create a floor for what really counts as adequate, basic coverage,” said Cindy Zeldin, executive director of Georgians for a Healthy Future, a statewide consumer organization.
Ramsey said Georgians who want to maintain their coverage under Georgia law could. He said his bill simply would offer another option.
It’s unclear how much impact the proposal would have on Georgia’s large population of uninsured residents. Studies of bare-bones insurance coverage have found that the cost doesn’t decline significantly enough to prompt a wave of uninsured people to buy insurance, said William S. Custer, a Georgia State University professor who is an expert on insurance issues.
Ramsey’s bill, which has sparked emotional debates during hearings, will be considered by a House committee this week.
The bill to set up a commission to study mandates appears to be garnering more support among both industry representatives and consumer advocates than the bill to let Georgians buy policies allowed in other states. The study commission, if approved, would be formed next year. It would evaluate the costs and benefits of existing mandates by the end of 2012. It also would look at new proposals for mandates.
While each mandate may bump up the cost of coverage by only a percentage point or two, insurers say numerous requirements do raise costs significantly when taken together.
“There are 2,000 different benefit mandates across the country that vary from state to state,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans. “It’s important to consider the cumulative impact of all of those mandates on the affordability of coverage.”
Requirements of the new federal health care law may boost support for Golden’s bill. The law will establish a new set of minimum requirements for health plans.
If states mandate coverage beyond the federal government’s list, they will have to pay a portion of the federal subsidies for insurance to cover the cost of their extra mandates. The federal government is still coming up with its list.
The possibility of extra costs is driving a lot of states to examine the mandates currently on their books. “It is potentially a lot of money,” Custer said.
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