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Council for Affordable Health Insurance



April 9, 2013
CAHI Identifies 2,271 State Health Insurance Mandates

(Alexandria, VA) – Today the Council for Affordable Health Insurance (CAHI) released “Health Insurance Mandates in the States, 2012.” According to the study, the number of state mandated benefits -- which has increased steadily for 20 years – is now up to 2,271 mandates nationwide.

“One of the biggest cost drivers in our health care system is the steady proliferation of federal and state-based coverage mandates. When CAHI started tracking mandates in 1992, there were about 850 mandates across all 50 states,” explained CAHI Research and Policy Director, Victoria Craig Bunce. “Over the last twenty years the number of state mandated benefits has grown to 2,271. That’s an increase of 167 percent! 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.”

Most Mandated Benefits
Least Mandated Benefits
Most Popular Mandates
Least Popular Mandates
Rhode Island 69 Idaho 13 Mammography Screening 50 Breast Implant Removal 1
Maryland 67 Alabama 19 Maternity Minimum Stay 50 Cardiovascular Disease Screening 1
Virginia 66 Michigan 24 Breast Reconstruction 49 Circumcision 1
Minnesota 65 Iowa 26 Mental Health Parity 48 Gastric Electrical Stimulation 1
Connecticut 65 Utah 26 Alcohol & Substance Abuse 46 Organ Transplant Donor Coverage 1

“The sheer number of state mandates will make it difficult for states to deliver on one of the key promises repeatedly made by supporters of Obamacare: it would provide all Americans with affordable health coverage. The essential health benefit plan design was supposed to give states the flexibility to craft benefit packages which would be suitable and affordable for their unique populations. But HHS shackled the states to the full load of mandated benefits on their books, and the prices of next year’s offerings in the health insurance exchanges are going to bear witness to the free-wheeling mandate craze of the last twenty years. Recent studies have predicted double digit increases in health insurance premiums next year -- the mandates are coming home to roost,” said Roy Ramthun, CAHI’s Director of Federal Affairs.

A health insurance mandate requires insurers to cover specific health care providers, benefits or patient populations. Mandates make health insurance more expensive because they require insurers to pay for care consumers previously funded out of their own pockets.

When policymakers complain about the high cost of health insurance, CAHI wants legislators to know they are partially to blame. The mandate explosion and the corresponding effect on the cost and availability of health insurance is a direct result of legislative action. We hope this publication will encourage them to think twice when asked to sponsor or vote on legislation that contains a mandate providing services to the few at the expense of the majority.

The study's author, CAHI Research and Policy Director Victoria C. Bunce, assisted by CAHI staff, tracks hundreds of mandate bills annually and identifies those that are enacted into law. A team of actuaries, supervised by CAHI’s Actuarial Working Group on Mandated Benefits provides an estimate of each mandate’s cost. For an executive summary, or to order the full report, please visit

Since 1992, CAHI has been the principled, free-market voice protecting and promoting access, affordability and choice in American health care. CAHI's membership includes health insurers, small businesses, physicians, actuaries, insurance producers and brokers and consumers. It's your health; it's your choice.

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