Insurance ‘’mandates.’’ Many conservatives use the term disparagingly in describing the health insurance coverages required by state or federal law. The mandates are criticized...

Insurance ‘’mandates.’’

Many conservatives use the term disparagingly in describing the health insurance coverages required by state or federal law. The mandates are criticized for being costly and limiting consumer choice.

But consumer advocacy groups say mandated benefits such as cancer screenings protect people from policies that don’t cover important tests and services.

The issue of mandates has erupted again in the Georgia General Assembly with the introduction of House Bill 47. The legislation would allow insurance companies to sell any policy in Georgia that they now offer in other states. Thus, an insurer could skirt Georgia’s required coverages with barer policies sold in states with fewer consumer protections. An out-of-state plan could lower the sticker price of insurance for uninsured Georgians, the bill’s proponents say.

The bill, proposed by state Rep. Matt Ramsey (R-Peachtree City), was approved by a House Insurance subcommittee Tuesday. It’s supported by the Georgia Chamber of Commerce and the National Federation of Independent Business.

A similar bill cleared the House last year but stalled in the state Senate.

Ramsey has said the legislation would reduce the price of insurance and thus get more people covered. The bill’s supporters argue that a single man, for example, would not need a policy that covers mammograms and shouldn’t have to pay for that coverage.

Georgia’s insurance mandates include requirements for health policies to cover screenings for cervical, prostate and colorectal cancer, along with mammograms. Consumer groups and legislators in the past fought long, hard battles to get these coverages approved by the General Assembly.

The American Cancer Society opposes the House bill. It would allow insurance policies to not cover essential cancer screenings, said Brittany Freeman, the director of health policy for the organization’s South Atlantic division. “Early detection not only saves lives but also saves money,’’ she said. “It’s more expensive to treat later,’’ Freeman said, adding that the extra cost would be borne by other policyholders.

Ramsey has said the bill would ‘’put more power into the hands’’ of  consumers to choose whatever benefits they want. Coverages would be spelled out to consumers before they purchase a policy, he said.

Both sides would agree that Georgia has a big problem with its number of uninsured. An estimated 20 percent of the state’s residents, or about 1.9 million people, lacked health insurance in 2009, the latest year for which Census Bureau statistics are available.

The House bill would apply only to policies sold to individuals, and not to those offered by employers. That’s only about 5 percent of the state’s health insurance marketplace.
Georgia’s market for individual coverage, though, is often problematic for consumers. An Atlanta Journal-Constitution investigation in 2009 found that individual policies accounted for a disproportionately high percentage of consumer insurance complaints that were investigated by state regulators. Consumers complained about premiums as high as mortgage payments, and coverages that left them with thousands of dollars in unpaid bills, the AJC found.

Health insurance often comes down to a cost-versus-coverage conundrum. Even large employers wrestle with what benefits to include in their health plans, weighing the price of added coverages.

Rep. Darlene Taylor (R-Thomasville) voted for the bill in the insurance subcommittee. She is a third-party administrator, managing benefits for small and large employers. “I’m hoping [the bill] will pick up a few individuals who have no coverage now,’’ she said after the vote.

Yet Cindy Zeldin, executive director of advocacy group Georgians for a Healthy Future, said the legislation would set up a separate class of insurance benefits that would attract the young and healthy. That, in turn, would leave a group of older and sicker people in existing health insurance groupings, and thus drive their costs even higher, she said. “People with high medical needs would be priced out’’ of insurance, she said.

Insurance should spread the risk among people of all ages and health conditions, Zeldin said.

A separate piece of legislation, Senate Bill 17, would create a commission to study the effects of health insurance mandates.

Still, health care reform, if it survives legislative and court challenges, could trump the Georgia mandate issue in three years. The reform law calls for the federal government to define an ‘’essential benefits package’’ to be offered to individuals and small businesses who enter the health insurance exchanges in 2014.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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