Without a doubt, many of us working deep in the weeds of our organization's health plans are wary of the ever-mounting regulations surrounding health care reform. Recently, I attended a presentation that included a flowchart of implementation dates that looked sort of like a MapQuest depiction of lower Manhattan.
With all of these changes raining on the day-to-day lives we've so lovingly dedicated to our chosen professions, you'd think we'd be taking personal advantage of our own EAP programs in record numbers. But no - we're taking it all in stride. Most of my colleagues discuss these monumental changes in quiet, calm voices over cups of coffee in hotel lobbies where we attend endless seminars to educate us on it all.
So, why the collective calm in the eye of an ever-growing, government-fueled storm of industry chaos? My theory is that we're all used to it.
The Patient Protection and Affordable Care Act certainly will impact employer-sponsored plans like nothing before - but mandated changes to health plans are nothing new. State legislatures have been imposing mandates on health insurance plans since the mid-1960s. Not only do states have the power to determine who can offer health plans to residents, but they also can tell those health plan providers what specific benefits their plans must contain.
Although the tiny state of Rhode Island has the dubious distinction of having the most state mandates that apply to health insurance (last I heard, it was around 70), Florida, where I live, isn't far behind, with 52.
Long before Congress agreed that health plans would cover dependent "children" to their 26th birthday, Florida required coverage to dependent "children" who met certain eligibility requirements, until they turned 30. Some of us affectionately called that mandate the "failure to launch" bill. Others called it the "slacker" bill, after New Jersey's original "cover 'em 'til they're 30" mandate.
Each mandate has a history and an explanation. Most of us agree that a health plan covering a mastectomy also should cover reconstructive surgery. And certainly we don't want new moms to be thrown out of the hospital minutes after giving birth. Mandates like these exist in all 50 states and are subject to little or no debate. They fall into the general categories of common sense and doing the right thing.
But where there are state legislatures, there are also politics, politicians and - heaven forbid - special interest groups. Sometimes mandates come into play where the medical necessity of such mandated coverage may exist only in the mind of the individual pushing the mandate. (Although it should be said, I'm eternally grateful to whoever ensured that dental anesthesia became a mandate in Florida.) Sometimes the provider community becomes convinced about the efficacy of a treatment before the insurance community does - in the case of autism therapy, for example - and if the right providers know the right politicians, a mandate may result.
Sometimes this can positively affect patient treatment. But acupuncture? This is a mandate that one might consider debatable. As a benefits manager, however, I won't be standing in line to start that debate. After all, those pins and needles have to be a heck of a lot cheaper than surgery - so have at it.
Although the value of a mandate may lie in the eye of the beholder, the cost of the mandate lies in the premiums of policyholders. Savvy benefits professionals should keep an eye on their state capitals and make their voices heard when the discussion begins. Since the cost burden of health care reform seems to lie squarely on the shoulders of American businesses, it's a good idea for those businesses to have a voice in the ongoing debate.
Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.
