Insurance mandates and health care costs: requiring insurance companies to cover certain services has defendants and opponents.

• Author: Wasserman, Stephanie

Substance abuse and chemical dependency treatment. Colorectal cancer screening. Newborn testing for sickle-cell anemia. Is there a common thread?

These are three of the hundreds of health insurance benefits required by law. And they are the result of some 30 years of legislatures increasingly requiring insurance plans to either cover or offer specified benefits.

Today, state or federal laws mandate insurance coverage for more than 1,500 health services.

It's a dilemma. On the one band, lawmakers continue to adopt insurance mandates. On the other, they're eyeing, with increasing scrutiny, any and all factors that may contribute to rising health care costs. And they're specially looking at what role insurance mandates play, particularly on premiums.

Two trends are emerging.

First, a growing number of states no longer pass health insurance mandates without a fiscal impact study evaluating how they will increase insurers' costs. Second, a number of new laws are now on the books allowing insurers to sell cheaper policies that cover basic services, such as hospitalization, but not some of the required services.

Health insurance mandates affect the coverage benefits of more than 60 million people. Proponents of benefit mandates embrace them as useful tools for more comprehensive health care and consumer access to services. They claim that mandates improve patient care and protect people who work for small businesses from health insurance policies that have limited coverage. Opponents argue that mandates are a major cause of excess health care costs.

But whether the effect is costly to consumers remains debatable. There's evidence aplenty to support both sides of the argument.

PREVENTION A COST SAVER

One of the most compelling arguments in favor of mandates is that preventive services can save money through early detection of diseases. Researchers tout the cost effectiveness of preventive services, such as tobacco cessation treatment and colorectal cancer screening.

And yet many states pass health insurance mandates without such evidence. Only 15 states, for example, require coverage for colorectal cancer screening even though research finds it is highly effective at addressing the second leading cause of cancer deaths.

It's constituents who push legislators to expand health insurance mandates, not research.

"Consumers who have a condition or a disease or who need a service--and the coverage has been rejected by their insurance company--come to the...