Though their party complains often about health insurance coverage mandates from Washington, Republicans in North Carolina’s legislature are OK with adding more requirements upon state-regulated insurance companies.
Several bills have cleared at least one chamber in the GOP-led General Assembly this year that place new demands upon insurers – some to provide autism services, lower co-payments for certain cancer drugs and treat chiropractors like primary care providers. None have yet become law.
While some GOP lawmakers and their allies keep arguing that mandate expansion raises premium and out-of-pocket costs upon all those insured, bills keep getting heard and voted upon in the name of compassion and fairness.
“We cannot deny our citizens a better quality of life,” said Rep. David Lewis, R-Harnett, a sponsor of a bill requiring insurers to charge co-payments for orally-administered chemotherapy drugs no less favorable than those for IV-administered anti-cancer drugs. He spoke on the House floor when it passed by a wide margin.
Cancer survivors and parents of autistic children have previously attended committee meetings. Lawmakers also have personal experiences that surely impress upon viewpoints. Lewis’ parents recently died and had cancer diagnoses. Rep. Bobbie Richardson, D-Franklin, told colleagues that oral cancer drugs she took made her sickness more manageable.
Rep. Gary Pendleton, R-Wake, an independent insurance agent handling employer health plans, stressed in an interview his sympathy for people with health needs seeking help. But he estimated that approving five pieces of pending legislation he considers mandates would increase insurance premiums by about 16 percent.
“It’ll be a rate increase on everybody insured whether they use that benefit or not,” Pendleton said, adding that even with the GOP protests about President Barack Obama’s health care law, “my fellow Republicans are not serious about reducing health care costs for corporations and nonprofits.”
The state mandates apply to fewer than 40 percent of the covered persons living in North Carolina, according to Ken Lewis with the North Carolina Association of Health Plans. That group is critical of many mandate proposals. The state Insurance Department said 1.5 million people were covered under plans it regulates. Those on Medicaid, Medicare and veterans’ or self-funded plans aren’t.
North Carolina’s 55 state-sanctioned mandates ranked among the top 15 most in the country in 2012, according to the Council for Affordable Health Insurance. Brian Balfour with the conservative-leaning Civitas Institute in Raleigh said North Carolina is now at 56 – a 2014 law prevents some limits on what optometrists can charge. The group has a web page opposing any new mandates.
“You have interest groups that want these mandates, and what happens is the ones with clout ended up being heard,” said Don Taylor, associate professor at Duke University’s Sanford School of Public Policy.
The House approved legislation late last month barring health plans from charging co-payments for chiropractic services that are higher than those for primary care physicians.
North Carolina Chiropractic Association Executive Director Joe Siragusa said state law already prevents insurers from imposing treatment or coverage limits for services performed by a chiropractor. Insurers set higher co-pays to see chiropractors to discourage their use, he said.
The bill isn’t a mandate, Siragusa said in an interview: “We think it’s a patient choice bill.”
The association has studies showing the bill would result in health expense savings when compared to visiting a medical doctor. Blue Cross and Blue Shield of North Carolina, which has fought the measure as the North Carolina Chamber did, calls the co-pay parity a mandate that would shift $10.5 million to premium costs.
“Chiropractors are specialists, not primary care doctors,” BCBS spokesman Lew Bowman said.
Meanwhile, Blue Cross now supports a compromise Senate measure that would mandate coverage of autism treatment. The company already covers autism but opposed a different bill last session setting coverage parameters.
While this year’s autism bill breezed through the Senate, the chiropractor bill had a tougher time in the House, in part due to a clouded history when Democratic Rep. Jim Black was speaker.
This year’s measure narrowly passed the House Insurance Committee only after some members gave personal chiropractic experiences. Rep. James Langdon, R-Johnston, recalled how he went to a chiropractor to relieve arm numbness. He said the surgical alternative to repair his pinched nerve would have cost $180,000.
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