BusinessReport.com

Dan Juneau is frustrated.

Insurance mandates have gotten under his skin—laws the Legislature might or might not pass that require health insurers to cover a specific malady, treatment or therapy. Juneau is president of the Louisiana Association of Business and Industry, which has been fighting mandates for years, losing quite a few battles in the process: More than 30 have made it into law over the last couple of decades.

Indeed, the 2008 regular session has seen a cascade of mandate bills. There are nine proposed mandates in all—a record for a single session. For example, House Bill 958, which requires insurers to cover a type of effective but expensive therapy for autism spectrum disorder, was helped along by a massive grassroots effort guided by a national advocacy group, Autism Speaks.

When the insurance committee voted on Rep. Franklin Foil’s bill on April 30, representatives from LABI and the local chapter of the National Federation of Independent Business were clearly outgunned by supporters of H.B. 958. The bill’s supporters crowded the room, holding handmade signs and photos of children with autism. They had testimonials from a pediatrician and mothers of autistic children. They had a numbers man from Pennsylvania who explained to the committee how the actual impact on premiums would be negligible.

In the other corner, LABI and NFIB had the same argument they’ve always had: Mandates equal fewer people with insurance. Don’t pass them.

Juneau says it’s hard to hold the line on new bills with a term-limited Legislature with no memory of the many mandates already imposed over the years. It might seem like “a few pennies here and a few pennies there,” but they add up.

He cites a Council for Affordable Health Insurance study showing a 25% midrange estimate of additional premium cost because of mandates.

“Mandates are a part of this,” Juneau says. “You can’t have that many on the books without it having an impact.”

Juneau insists he empathizes with people grappling with health issues themselves or within their families. Still, the number of privately insured Louisianans is declining, and more mandates only hasten that trend, he says.

The business owners that make up LABI’s constituents won’t be happy with legislators’ votes, Juneau says. “We’re going to do is report all this very directly to employers,” he says. “They won’t like this. If that’s not important to [legislators] politically, then they can keep passing these mandates.”

Gil Dupré is CEO of the Louisiana Association of Health Plans, which also lobbies against mandates, but agreed to compromises on the autism and a prosthetics bill. LAHP hammered out a compromise with Foil over the autism bill and thus didn’t oppose it during the committee hearing.

Dupré notes that during the hearing, committee members complained about not hearing from individual employers—the people LAHP, LABI, NFIB and other lobbyists argue are the ones hurt by mandates. Having those voices front and center might make for a more effective defense against new mandates, Dupré says.

“I would think they would value hearing opinions from those folks about how they feel about these benefits on a bill-by-bill basis,” he says. “The mood of the Legislature—at least the House insurance committee—seems to be to look at each of those to evaluate each on own merits.”

That’s exactly how it ought to work, says Rep. Chuck Kleckley, a businessman and “anti-mandate” guy. He also chairs the insurance committee. H.B. 318, a mandate requiring health plans to extend more coverage to prosthetics and services, is his bill. It has been approved by the full House and gone to the Senate insurance committee.

A self-described pro-business Republican, Kleckley says H.B. 318 is important for those who could re-enter society as productive citizens after losing limbs but are prevented from doing so in many cases because their health plans don’t sufficiently cover the high cost of prosthetics and related services.

“I think long term it’s better to have these people return to work and become productive members of society than sit at home where they can’t do anything and become a burden to the state,” Kleckley says.

However previous insurance committees might have done it, Kleckley says his committee is made up of young, intelligent, inquisitive members interested in facts and numbers when it comes to debating an issue—not just a generic objection on the part of business lobbying groups. Not that every mandate is worthy, he says, though each should be judged on its own merits in terms of cost versus benefit rather than being rejected out of hand simply because it’s a mandate.

“If you’re going to oppose something, you better have your facts together and have a good reason,” Kleckley says.

The business lobby’s counterattack during the hearing for Kleckley’s prosthetics bill was roughly the same as the one mounted against Foil’s autism bill, which is to say it was underwhelming.

Dupré, who’s seen mandates work their way into the hearts of legislators plenty of times over the years, says that it’s time to sit down and have a talk in the wake of a record number of new mandates being introduced.

“I think maybe it’s an indication that we do have some educating to do of the legislators of what the impact is,” he says.

IT’S A MANDATE

Here are the nine insurance mandates under consideration by the Louisiana Legislature during its 2008 regular session:

Annual mammograms

House Bill 512: Would require health insurance coverage for mammography examinations as provided by the American Cancer Society

Autism spectrum

House Bill 958: Would require health insurance coverage of the diagnosis and treatment of autism spectrum disorders in individuals under 17 years of age

Contraceptives and services

House Bill 562: Would require certain coverage of medically prescribed contraceptives and contraceptive services

Fertility treatments

Senate Bill 354: Would require health insurers to provide coverage for fertility treatments

Human papillomavirus vaccine

House Bills 99, 357, 543: Would require health insurance coverage of the human papillomavirus vaccine

Mental health and substance abuse

Senate Bill 535: Would require insurance coverage of certain medically necessary treatments for alcoholism, drug abuse and mental illness, effective upon the enactment of an income tax credit equal to the cost of premiums related to providing such coverage

Prosthetic devices and services

House Bill 318: Would require health insurance coverage of prosthetic devices and prosthetic services

Rate filings

Senate Bill 148: Would prohibit insurers from including fines and penalties in rate filings

Reimbursement to doctors for services provided via telemedicine

House Bill 1265: Would provide for the reimbursement of certain physicians for diagnostic or consultative services provided via telemedicine