Mandating Costs

Workers across the country are feeling the pinch of higher health care costs. A recent corporate survey found one-fourth of companies raised deductibles by 9 percent last year, and a third said they expected to raise them as much as 14 percent this year. Companies also are increasing the share of premiums paid by employees. News articles relate sad stories of individuals forced to forgo treatment because of rising deductibles. The Washington Post reports, "Workers' health costs are rising much faster than wages."

That is the backdrop against which the General Assembly is debating a measure to raise the cost of insurance even further. The well-intentioned proposal -- what proposal isn't? -- would require insurance companies to pay for autism treatment.

Those pushing for the mandate insist the cost would be small. But state mandates already account for roughly one-fourth of the price of an insurance policy in Virginia. Marginally increasing the cost of insurance even further might not imperil large companies, but it could prove deleterious to those teetering on the edge between keeping and dropping their employee coverage.

And the cost might not be so marginal. It's worth noting the warning that accompanies another bill under consideration this year. The measure would require the commonwealth to abide by any new mandates imposed on private insurers. If the state required autism insurance in the private sector, then it also would have to provide the same to state workers.

A Department of Planning and Budget fiscal-impact statement warns: "This potentially widespread application of mandates to the state employee plan will increase the cost of the plan which will likely result in premium increases for both the employee and the employer . . . .It is not possible to predict how many such mandates will be approved this session and in future sessions, therefore the magnitude of the impact is not known."

It would be telling indeed if the commonwealth passed yet another mandate for the private sector this year -- but declined to enforce the same standards for its own health-care coverage.

Advocates of requiring coverage for various conditions and treatments -- including, a couple of years ago, a controversial cervical-cancer vaccine marketed by a giant pharmaceutical company -- already have succeeded in piling mandate upon mandate on insurance companies in Virginia. Ironically, those earlier mandates may be one reason more insurance companies don't offer autism insurance now: They have been forced by law to cover other conditions, and so can't afford to. Who knows what types of coverage they might be compelled to drop or forego if Virginia forces them to cover autism?

We recognize the plight of parents of autistic children, whose daily struggles deserve sympathy and consideration. But adding yet another state coverage requirement seems likely to solve one problem only by creating others -- less visible perhaps, but no less real.