A.1943/S.24 – Mandates Health Insurance Coverage for Congenital Anomalies
Memorandum in Opposition
|For Immediate Release: May 24, 2021|
Re: A.1943 (Simon)/S.24 (Kaplan) – AN ACT to amend the insurance law, in relation to enacting the “Give Kids a Chance – Carter’s Law” mandating health insurance coverage for congenital anomalies.
This legislation, A.1943/S.24, would require coverage for medical and dental treatments as well as rehabilitative therapies (physical, speech, occupational, etc.) to address conditions or illness related to or developed as a result of a congenital anomaly. The New York Health Plan Association (HPA) opposes this legislation because it creates a new coverage requirement for all fully insured policies sold in New York and health insurance mandates result in increased costs for individuals and employers purchasing health insurance in the state.
In the vast majority of cases of babies diagnosed with a congenital anomaly, treatment and services necessary to address these anomalies – both initial and follow up — are covered. In cases where there may be a dispute over treatment or services, or when it may be determined they are not medically necessary, there are processes in place – internal and external – to appeal a health plan’s decision. Although sympathetic to those affected when a child is diagnosed with a congenital defect, the impact of imposing new benefit requirements reaches far beyond these families. The additional costs of providing mandated benefits increases the cost of health insurance coverage for everyone and may threaten affordability for some.
Mandating coverage of specific services disproportionately impact small and medium-sized employers. Forcing employers to include benefits they and their workforce may not want or need exacerbates the challenge they face to find affordable health care options.
Moreover, mandated benefit bills pertain only to fully-insured policies, which are generally those purchased either by individuals who buy coverage on their own or receive it through a small or medium-sized business. Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers, which are governed by the federal Employee Retirement Income Security Act (ERISA) and therefore not subject to state mandated benefits. This exemption offers self-insured employers greater control over the particular benefits they cover for their employees.
One reason large employers typically self-insure is to avoid covering certain mandated benefits. Today, more than 50 percent of the commercial market in New York is covered under a self-insured plan. As more employers self-insure, state laws mandating specific types of benefits and services affect an increasingly smaller portion of the privately insured marketplace and fall largely on small and medium-sized employers.
At a time when many New Yorkers are struggling to afford the health insurance coverage they have, this bill is ill advised. We urge you to say no to A.1943/S.24.
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