THE EFFECT OF STATE INSURANCE MANDATES ON INFANT IMMUNIZATION RATES

While US infant immunization rates have been increasing in the last 20 years, the cost of fully immunizing a child with all recommended vaccines has almost tripled. This is partly not only due to new additions in the list of recommended vaccines but also due to the use of new, safer, but more expensive technologies in vaccine production and distribution. In recent years, many states have mandated that recommended childhood vaccines be covered by private health insurance companies. Currently, there are 33 states with such a mandate. In this paper, I examine whether the introduction of mandates on private insurers affected immunization rates. Using state and time variation, I find that mandates increased the immunization rate for three vaccines--the diphtheria-tetanus-pertussis, polio, and measles-mumps-rubella vaccines--by about 1.8 percentage points. These results may provide a lower bound for the expected effect of the Affordable Care Act, which mandates coverage of childhood vaccines for all private insurers in the USA. I also find evidence that the mandates shifted a significant portion of vaccinations from publicly funded sources to private ones, with a decline in public health clinic visits and an increase in vaccinations at hospitals and doctor's offices.

Colorectal Cancer Screening and State Health Insurance Mandates

Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women.

The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment

As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.

Utilization of infertility treatments: the effects of insurance mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.