Mandated Benefits Review - Senate Bill 1183 - Executive Summary

After reviewing the staff analysis of Senate Bill 1183-infertility diagnosis and treatment-Pennsylvania Health Care Cost Containment Council does not find evidence to recommend this bill at this time. While this issue is emotionally compelling, we were unable to find needed proof in the review of Senate Bill 1183 that comprehensive coverage of infertility services would be cost effective. In general, the Council believes that recommending the passage of legislation calling for health care mandates be limited to those measures which are of both proven efficacy and cost effectiveness. Infertility treatments are costly and have a relatively low rate of success in comparison to treatments for many medical conditions.

The Council also considered SB 1183 in light of serious concerns about the cumulative impact which mandates have on the costs of health care. While mandated benefits provide people with health insurance more health care options, they also play a role in fewer Pennsylvanians being insured. We conclude that mandating insurance coverage of costly treatments which benefit comparatively few Pennsylvania residents is not a cost effective means of utilizing limited health care resources. With many health care needs not covered and with 12 percent of the adult population in Pennsylvania without even basic coverage, there is no persuasive reason to give infertility treatment special priority under law. We note the following points:

The Council suggests that caution must be used when considering health care mandates. In particular, attention must be given to the cumulative financial effect of enacting mandates. The Council notes the correlation between the number of mandates and the increasing cost of health insurance, the increasing number of uninsured, the incentive for large employers to self insure, and the decreasing number of employees covered by employer sponsored health insurance. As a Council, we are charged with the responsibility to "promote the public interest by encouraging the development of competitive health care services in which health care costs are contained and to assure that all citizens have reasonable access to quality health care" (Act 34 of 1993).

The Council contends that some mandates have the potential to meet proven efficacy and cost-effectiveness standards. For others, however, the balance is not so clear. While the Council is sensitive to those suffering from infertility, we were unable to find needed proof in the review of SB 1183 that coverage of infertility benefits would be cost effective.