Law and the Public's Health

Abstract

This installment of Law and the Public’s Health examines the problem of state laws that permit various types of insurers to exclude from coverage all costs related to “intoxication” injuries and considers the implications of these laws for public health policy and practice. Although laws permitting insurers to use intoxication exclusionary clauses have fallen out of favor with the National Association of Insurance Commissioners (NAIC), nearly all states and the District of Columbia continue to explicitly or implicitly permit licensed insurers to exclude coverage for diagnostic and treatment services for conditions related to the use of alcohol or drugs. 1 Such exclusions not only have potentially significant consequences for health care quality and financing, but also may impede efforts to protect the public’s health through efforts to encourage providers to promptly identify and begin treatment for acute intoxication and chronic substance use disorders. Indeed, laws permitting intoxication exclusions represent a fundamental disjunction between evidence-based medical care on the one hand and health financing on the other, since intoxication exclusions financially disincentivize precisely the type of medical response that has been identified as a benchmark of clinically appropriate medical care. 2