Insurance Mandate Research Articles

Comparison of Reference and Biosimilar Medications for Pediatric Noninfectious Uveitis.

Compare outcomes and costs of TNF-alpha inhibitor biosimilars to reference medications in the treatment of pediatric NIU. Patients 18 years old or below treated with reference or biosimilar TNF-alpha inhibitor for noninfectious uveitis and had a history of active ocular inflammation with at least 1 month of ophthalmology follow-up from January 1, 2013, to June 1, 2023, were included. Retrospective chart review was performed. Nineteen patients met the inclusion criteria. Mean age was 9.3±4.0 years, and 47.4% (9/19) were female. Of the patients who were on infliximab at any time point in their disease course (n=9), the mean duration on infliximab was 3.6 years (42mo). Of the patients on biosimilar infliximab (n=10), the mean duration was 0.82 years (9.8mo). Mean flares/year was 0.22±0.3 on infliximab and 0.15±0.3 on biosimilar infliximab. The average annual cost was $42,298.97 for infliximab (n =9), $41,141 for infliximab-dyyb (n=9), and $40,950 for infliximab-axxq (n=1). Reasons for switching to biosimilar infliximab from adalimumab included a combination of insurance mandate (100%), worsening disease activity (37.5%), or other issues such as noncompliance (37.5%). The most common reason for biosimilar initiation was insurance mandate. Compared with the reference infliximab, pediatric patients had fewer number of flares per year on biosimilar infliximab, but they were also on the biosimilar for a shorter duration of time compared with the reference which may confound an accurate assessment. Biosimilar infliximab had a lower cost profile compared with reference infliximab.

Preserving Fertility in People With Rheumatic Diseases.

Rheumatology patients historically were told they "can't" or "shouldn't" become pregnant. Improved rheumatic diagnostics and treatments have led to decreased morbidity and mortality and increased quality of life resulting in an opportunity to focus on fertility and its preservation. In the same vein as rheumatic disease care, assisted reproductive technology (ART), which includes freezing of egg and sperm as well as in vitro fertilization, has made considerable strides in the recent past. ART is safe for those with rheumatic diseases and has comparable outcomes to the general public, but may take additional effort due to optimal timing, rheumatic medications, and other nuances. In a specialty that treats chronic inflammatory diagnoses using teratogens and gonadotoxins, it is important to address family building desires with patients so their goals can be met.Rheumatologists have little knowledge of ART and how it impacts or applies to their patients; however, patients want their rheumatologist to be the source of knowledge for this information (Arthritis Rheumatol. 2022;74:suppl 9). Many barriers to ART exist and will be explored, with the financial burden being paramount (Glob J Health Sci. 6;1:181-191). Future efforts to examine the future fertility of rheumatology patients in an era of biologics and "treat-to-target" are needed to better understand who would most benefit from this costly and not without risk medical treatment. Given the changing landscape of financial support for ART due to insurance mandates, rheumatologists should not modify counseling based on the anticipated ability of patients to afford care. Preservation should also be broached with patients without partners and those from the LGBTQAI+ community. In addition to expanding the education of rheumatologists regarding this topic and its incorporation into clinical care, advocacy for ART access and insurance coverage is a much-needed future direction.

Health Insurance Mandates for Nonpharmacological Pain Treatments in 7 US States

This cross-sectional study examines the extent to which states have introduced or enacted mandates for coverage of nonpharmacological pain treatments and characterizes the variation in such mandates.

Effects of State-Level Individual Mandate on Veterans’ Access to Health Care in the United States

Following the repeal of the federal individual health insurance mandate, five states and D.C. adopted their own state-level individual mandates to counteract the potential negative consequences of the repeal. This study examines the actual changes in veterans’ enrollments in private and Veterans Affairs (VA) insurance following the 2019 repeal. By analyzing data from 65,297 non-elderly veterans aged 18 to 64 in the U.S. between 2019 and 2021, we found that state-level individual mandates have positive effects on veterans’ enrollments in private and VA insurance, but the effects vary depending on individual income levels. The state-level individual mandate successfully serves as a substitute for the federal mandate. The results imply that veterans in states without individual mandate policies are more likely to worry about health insurance premiums and medical bills, limiting access to health care and potentially worsening health outcomes. Thus, the Veterans Health Administration should endeavor to encourage more state governments to adopt individual mandate policies.

The Status of Fertility Preservation (FP) Insurance Mandates and Their Impact on Utilization and Access to Care.

Fertility preservation (FP) is the use of a specific medical intervention to protect the fertility of individuals whose disease or disease treatment may lead to infertility. These medical interventions include the cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue; oocyte and embryo cryopreservation are the most widely used interventions in the United States. Although guidelines recommend FP prior to undergoing gonadotoxic treatments, cost barriers are high. For example, the average cost of an oocyte cryopreservation cycle in the United States exceeds $10,000. High cost and lack of insurance coverage are two of the most cited reasons explaining the low Reproductive Endocrinology and Infertility (REI) referral rates and limited FP utilization. Broadening insurance mandates for FP prior to gonadotoxic treatments could improve utilization and provide cancer survivors with improved quality of life post treatment.

The Academic and Behavioral Impacts of an Autism Health Insurance Mandate: Evidence from Massachusetts

Abstract Today, all 50 states have enacted mandates requiring some level of insurance coverage for the treatment of autism spectrum disorders (ASD). In this paper, I examine the impact of Massachusetts’ mandate, ARICA (An Act Relative to Insurance Coverage for Autism) on the academic and behavioral outcomes of students with ASD in the state. Using administrative data on Massachusetts public school students, I use a triple difference strategy to estimate impacts on special education setting, attendance, suspensions and achievement. I find that ARICA increased inclusion for students with ASD; they were 4 percentage points more likely to be fully included after the reform. Further, days suspended decreased by about 26 percent, and the likelihood of receiving a suspension decreased by about 2 percentage points. I find that improvements in student outcomes were larger for students in grades 6–8 (versus elementary students). While I find no statistically significant improvement in test scores for students with ASD overall, math (English language arts) achievement increased by 0.09 (0.13) standard deviation for students in middle grades.

The General Influence of Government and Politics in US Healthcare

ABSTRACT Politics in the United States are deeply intertwined with its healthcare. Interventions from the US government may be to remedy problems that the individual citizen is otherwise incapable of remedying. Government healthcare policy can result in tensions between the individual needs during illness and the government goals of achieving population-based benefit. Some of these challenges are further highlighted with rising use of social media, the development of healthcare insurance mandates, and the inherent differences of each political party.

Minimum wage, social insurance mandate, and working hours

Raising the minimum wage may have unintended negative consequences for workers. In South Korea, employers are required to contribute towards their employees’ social insurance, with the amount proportional to earnings. However, workers employed for less than 60 h per month are exempt from this contribution requirement. Using administrative payroll records from 2011 to 2019, we find that raising the minimum wage results in a higher share of the exempt workers. Our results remain robust when focusing on unanticipated hikes in the minimum wage in 2018 and 2019.

Association of State Insurance Mandates for Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing for Aneuploidy

(Abstracted from JAMA Network Open 2023;6(1):e2251739) Multiple gestation is one of the most common risks associated with fertility treatment, such as in vitro fertilization (IVF). Compared with singleton pregnancies, pregnancies with multiples are at increased risk of maternal and neonatal morbidity and mortality as well as higher health care costs.

Health Insurance Mandates and Traffic Fatalities

Next article No AccessHealth insurance mandates and traffic fatalities: The effect of substance use disorder parity lawsMichael T. French, Catherine Maclean, and Ioana PopoviciMichael T. French Search for more articles by this author , Catherine Maclean Search for more articles by this author , and Ioana Popovici Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by American Journal of Health Economics Just Accepted Published for the American Society of Health Economists (ASHEcon) Article DOIhttps://doi.org/10.1086/724864 HistoryAccepted March 02, 2023 © 2023 American Society of Health Economics. All Rights reserved.PDF download Crossref reports no articles citing this article.

Outcomes for Standardized Home and Hospital-Based Infusions of Infliximab for Children With Inflammatory Bowel Disease.

Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse outcomes (AOs) of infliximab infusions in children with IBD receiving HI compared to hospital-based infusions. Children receiving HI between September 2016 and September 2018 were retrospectively matched based on age, race, ethnicity, sex, and disease type to a cohort receiving infliximab at a hospital-based center. A survival analysis evaluated the hazard ratio for AOs in HI relative to hospital-infused children over 2 years. AOs were defined as discontinuation of therapy for clinically relevant reasons, IBD-related hospitalizations, and emergency department visits. We included 102 children (51 pairs) (63% male, 91% White, 92% Crohn disease). Disease location, behavior, growth status, and disease severity were similar between the 2 cohorts. Quiescent disease increased from 3% to 93% after 2 years without cohort differences. At baseline, 94% of HI patients and 88% of controls were on 5 mg/kg every 8 weeks as standard maintenance therapy. Within 2 years, only 19% remained on 5 mg/kg and the remainder required increased dosing or decreased interval. The HI cohort had fewer labs obtained ( P < 0.001), though laboratory values, number of clinic visits, and frequency of AOs were similar. Drug durability, AOs, and laboratory values were similar between HI and hospital-based infusions. These findings suggest HI may be as effective as hospital-based infusions, provided a standardized care approach is utilized.

Association of State Insurance Mandates for Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing for Aneuploidy

Multiple gestation is one of the biggest risks after in vitro fertilization (IVF), largely due to multiple embryo transfer (MET). Single embryo transfer (SET) uptake has increased over time and has been attributed to various factors, such as mandated insurance coverage for IVF and preimplantation genetic testing for aneuploidy (PGT-A). To investigate whether mandates for IVF insurance coverage are associated with decreased use of MET after PGT-A. This cohort study was conducted using data on embryo transfers reported to the Society for Assisted Reproductive Technology between 2014 and 2016. Data were analyzed from January to October 2021. State-mandated coverage for fertility treatment and type of cycle transfer performed (PGT-A, untested fresh, and untested frozen). Use of MET compared with SET, live birth, and live birth of multiples. There were 110 843 embryo transfers (mean [SD] patient age, 34.0 [4.5] years; 5520 individuals identified as African American [5.0%], 10 035 as Asian [9.0%], 5425 as Hispanic [4.9%], 45 561 as White [41.1%], and 44 302 as other or unknown race or ethnicity [40.0%]); 17 650 transfers used embryos that underwent PGT-A. Overall, among transferred embryos that had PGT-A, there were 9712 live births (55.0%). The odds of live birth were 70% higher with MET vs SET after frozen embryo transfer with PGT-A (OR, 1.70; 95% CI, 1.61-1.78), but the risk of multiples was 5 times higher (OR, 5.33; 95% CI, 5.22-5.44). The odds of MET in cycles with PGT-A in states with insurance mandates were 24% lower than in states without mandates (OR, 0.76; 95% CI, 0.68-0.85). This study found that despite the promise of using SET with PGT-A, MET after PGT-A was not uncommon. This practice was more common in states without insurance mandates and was associated with a high risk of multiples.

Do Firms Avoid Health Insurance Mandates? Evidence from the Self-Funding of Employer Plans

Do Firms Avoid Health Insurance Mandates? Evidence from the Self-Funding of Employer Plans

Gun Insurance Mandates and the Second Amendment

Gun Insurance Mandates and the Second Amendment

State insurance mandates for in vitro fertilization are not associated with improving racial and ethnic disparities in utilization and treatment outcomes

Racial and ethnic disparities in utilization and clinical outcomes following fertility care with invitro fertilization in the United States are well-documented. Given the cost of fertility care, lack of insurance is a barrier to access across all races and ethnicities. This study aimed to determine how state insurance mandates are associated with racial and ethnic disparities in invitro fertilization utilization and clinical outcomes. This was a cohort study using data from the Society for Assisted Reproductive Technology Clinical Outcome Reporting System from 2014 to 2019 for autologous invitro fertilization cycles. The primary outcomes were utilization-defined as the number of invitro fertilization cycles per 10,000 reproductive-aged women-and cumulative live birth-defined as the delivery of at least 1 liveborn neonate resulting from a single stimulation cycle and its corresponding fresh or thawed transfers. Most (72.9%) of the 1,096,539 cycles from 487,191 women occurred in states without an insurance mandate. Although utilization was higher across all racial and ethnic groups in mandated states, the increase in utilization was greatest for non-Hispanic Asian and non-Hispanic White women. For instance, in the most recent study year (2019), the utilization rates for non-Hispanic White women compared with non-Hispanic Black/African American women were 23.5 cycles per 10,000 women higher in nonmandated states and 56.2 cycles per 10,000 women higher in mandated states. There was no significant interaction between race and ethnicity and insurance mandate status on any of the clinical outcomes (all P-values for interaction terms > .05). Racial and ethnic disparities in utilization of invitro fertilization and clinical outcomes for autologous cycles persist regardless of state health insurance mandates.

WHEN STATES REQUIRE FULLY-INSURED EMPLOYERS TO PROVIDE INSURANCE COVERAGE FOR IN-VITRO FERTILIZATION (IVF), DO SELF-INSURED EMPLOYERS FOLLOW SUIT?

In the United States, access to fertility care is mediated by health insurance coverage, and most reproductive-age adults receive insurance from their employers. Employers can be “fully-insured” and beholden to state insurance mandates or can be “self-insured” and exempt from state insurance mandates. Thirteen states mandate that fully-insured employers provide insurance coverage for IVF(1). However, 65% of adults with employer-sponsored insurance work for self-insured employers(2). Our objective was to evaluate the fertility coverage offered by self-insured employers in those 13 states, even though they are exempt from the state mandates.

Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis.

To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.

The Massachusetts Infertility Insurance Mandate: not nearly enough

To assess the impact of statutory federal and state exceptions to the state law mandating insurance coverage for the diagnosis and treatment of infertility. Population-based cross-sectional study comprised of reproductive-age women (defined herein as 20-44 years of age) who resided in Massachusetts during the 2016-2019 interval. Statutory exemptions to the benefits afforded by the Massachusetts Infertility Insurance Mandate were identified in the Massachusetts General Laws as well as in the United States Code. Not applicable. Publicly available, deidentified, population-level data pertaining to state-based reproductive-age women (aged 20-44 years) were procured for the 2016-2019 interval. Data sources included the Massachusetts Census Bureau, Massachusetts Center for Health Information and Analysis, US Department of Defense, and US Office of Personnel Management. None. The proportion of state-based reproductive-age women who constitute beneficiaries of the Massachusetts Infertility Insurance Mandate after accounting for the applicable state and federal statutory exemptions that limit its impact. Public health plans (Medicare, MassHealth [state Medicaid], TRICARE, and the Federal Employees Health Benefits Program) are exempted from the Massachusetts Infertility Insurance Mandate by dint of federal or state statute. Self-insured employer-sponsored health plans are exempted from the Massachusetts Infertility Insurance Mandate by dint of the federal Employee Retirement Income Security Act. It follows that only 26.2%-36.0% of state-based reproductive-age women comprised eligible beneficiaries of the Massachusetts Infertility Insurance Mandate over the 2016-2019 interval. Contrary to commonly held views, multiple statutory exemptions to the Massachusetts Infertility Insurance Mandate render a significant proportion of state-based reproductive-age women ineligible for its cognate benefits. We propose herein that the Essential Health Benefit categories of the Affordable Care Act be expanded by the US Congress to include infertility care services.

The impact of insurance mandates on donor oocyte utilization: an analysis of 39,338 donor oocyte cycles from the Society for Assisted Reproductive Technology registry

A total of 19 states passed legislation mandating insurance coverage of assisted reproductive technology, and out-of-pocket costs associated with invitro fertilization vary significantly depending on the region. Consequently, it has been observed that assisted reproductive technology utilization differs regionally and is associated with the presence of an insurance mandate. However, it is unknown whether regional differences exist among patients using donor oocytes. This study aimed to determine the patient and cycle-specific parameters associated with the use of donor oocytes according to the insurance mandate status of the Society for Assisted Reproductive Technology clinic in which the assisted reproductive technology cycle was performed. This study was a retrospective cohort study using national data collected from the Society for Assisted Reproductive Technology registry for 39,338 donor oocyte cycles and 242,555 autologous oocyte cycles performed in the United States from January 1, 2014, to December 31, 2016. Cycles were stratified by insurance mandate of the state in which the assisted reproductive technology cycle was performed: comprehensive (coverage for at least 4 cycles of assisted reproductive technology), limited (coverage limited to 1-3 assisted reproductive technology cycles), offer (insurance mandates exist but exclude assisted reproductive technology treatment), and no mandate. The primary outcome was the number of previous autologous assisted reproductive technology cycles of the recipient. The secondary outcomes included age, serum follicle stimulating hormone level, frozen donor oocyte utilization, day of embryo transfer, number of embryos transferred, clinical pregnancy rate, and live birth rate. Analyses were adjusted for day of transfer, number of embryos transferred, and age of the recipient. Patients in no mandate states underwent fewer autologous assisted reproductive technology cycles (mean, 1.1; standard deviation, 1.6) before using donor oocytes than patients in offer (mean, 1.7; standard deviation, 2.5; P<.01), limited (mean, 1.5; standard deviation, 2.5; P<.01), and comprehensive (mean, 1.7; standard deviation, 2.0; P<.01) states. Patients in no mandate states were more likely to use frozen oocytes than patients in offer (relative risk, 0.54; 95% confidence interval, 0.52-0.57), limited (relative risk, 0.50; 95% confidence interval, 0.46-0.54), and comprehensive (relative risk, 0.94; 95% confidence interval, 0.89-0.99) states. Clinical pregnancy and live birth rates were similar among recipients of donor oocytes, regardless of insurance mandate. Despite similar ages and ovarian reserve parameters, patients without state-mandated insurance coverage of assisted reproductive technology were more likely to use frozen donor oocytes and undergo fewer autologous invitro fertilization cycles than their counterparts in partial or comprehensive insurance coverage states. These differences in donor oocyte utilization highlight the financial barriers associated with pursuing assisted reproductive technology in uninsured states.

Integration Strategy for e-Intensive Care Unit: A Narrative Review and Implementation Plan.

Introduction: The objectives of this article are to review previously established tele-intensive care unit (ICU) services describing their impact at the technical and medical level, and to propose an implementation plan to equip health care facilities in need of telehealth. Materials and Methods: We searched MEDLINE, EMBASE, PubMed, and ISI web of knowledge, using terms related to "e-ICU" and "tele-ICU" from inception to May 2021. Discussion: At the technical level, an increase in private insurance enrollment and routine checkups, as well as a reduction in hospital utilization rates and improvement in health outcomes was seen in the aftermath of the adoption of telehealth insurance mandates. Moreover, e-ICU helped reducing mortality and length of hospital stay of critically ill patients. The main approach to implementation should include features that are widely accepted for quality improvement, including being focused on patient-centered outcomes, having strong executive support, and targeting changes that were known to improve outcomes. HL7 Fast Healthcare Interoperability Resources stands out as one of the best candidates to achieve structural interoperability for patient health records. Conclusions: Adoption of tele-ICU services requires a substantial up-front investment and ongoing cost of maintenance. This could be challenging for hospitals with low budgets. Hence the importance of further investigating more efficient strategies of e-ICU services integration and implementation.