Address correspondence to Gerald F. Kominski, Ph.D., Department of Health Services, and the Center for Health Policy Research, UCLA School of Public Health, 650 Charles E. Young Drive South Box 177220, Los Angeles, CA 90095. Jay C. Ripps, F.S.A., M.A.A.A., is with Milliman Inc. (“Milliman”), San Francisco, CA. Miriam J. Laugesen, Ph.D., is with the Department of Health Services, UCLA School of Public Health, Los Angeles, CA. Robert G. Cosway, F.S.A., M.A.A.A., is with Milliman Inc. (“Milliman”), Milliman USA, La Jolla Centre II, San Diego, CA. Nadereh Pourat, Ph.D., is with the Department of Health Services, and the Center for Health Policy Research, UCLA School of Public Health, Los Angeles, CA.
The California Cost and Coverage Model: Analyses of the Financial Impacts of Benefit Mandates for the California Legislature
Article first published online: 13 MAR 2006
Health Services Research
Volume 41, Issue 3p2, pages 1027–1044, June 2006
How to Cite
Kominski, G. F., Ripps, J. C., Laugesen, M. J., Cosway, R. G. and Pourat, N. (2006), The California Cost and Coverage Model: Analyses of the Financial Impacts of Benefit Mandates for the California Legislature. Health Services Research, 41: 1027–1044. doi: 10.1111/j.1475-6773.2006.00518.x
- Issue published online: 13 MAR 2006
- Article first published online: 13 MAR 2006
- Insurance mandates;
- health care expenditures;
- utilization and cost impacts;
- evidence-based policy analysis
Objective. To produce cost estimates of proposed health insurance benefit mandates for the California legislature.
Data Sources. The 2001 California Health Interview Survey, 2002 Kaiser Family Foundation/Health Research and Education Trust California Employer Health Benefits Survey, Milliman Health Cost Guidelines, and ad hoc surveys of large health plans were used.
Study Design. We developed an actuarial model to estimate short-term (1 year) changes in utilization and total health care expenditures, including insurance premiums and out-of-pocket expenditures, if insurance mandates were enacted. This model includes baseline estimates of current coverage and total current expenditures for each proposed mandate.
Principal Findings. Analysis of seven legislative proposals indicated 1-year increases in total health care expenditures among the insured population in California ranging from 0.006 to 0.200 percent. Even when proposed mandates were expected to reach a large target group, either utilization or cost was sufficiently low to keep total cost increases minimal.
Conclusions. Our ability to develop a California-specific model to estimate the impacts of proposed mandates in a timely fashion provided California legislators during the 2004 legislative session with more-detailed coverage and cost information than is generally available to legislative bodies.