LITTLE ROCK — Insurance Commissioner Jay Bradford has adopted benchmark health benefits that don’t require coverage of in vitro fertilization, leaving the state on the hook for up to $3.8 million in fertility treatment bills after the new health-insurance exchange starts operating in 2014.
But the state might never have to pay that money if lawmakers decide to repeal the 1987 law that requires most insurance policies to offer in vitro coverage.
At least some bipartisan support exists for repeal, said Cynthia Crone, planning manager for the state’s insurance exchange - designed to help cover the state’s approximately 526,000 uninsured.
If the state mandate is abolished, insurance companies will decide whether Arkansas families that want in vitro fertility treatments will have to pay extra for them or if coverage will be offered at all, she and other exchange officials said.
Fifteen states currently mandate some type of insurance coverage for infertility treatments, according to the National Infertility Association, a trade group based near Washington.
Dr. Dean Moutos, a Little Rock fertility specialist, said that in states that don’t have some sort of mandate, insurance companies usually don’t offer fertility coverage, raising the average price for an in vitro cycle from $1,500 to $2,000 to up to $12,000.
Moutos’ clinic, the only one in the state, performs about 230 cycles a year. Most of his patients are “working people” that rely on the state mandate to afford the treatments, he said.
If the mandate goes away, “then you’re denying them a chance to have a family,” Moutos said.
But Rep. Terry Rice, R-Waldron, who would become House speaker if Republicans win control of that legislative body in November, said he doesn’t support the in vitro mandate.
“There are so many things that we can do that we can’t afford to do. We’ve got to draw the line somewhere,” Rice said.
On Friday, Bradford approved a benchmark coverage of 10 essential health benefits to be offered in all Arkansas individual and small-group insurance policies after the federally mandated health exchange starts operating in January 2014.
“It’s middle of the road. Nothing too rich - because I’ve got to control costs - but one that would serve our citizens well,” Bradford said in an interview Monday.
Arkansas Blue Cross Blue Shield’s Health Advantage was selected as providing most of the benchmark benefits. Exchange planners supplemented the Blue Cross plan with pediatric vision and dental insurance as well as mental-health and substance-abuse coverage.
Although the plan functions on a point-of-service model, it is licensed as a health-maintenance organization or HMO. The state law that requires most insurance policies to provide in vitro treatments exempted HMOs, said Zane Chrisman, planning specialist for the exchange.
The exemption was one of several reasons Bradford chose Blue Cross’s plan, said Crone.
Lower overall costs, a better package of benefits and lower premiums also figured into his decision, she said.
The exchange’s plan-management advisory committee voted 16-11 to recommend a Blue Cross preferred provider organization plan or PPO. That plan was required to offer in vitro coverage. The exchange’s steering committee recommended by a 13-1 vote to leave the decision up to Bradford.
By avoiding the state mandated in vitro fertilization coverage in selecting an HMO, Arkansas will be required to subsidize the portion of insurance premiums that cover in vitro treatments, said Crone.
That could cost the state anywhere from $496,080 to $3.8 million, according to Bradford’s directive.
But if the state law is repealed, the state doesn’t have to pay anything and no insurance company will be required to offer in vitro coverage as part of their plans or even as “riders” or extra, pricier coverage, exchange officials said.
Since the in vitro requirement - which provides up to $15,000 in coverage - became state law, some lawmakers have objected to it. In 1990, a North Little Rock state representative argued that the mandate discriminated against working-class Arkansans who paid for the treatments in their premiums but couldn’t afford the treatments for themselves.
In 2009, then-Rep. Dan Greenberg, a Little Rock Republican, briefly introduced legislation that would repeal the mandate, but withdrew it.
In a blog post after pulling his bill, Greenberg said that in vitro mandates raised health insurance costs by 3 percent to 5 percent nationwide.
Moutos said the costs for the average premiums are much smaller.
“When you spread the costs among every person in the state, it adds just a few dollars to their premiums,” Moutos said.
The state’s insurance exchange is part of the federal health-care law. In 2011, the state Legislature killed efforts to create a state-run exchange.
The current model is a federal-state “partnership,” in which the state retains some control.
Consumers won’t pay more than a share of their income, which will be determined by where they fall between 100 percent and 400 percent of the poverty level.
That means that an individual earning up to $43,000 or a family of four earning up to $88,080 would receive some subsidy.
If premiums rise, the federal government - not the consumer - is on the hook for the difference.
Exchange officials estimate that 572,000 Arkansans will be eligible for exchange coverage.
About 328,000 will enroll, exchange officials estimated in July.
Individuals, families and small businesses with fewer than 50 employees will be eligible for enrollment in October 2013.
Front Section, Pages 1 on 09/25/2012