Many of us working deep in the weeds of our organization's health plans no doubt are wary of the ever-mounting regulations surrounding health care reform.

Recently, I attended a presentation that included a flowchart of implementation dates that sort of looked like a MapQuest version of lower Manhattan.

As early as January 2011, we'll be covering dependents up to their 26th birthday. We'll be allowing for free preventive care exams. If we make plan changes for 2011 (and recent surveys indicate that many of us will), we'll likely lose grandfathered status.

And there's no time like open enrollment to break the news to employees that over-the-counter drugs will no longer be covered under their flexible spending accounts. The list goes on and on and continues through 2018, when the dreaded excise tax goes into place for so-called Cadillac plans.

With all of these changes raining on the day-to-day lives we've so lovingly dedicated to our chosen professions, you'd think we'd be taking personal advantage of our EAP programs in record numbers or jumping out of windows at our corporate headquarters - but no.

We're taking it all in stride. Most of my colleagues discuss these monumental changes in quiet, calm voices over cups of coffee in hotel lobbies where we attend endless seminars to educate us on it all.

So, why the collective calm in the eye of an ever-growing, government-fueled, storm of industry chaos? My theory is that we're all used to it.

The Patient Protection and Affordable Care Act certainly will impact employer-sponsored plans like nothing before - but mandated changes to health plans are nothing new. State legislatures have been imposing mandates on health insurance plans since the mid-1960s.

Not only do states have the power to determine who can offer health plans to residents, but they also can tell those health plan providers what specific benefits their plans must contain.

State mandate overload

Although the tiny little state of Rhode Island has the dubious distinction of having the most state mandates that apply to health insurance (last I heard, it was around 70), Florida isn't far behind, with 52.

Long before Congress agreed that health plans would cover dependent "children" to their 26th birthday, Florida required coverage to dependent "children" who met certain eligibility requirements until they turned 30. Some of us affectionately called that mandate the "failure to launch" bill.

Others called it the "slacker" bill, after New Jersey's original "cover 'em 'til they're 30" mandate. And since health plans were not required to "eat" the cost of coverage, Palm Beach County offered it at the full actuarial rate, and as a result, had very few takers.

Our union-bargained coverage is still quite competitive, which makes it rather pricey for those footing the full cost. Sometimes, healthy youngsters can do better in the individual markets when they're not priced along with the collective experience of 50-year-old government workers.

We're expecting many more dependents in the 25-to-26 age group to join the plan, since our interpretation of the new laws doesn't lead us to believe we can charge an additional rate for them.

There's a story behind every mandate

Each mandate has a history and an explanation. Most of us agree that a health plan covering a mastectomy also should cover reconstructive surgery. And certainly we don't want new moms to be thrown out of the hospital minutes after giving birth.

Mandates like these exist in all 50 states and are subject to little or no debate at all. They fall under the general categories of common sense, the right thing to do and, as my six-year-old nephew might say, "Duh."

But where there are state legislatures, there are also politics, politicians and - heaven forbid - special interest groups. Sometimes mandates come into play where the medical necessity of such mandated coverage may exist only in the mind of the individual pushing the mandate.

(Although it should be said, I'm eternally grateful to whoever it was that ensured dental anesthesia was to become a mandate in Florida.)

Sometimes the provider community becomes convinced about the efficacy of a treatment before the insurance community - in the case of autism therapy, for example - and if the right providers know the right politicians, a mandate may result.

Pins and needles

Sometimes, this can positively affect patient treatment. But acupuncture? This is a mandate that one might consider debatable. As a benefits manager, however, I won't be standing in line to start that debate. After all, those pins and needles have to be a heck of a lot cheaper than surgery - so have at it.

Although the value of a mandate may lie in the eye of the beholder, the cost of the mandate lies in the premiums of policyholders. Savvy benefits managers should keep an eye toward their respective state capitals and make their voices heard when the discussion begins.

Since the cost burden of health reform seems to lie squarely on the shoulders of American businesses, it's a good idea for those businesses to have a voice in the ongoing debate.

Contributing Editor Nancy L. Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.

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