State representative from Marshfield, member of the Joint Committee on Financial Services, which reviews legislation on mandated insurance coverage
Following years of review and expert testimony, the Massachusetts House recently voted to require insurance coverage for diagnostic testing and long-term antibiotic treatment of Lyme disease. I am among 124 cosponsors of the legislation championed by my colleague, David Linsky.
My experience with Lyme disease began in 2013. Days after a camping trip with my son, I experienced fatigue, headaches, and disorientation. A visit to the emergency room and correct diagnosis revealed I had Lyme. I completed an antibiotic regimen, and my symptoms subsided.
I was lucky. But for 10-20 percent of those contracting Lyme, the standard/limited treatment doesn’t work and folks can experience unrelenting fatigue, muscle and joint pain, and cognitive difficulties, according to the state Center for Health Information and Analysis. These cases are often referred to as chronic Lyme disease.
Those suffering from chronic Lyme can experience debilitating effects, including lost employment, failed businesses, and the inability to participate in normal activities.
Although some medical organizations haven’t altered recommendation for antibiotics, the International Lyme and Associated Diseases Society states, “Most studies demonstrate a beneficial effect of antibiotics in the management of chronic Lyme disease,” and asserts that the duration of antibiotic therapy “should be guided by clinical response, rather than by an arbitrary (i.e., 30-day) treatment course.”
New research from Northeastern University, Toledo University, and Columbia University also offers promise for further support for long-term chronic Lyme treatment.
While bureaucracies slowly catch up, many residents suffer unnecessarily because insurance companies limit antibiotic treatment to one or two regimens. We can help them by requiring coverage of long-term treatment.
With any mandated coverage, the Legislature must balance costs and benefits, while considering the impacts for those suffering. Unlike the insurance industry, the Legislature is not substituting its judgment for doctors’ but empowering doctors to make judgments based on clinical history and evidence.
What’s the cost? The Center for Health Information and Analysis estimates the mandated coverage would result in an average annual increase in monthly premiums from a negligible amount to 11 cents a year.
Given Lyme’s epidemic rates, chronic Lyme’s prolonged effects, existing expert recommendations, and emerging science, this mandated coverage is justified.
Norton resident, Massachusetts state director for the National Federation of Independent Business, former state representative
Lyme disease is a horrific disease with varied impacts that have long mystified medical professionals. But imposing mandates for specific types of services to treat this disease would be a mistake for a number of reasons.
When the state passes laws to mandate coverage for specific services, legislators think they’re mandating coverage for everybody. They are not. Instead, mandate laws disproportionately affect small and medium-sized businesses. Large companies typically “self-insure” and are not subject to state-mandated benefits since they are only subject to federal requirements.
In 2015, nearly 60 percent of commercially insured individuals in Massachusetts were enrolled in a self-insured plan, up from 49 percent in 2011. One reason large employers typically self-insure is to avoid covering certain mandated benefits. Unfortunately, small businesses don’t have that option. As more employers self-insure, state laws mandating specific types of benefits and services, like the proposed Lyme disease mandate, affect an increasingly smaller portion of the privately insured marketplace and add to the rising cost of health care for small businesses.
That rising cost is a major challenge for small businesses and for their workers. Increases in premiums of 10-25 percent are not unusual in 2016.
While mandating coverage of specific services may not appear to be that costly, the cumulative effect of mandates adds to the health care costs for employers. The state’s Center for Health Information and Analysis has estimated that more than 11 cents of every premium dollar pays for mandated benefits. Put another way, we estimate that mandated benefits cost as much as $36.75 per insured per month.
Additionally, the long-term antibiotic treatment for Lyme disease being mandated is subject to debate within the medical community. For example, the US Centers for Disease Control and Prevention, the National Institute for Allergy and Infectious Disease, and the Infectious Disease Society of America all state that the use of long-term antibiotic treatment for Lyme disease is not effective and may result in serious complications.
Legislators have no business requiring that workers pay for coverage for uncertain remedies. This mandate will not only increase health care costs for small businesses, but could also be bad medicine for patients.
Last week’s Argument: Should Stoughton exceed its tax limit to build a new high school?
Yes: 80 percent (188 votes)
No: 20 percent (47 votes)
As told to Globe correspondent John Laidler. He can be reached at email@example.com.