State health insurance mandates—laws requiring health plans to cover specific treatments or providers—are widespread in the U.S., but their broader effects remain poorly understood. For example, do they reduce hospitals’ unpaid care burdens? How do they influence deductibles or provider incomes? Answering these questions could help policymakers design fairer, more effective healthcare systems.

How the research could work

One approach would be to compare firms that self-insure (and are exempt from state mandates due to federal law) with firms that don’t, using datasets like MEPS-IC. This "natural experiment" could reveal causal effects by isolating mandate impacts from other factors. The study might examine:

• Uncompensated hospital care costs
• Changes to patient deductibles and copays
• Provider revenue and employment shifts

Advanced econometric methods, like difference-in-differences analysis, could address challenges such as states with stronger mandates also having other pro-healthcare policies.

Why this could fill gaps in existing research

Prior studies often focused narrowly—for example, analyzing single mandate types or just cost impacts. This project could advance understanding by:

• Breadth: Studying multiple mandate types and outcomes simultaneously
• Innovation: Leveraging self-insured firms as a novel control group
• Policy relevance: Providing timely insights as healthcare reform debates continue

Potential execution path

A phased approach might start with a literature review and data validation, followed by econometric analysis and policy-focused dissemination. Early stages could test key assumptions, like whether self-insured firms truly mirror broader trends. Funding might come from health policy grants, with findings shared through academic papers and briefings for state governments.

While primarily an academic endeavor, such research could indirectly benefit insurers, providers, and patients by informing more balanced mandate designs—potentially improving coverage while containing costs.