insured nonfederal governmental plans, and 1,000 issuers in the individual market. For a variety
of reasons, these totals cannot be broken down by State. These reasons include a lack of detailed
data at the State level and inconsistencies in how data are reported, both within and across States.
In addition, the complexities and volatility of today’s health care environment, the segmentation
of the health care markets, and the rapid increase in various forms of managed care arrangements
make it difficult to define and track such plans.18
The Congressional Budget Office (CBO) did not estimate costs for implementing
NMHPA, passed by the Congress in September 1996. However, CBO estimated the costs for
implementing S.969, the Senate version of NMHPA. While there are several differences between
S.969 and the final joint legislation19, the CBO estimates for implementing S. 969 are the only
relevant cost data available, and can be used as a baseline estimate for the cost impact of
After making adjustments to reflect the effects of State laws in effect at the time of their
estimates, CBO concluded that about 900,000 insured births a year have shorter hospital lengths
of stay than the minimum lengths of stay provided under NMHPA. CBO assumed that some of
these births would result in an additional inpatient day, and some would receive a follow-up visit.
Some mothers would still choose to go home before the full time allowed by NMHPA, while
others are already receiving a timely follow-up visit and therefore would not incur any additional
18 See, for example, Chollet, D.J., Kirk, A.M. and Ermann, R.D. (1997). Mapping Insurance Markets: The Group and Individual Insurance Markets in 26 States. Washington: The Alpha Center.
19 S. 969 contained provisions for post-delivery follow-up care, or home health visits. In addition, the costs provided by CBO assumed an implementation date of January 1, 1997, rather than January 1, 1998.