Although the CBO estimates for implementing S. 969 can be used as a baseline for
determining the cost impact of NMHPA, they must be updated to reflect the enactment in several
additional States of laws or regulations meeting the criteria specified in NMHPA and for the
elimination of post-delivery follow up care. Adjusting the CBO estimates for 28 States that had
laws that met the criteria specified in NMHPA at the time of NMHPA’s enactment, reduces the
number of people directly affected by NMHPA. Approximately 60 percent of people covered by
insured ERISA plans and therefore subject to State laws, are in the 28 States that had enacted
laws prior to NMHPA.
With fewer people affected, the assumed increase in utilization is also lower, which should
translate into a smaller increase in aggregate health care costs. However, as discussed previously,
S. 969 had a provision for follow-up visits in place of an additional inpatient day. CBO assumed
that about one-third of the additional utilization would be follow-up visits, and that the cost of a
follow-up visit is only about one-fourth the cost of a post-delivery hospital day.
Based on those assumptions, if all of those who would have chosen a follow-up visit under
S. 969 elected to remain in the hospital for an additional day, the estimated aggregate increase in
insured costs would be 0.07 percent, slightly higher than the CBO estimate. If, however, mothers
and physicians determine that some of the follow-up care is unnecessary, and that less than the
minimum hospital length of stay is necessary, some of the additional costs will not be incurred. If
none of the follow-up visits were converted to additional inpatient days, the estimated aggregate
increase in insured costs would be 0.04 percent. Therefore, the impact of NMHPA on insured
costs is in the 0.04 to 0.07 percent range, or $130 million to $200 million (1996 dollars).
It should be noted that since the enactment of NMHPA, twelve additional States have