Rep. Kerry Wood (D-Rocky Hill), co-chair of the state legislature’s Insurance and Real Estate Committee, says she often hears the same thing about health insurance in Connecticut when she meets legislators from across the country.
“I go to national conferences and talk to my colleagues in other states, and (Connecticut is) known as the most mandate-rich state,” Wood said. “That directly impacts the cost of insurance coverage.”
Business groups have long criticized Connecticut’s large and growing list of mandated benefits, arguing they add to insurance coverage costs, particularly for small employers. Some lawmakers have pushed for greater scrutiny and transparency — including requiring cost-benefit analyses of existing benefits and any proposed additions — but a bill last year to create that review process did not pass.
Instead, lawmakers approved at least one new health insurance benefit requirement during the 2025 session and expanded others.
A recent Office of Legislative Research (OLR) report found Connecticut now has 81 mandated health insurance benefits for fully insured commercial plans, ranging from coverage for accidentally ingesting controlled drugs to Lyme disease treatment and wheelchair repairs.
The mandates generally apply to individual plans, group plans or both.
Of the four health insurance benefit changes enacted in 2025, three are already in effect, including a requirement that insurers cover biomarker testing. The fourth — which expands autism spectrum disorder behavioral therapy coverage from under age 21 to under age 26 — takes effect Jan. 1, 2027.
The OLR report’s mandate count is significantly higher than earlier tallies. A 2014 analysis by UConn’s Center for Public Health and Health Policy identified 46 required health insurance mandates at the time, though individual studies may categorize or count them differently.
Separately, in 2018, the Blue Cross Blue Shield Association said Connecticut had the second most health benefit mandates of any state.
The Connecticut Business & Industry Association (CBIA) last February said Connecticut ranks among the top three states for state-mandated health benefits, and that the requirements drive up premiums by forcing insurers to expand coverage.
CBIA said mandated benefits “add more than $2,000 to the cost of health insurance premiums in Connecticut.”
Wood, however, believes that, like the number of mandates, the effect on premium costs has also “probably doubled, if not tripled” over the past 10 years.
“When you tell people in Connecticut that, just alone, the health benefit mandate cost is $5,000 or $6,000 a year before you even get insurance coverage, I think that’s a crazy number,” she said. “If we’re looking for ways to save costs for people on Affordable Care Act plans, here’s a benefit right here that we can do.”
Mandating a review
Wood and Rep. Cara Pavalock-D’Amato (R-Bristol), ranking member of the Insurance and Real Estate Committee, said lawmakers have periodically tried to require the state Insurance Department to analyze the impact of health benefit mandates.
Last year’s effort — House Bill 6895 — cleared the insurance committee on a 12-1 bipartisan vote but stalled after being referred to the Appropriations Committee.
Pavalock-D’Amato said the legislature has not approved a comprehensive mandate review since 2014.
Last year’s proposal would have required an analysis of how each new mandate would affect premium costs before lawmakers vote on it. Pavalock-D’Amato compared the concept to a fiscal note, which estimates how legislation would affect the state budget.
“I think people would think twice if they had that actual number,” she said.
Wood said she supports that approach, but also wants broader scrutiny of existing mandates.
“Maybe we should review all the state benefits and see what’s working and what’s not,” she said.
Wood said the committee asked the Insurance Department last year to analyze the cost impacts of existing mandates, a process she said is ongoing.
The Insurance Department confirmed it received the committee’s request and said it has received several responses to a request for proposals to conduct the review.
Cost pressures
Any effort to rein in health insurance costs would likely be welcomed by small businesses and their employees.
In September, the state Insurance Department approved an average rate increase of 16.8% for fully insured individual health plans and 11% for small-group policies. Combined, those markets cover about 224,000 Connecticut residents.
The small-group market has also grown more concentrated in recent years, with Aetna, Cigna/Oscar Health, ConnectiCare and nonprofit Harvard Pilgrim HealthCare all exiting since 2022. Only two carriers remain: Anthem Blue Cross and Blue Shield and Oxford Health Plans.
The premium hikes come as enhanced federal subsidies under the Affordable Care Act have expired, raising concerns that many individuals and families may no longer be able to afford coverage. State officials estimate Connecticut could lose about $295 million in enhanced federal tax credits that help tens of thousands of residents pay health insurance premiums.
Gov. Ned Lamont said in December that the state plans to spend $70 million from its rainy day fund to partially offset the loss of federal subsidies.
Pressure is also building in the employer market. A December analysis by the State Health Access Data Assistance Center at the University of Minnesota found that average annual premiums for employer-sponsored family coverage nationwide rose to $24,540 last year, an increase of more than $600 from the year before.
How much Connecticut’s mandate-heavy approach contributes to premium costs remains an open question — one raised not only by legislators but also by business groups.
“One of the things that CBIA has been lobbying on in the past three years is health benefit mandate reviews,” said Grace Brangwynne, CBIA’s policy director for health care, insurance and housing issues.
Brangwynne said CBIA supports adding fiscal-note-style analyses to mandate proposals, including cost-benefit estimates.
Assessments
In addition to mandates, Wood said another driver of rising premiums is the assessments the state charges insurers.
The state raises more than $100 million annually through these levies and fees, which help fund the state Insurance Department and several other state programs, including public health initiatives.
“Just a few years ago, we did a working group on the assessments,” Wood said. “It’s over $100 million in assessments, which is thousands and thousands of dollars a year on everyone’s premiums.”
If you add the cost of assessments to the cost of mandated benefits, Wood said, “we have already priced people out of these plans.”
Wood said the working group developed recommendations on “what should and should not be assessed,” but received little support.
She said legislation intended to implement the working group’s recommendations died in committee last year.
Asked what she expects lawmakers to accomplish during the short legislative session that begins Feb. 4, Wood said the goal is to avoid adding costs.
“I get like 40 (proposed) new mandates every year,” she said. “So if we can get through the session without adding additional pain, that would be a win.”
