Senate Bill 22-49 would direct the Legislative Management to study health-care mandates. Proponents said the study is needed to understand the cumulative cost of state and federal coverage mandates and to inform future policymaking.

Senator Jeff Bard, sponsor of the item, said the measure evolved from a bill on step therapy and that, after stakeholder conversations, it is now a request for a study to examine questions about insurer practices, patient access and costs. "This started off as a bill on step therapy... but with a lot of questions... it evolved into a study," Bard said.

Megan Rubin of Blue Cross Blue Shield of North Dakota said the insurer supports the study and urged lawmakers to consider how mandates affect premiums and market stability. Rubin told the committee that Blue Cross has tracked many proposed coverage mandates in the current session — for infertility, insulin caps, step therapy and other areas — and warned the cumulative impact could push premiums higher. "If all of the proposed mandate bills passed ... policyholders would be facing consequences ... costing hundreds of millions of dollars," Rubin said.

Eric Spencer of the Greater North Dakota Chamber said businesses are concerned about health insurance affordability and urged a due-pass for the study. After discussion, the committee recommended a due pass on SB 22-49; the clerk recorded the vote as 12 yes, 0 no and 1 absent. The chair said the item would go to the consent calendar.

The committee noted the bill language uses "shall study" and suggested changing wording to "shall consider"; sponsors and staff can refine language as the study is scheduled.