# Did State Mandates and Third-Party Payer Rules Shield Prices from Consumers?: 37 Sourced Claims, Contested Facts & Evidence Frustration stems from government tax subsidies and compliance mandates that separated patients from true prices and expanded bureaucracy. Authors: david HTML: https://moyomap.com/maps/did-state-mandates-third Markdown: https://moyomap.com/maps/did-state-mandates-third.md License: HTML and markdown are for reading and citation. Bulk copying and AI training need a written license. See /terms and /developers#maps-data. Cite a claim as: MoyoMap, "Did State Mandates and Third-Party Payer Rules Shield Prices from Consumers?: 37 Sourced Claims, Contested Facts & Evidence", claim {id}, https://moyomap.com/maps/did-state-mandates-third.md#{id}. “Moyo, a product of SenTeGuard Inc.” ### New York passed the first healthcare certificate-of-need (CON) statute in the United States in 1964 via the M… Id: claim_0237c09c5d99d194079f4770 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 New York passed the first healthcare certificate-of-need (CON) statute in the United States in 1964 via the Metcalf–McCloskey Act. Labels: Source-linked, Low, known ### In a 2023 American Medical Association survey, responding physicians reported processing an average of 45 pri… Id: claim_21f091c0004f651ecf24a447 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 In a 2023 American Medical Association survey, responding physicians reported processing an average of 45 prior-authorization requests per week and spending approximately 14 hours weekly managing them. Labels: Inferred, Low, known ### The rationale for CON laws originated largely from Milton I. Id: claim_2cb6ac8151ef25e63f2c0807 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 The rationale for CON laws originated largely from Milton I. Roemer's 1959 UCLA study showing a positive correlation between hospital beds per capita and hospital days used. Labels: Inferred, Low, known ### States without service-level CON laws maintain approximately 24 percent more ICU capacity, 50 percent more ne… Id: claim_c320d59970c0639e0872c5a4 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 States without service-level CON laws maintain approximately 24 percent more ICU capacity, 50 percent more neonatal ICU capacity, and 37 percent more surgical ICU capacity per capita. Labels: Inferred, Low, known ### During the COVID-19 pandemic, hospitals in states with CON bed restrictions were 27 percent more likely to re… Id: claim_c6df0b0f9f537fb8cf4cfa76 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 During the COVID-19 pandemic, hospitals in states with CON bed restrictions were 27 percent more likely to reach full bed capacity and experienced 12 percent higher bed utilization rates. Labels: Inferred, Low, known ### Rural states lacking CON laws have 21.5 rural hospitals per 100,000 residents compared to 7.4 in states with… Id: claim_f6da66003f3e40d4894abbd9 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Rural states lacking CON laws have 21.5 rural hospitals per 100,000 residents compared to 7.4 in states with CON laws. Labels: Source-linked, Low, known ### In a 2023 AMA survey, 94% of responding physicians reported that prior authorization delayed patient access t… Id: claim_fa5d5589984161477dc2b2e7 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 In a 2023 AMA survey, 94% of responding physicians reported that prior authorization delayed patient access to necessary care, and 80% stated it could lead patients to abandon treatment. Labels: Source-linked, Low, known ### Physician Administrative Burden and Prior Authorization Id: section_1ef1fc31209ea8905050ea15 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Physician Administrative Burden and Prior Authorization Labels: Inferred, Low ### Growth of Healthcare Administrators and Administrative Personnel Id: section_224a8f6e95e2f459b44ed5e8 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Growth of Healthcare Administrators and Administrative Personnel Labels: Inferred, Low ### Healthcare Administrator and Physician Compensation Trends Id: section_35a387160b9ed0f271f9b9fa Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Healthcare Administrator and Physician Compensation Trends Labels: Inferred, Low ### History and Policy of the Employer Health Insurance Tax Exclusion Id: section_69793f3d6fea39a3768316a0 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 History and Policy of the Employer Health Insurance Tax Exclusion Labels: Inferred, Low ### Medicare Administration and Contracting Reforms Id: section_75538b4cc5f7708d2df10f0c Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Medicare Administration and Contracting Reforms Labels: Inferred, Low ### U.S. Healthcare Administrative Costs and Spending Id: section_a2373359a56e48b93fa16a09 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 U.S. Healthcare Administrative Costs and Spending Labels: Inferred, Low ### Certificate-of-Need Laws and Healthcare Capacity Id: section_ecb3890ff747962561b132a0 Parent: topic_DRPMnhquG6FG83CQUsv9 Depth: 1 Certificate-of-Need Laws and Healthcare Capacity Labels: Inferred, Low #### A 2014 peer-reviewed study estimated that U.S. Id: claim_083f3d5af8d609a0844e6bc1 Parent: section_a2373359a56e48b93fa16a09 Depth: 2 A 2014 peer-reviewed study estimated that U.S. healthcare billing and insurance-related costs reached $471 billion in 2012, with approximately $375 billion (roughly 80%) considered excess compared to a simplified benchmark system. Labels: Inferred, Low, known #### A study by Steffie Woolhandler, Terry Campbell, and David Himmelstein estimated that total U.S. Id: claim_0d43ad8911efb4c78a7b6674 Parent: section_a2373359a56e48b93fa16a09 Depth: 2 A study by Steffie Woolhandler, Terry Campbell, and David Himmelstein estimated that total U.S. healthcare administrative costs reached approximately $294.3 billion in 1999, representing $1,059 per capita. Labels: Inferred, Low, known #### Medicare physician reimbursement declined 29 percent in real terms since 2001, whereas administrator compensa… Id: claim_1e3e3f2dcf5a1e8e99c61449 Parent: section_35a387160b9ed0f271f9b9fa Depth: 2 Medicare physician reimbursement declined 29 percent in real terms since 2001, whereas administrator compensation increased by 443 percent over the same period. Labels: Inferred, Low, known #### In 1943 the IRS exempted employer contributions to group health insurance from employee income taxes, and Con… Id: claim_4f0a507123c00bbde6f1c689 Parent: section_69793f3d6fea39a3768316a0 Depth: 2 In 1943 the IRS exempted employer contributions to group health insurance from employee income taxes, and Congress codified the tax exclusion into Internal Revenue Code Section 106 in 1954. Labels: Source-linked, Low, known #### In 1999, administration accounted for an estimated 31% of total healthcare spending in the United States comp… Id: claim_50f9bada2bf39b783f23ec5e Parent: section_a2373359a56e48b93fa16a09 Depth: 2 In 1999, administration accounted for an estimated 31% of total healthcare spending in the United States compared to 16.7% in Canada, driven largely by private insurance overhead and billing. Labels: Inferred, Low, known #### The hospital CEO-to-physician compensation ratio expanded from 1.5:1 in 1940 to 12:1 by 2026, with nonprofit… Id: claim_586dcf6d540eab84b31b9416 Parent: section_35a387160b9ed0f271f9b9fa Depth: 2 The hospital CEO-to-physician compensation ratio expanded from 1.5:1 in 1940 to 12:1 by 2026, with nonprofit hospital CEOs averaging $3.8 million compared to $287,000 for primary-care doctors. Labels: Inferred, Low, known #### MGMA's 2026 Regulatory Burden Report found that 95 percent of surveyed group practices experienced increased… Id: claim_66c45d56f4aca3e0ae59eac8 Parent: section_1ef1fc31209ea8905050ea15 Depth: 2 MGMA's 2026 Regulatory Burden Report found that 95 percent of surveyed group practices experienced increased regulatory burden over three years, with 40 percent maintaining at least three administrative staff members per physician. Labels: Inferred, Low, known #### CMS launched its 'Patients over Paperwork' initiative after estimating in 2019 that healthcare clinicians col… Id: claim_692291ef39c1a59afa26890f Parent: section_1ef1fc31209ea8905050ea15 Depth: 2 CMS launched its 'Patients over Paperwork' initiative after estimating in 2019 that healthcare clinicians collectively spent millions of hours completing Medicare-related regulatory paperwork. Labels: Source-linked, Low, known #### The tax exclusion for employer-sponsored health insurance reduced federal income and payroll tax receipts by… Id: claim_7e4c3e0d114e84cccf60ac5a Parent: section_69793f3d6fea39a3768316a0 Depth: 2 The tax exclusion for employer-sponsored health insurance reduced federal income and payroll tax receipts by an estimated $299 billion in 2022, representing the largest single tax expenditure. Labels: Source-linked, Low, known #### The employer health insurance tax preference has a regressive incidence because excluded compensation confers… Id: claim_8391ec5f92b7e885e8a40ea7 Parent: section_69793f3d6fea39a3768316a0 Depth: 2 The employer health insurance tax preference has a regressive incidence because excluded compensation confers a larger per-dollar tax benefit to households in higher marginal tax brackets. Labels: Source-linked, Low, known #### A study by David U. Id: claim_9147fd5edeed5a16531b066b Parent: section_224a8f6e95e2f459b44ed5e8 Depth: 2 A study by David U. Himmelstein and colleagues estimated that the number of U.S. healthcare administrators grew by roughly 3,200% between 1975 and 2010, compared to approximately 150% growth in physicians. Labels: Inferred, Low, known #### BLS OEWS data show U.S. Id: claim_94b1ae151edec273ffd8ab0d Parent: section_224a8f6e95e2f459b44ed5e8 Depth: 2 BLS OEWS data show U.S. healthcare administrators increased from 224,070 in 2004 to 565,840 in 2024, raising the administrator-to-physician ratio from 0.48 to 0.73. Labels: Source-linked, Low, known #### A peer-reviewed analysis by Himmelstein and colleagues calculated that U.S. Id: claim_a9af9a91eb1b91e4c3204679 Parent: section_224a8f6e95e2f459b44ed5e8 Depth: 2 A peer-reviewed analysis by Himmelstein and colleagues calculated that U.S. administrative healthcare personnel grew from 25.5 per 1,000 population in 1987 to 30.2 per 1,000 population in 1999. Labels: Inferred, Low, known #### A physician essay reports that between 1970 and 2026, U.S. Id: claim_ad8a9a7558384d321c4301c6 Parent: section_224a8f6e95e2f459b44ed5e8 Depth: 2 A physician essay reports that between 1970 and 2026, U.S. healthcare administrators grew by 3,800 percent while physicians grew by roughly 200 percent, yielding a 10:1 administrator-to-physician ratio. Labels: Contested, Low, known #### In 1943, the IRS ruled that employer contributions to group health insurance were not taxable employee income… Id: claim_af63e22d4e6a5778d425e2d6 Parent: section_69793f3d6fea39a3768316a0 Depth: 2 In 1943, the IRS ruled that employer contributions to group health insurance were not taxable employee income, allowing employer health benefits to bypass wartime wage controls. Labels: Source-linked, Low, known #### According to KFF estimates, 49% of the U.S. Id: claim_b354738dff7d19ee18aa29b4 Parent: section_69793f3d6fea39a3768316a0 Depth: 2 According to KFF estimates, 49% of the U.S. population was covered by employer-sponsored health insurance in 2023. Labels: Source-linked, Low, known #### Following its establishment in 1965, Medicare claims administration was intentionally outsourced to private c… Id: claim_c79242854272b46e320d8822 Parent: section_75538b4cc5f7708d2df10f0c Depth: 2 Following its establishment in 1965, Medicare claims administration was intentionally outsourced to private contractors, designated as fiscal intermediaries and carriers, rather than using a centralized federal claims workforce. Labels: Inferred, Low, known #### The Congressional Budget Office estimated that the federal exclusion of employer-sponsored health insurance f… Id: claim_d572417bb7623c32f31a0185 Parent: section_69793f3d6fea39a3768316a0 Depth: 2 The Congressional Budget Office estimated that the federal exclusion of employer-sponsored health insurance from taxable income would reduce federal revenues by approximately $299 billion in fiscal year 2024. Labels: Inferred, Low, known #### Administrative costs represent 15 to 25 percent of U.S. Id: claim_d70ce5de666d6059fa12f747 Parent: section_a2373359a56e48b93fa16a09 Depth: 2 Administrative costs represent 15 to 25 percent of U.S. health spending, with one 2017 estimate totaling $812 billion (34.2 percent) for combined insurer and provider administration compared to 17 percent in Canada. Labels: Source-linked, Low, known #### The National Health Planning and Resources Development Act of 1974 conditioned federal health planning funds… Id: claim_f65684078f6d275471fdf7d1 Parent: section_ecb3890ff747962561b132a0 Depth: 2 The National Health Planning and Resources Development Act of 1974 conditioned federal health planning funds on states establishing health-planning programs, driving the nationwide spread of Certificate-of-Need (CON) laws. Labels: Source-linked, Low, known ##### The reported 3,200% growth in healthcare administrators relies on a broad occupational definition combining g… Id: claim_10aa769375ef1fddf56a9b7d Parent: claim_9147fd5edeed5a16531b066b Depth: 3 The reported 3,200% growth in healthcare administrators relies on a broad occupational definition combining general managers and administrative staff rather than exclusively measuring executives or regulators. Labels: Inferred, Low, known ##### The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandated Medicare contracting refo… Id: claim_b7ec1f6c25d44debbbfdc092 Parent: claim_c79242854272b46e320d8822 Depth: 3 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandated Medicare contracting reform to eliminate inconsistent procurement rules, redundant processes, and fragmented accountability under the intermediary/carrier system. Labels: Inferred, Low, known ##### The mean healthcare administrator-to-physician ratio increased from 0.46 pre-ACA (2004–2010) to 0.56 post-ACA… Id: claim_bd3566cf6040e601ecee14e6 Parent: claim_94b1ae151edec273ffd8ab0d Depth: 3 The mean healthcare administrator-to-physician ratio increased from 0.46 pre-ACA (2004–2010) to 0.56 post-ACA, shifting from a flat pre-ACA trend to a statistically significant upward slope. Labels: Source-linked, Low, known