I can think of no other reason than that the rehab lobby pushed it hard enough. Can you?
What would be wrong with letting people opt out of mandates for a corresponding reduction in premiums? A normal life insurance policy will exclude a pay-out if someone dies while committing a violent crime. So why does a health insurance policy require a higher premium from me to subsidize someone who stuffs an illegal substance up their nose?
I understand where you are coming from. The reason why you have to have the mandate even if you don't use it is ue to the fact it's easier and more cost effective to have it on your plan due to administrative reasons. It would be a nightmare for insurance carriers to have a ala carte plan-hard to keep track of who has what. Very similar to why car companies went to package deals where if you want AC you have to get power seats to. It's cheaper to make cars this way versus each one totally different.
What would be wrong with letting people opt out of mandates for a corresponding reduction in premiums?
Take for instance mandatory maternity clause. Every group plan has it. It's built into the rates that only so many people will use maternity. If the carriers removed maternity off your plan it would not lower the rates. Again it's easier(less expensive) administratively to have all plan benefits the same.
I never liked the substance abuse mandate either. Some mandates are good like forcing carriers to pay for at least 48 hours of a hospital stay after a pregnancy.
Oh and yes you are correct the lobbying groups that push this stuff are very very very powerful.