Why is health insurance so expensive? There are several reasons, but one is that state laws mandate benefits that increases costs to insurers, and in turn patients. A new report from the Council for Affordable Health Insurance (CAHI), out today, gives the details.

Mandates are state laws that limit what kinds of insurance may be sold. There are three broad categories. The first is what kind of procedures must be covered. Some procedures, such as breast reduction, circumcision, or heart transplants, are build into insurance policies (by law) in only one state. Others, such as mammography, are required in all 50.

The second kind of mandate tells insurance companies what kind of service providers they must pay. Chiropractors and psychologists have been quite successful in lobbying for inclusion; 44 states mandate their services. Two states require insurance policies cover payments to massage therapists. (Is this the “Al Gore” mandate?) In 17 states, marriage counseling is a mandatory “health care” benefit.

The final kind of mandate requires policies to cover certain people. All states require coverage of newborns and 18 require coverage of domestic partners.

Are mandated benefits a good idea? Consumers may find them handy if they happen to need them, but they are in fact acts of the political sphere intervening in what would otherwise be private decisions of consumers. Think that chiropractors are quacks? Too bad; you have to pay more to your insurance company because the Legislature has decided you might need them some day.

Minnesota has 64 mandates, more even than most other states, including Connecticut (59) and California (56), but less than Rhode Island (67) and Maryland (67). Even Texas, a state with a reputation for having a minimally active state government, has 60 mandates. On the other hand, if you think the market rather than the Legislature is the best place for these sorts of decisions to be made, fear not: Idaho imposes only 13 mandates.

By the way, Minnesota is one of four states to require payments to dieticians, one of three states to require coverage of Lyme disease, one of three to require payments to opticians, and one of two to require payment for the removal of port wine stains.