Azagba Sunday, Ebling Todd, Hall Mark
College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
Health Law and Policy Program, Wake Forest School of Law, Winston-Salem, North Carolina, USA.
Alcohol Clin Exp Res (Hoboken). 2023 Sep;47(9):1748-1755. doi: 10.1111/acer.15153. Epub 2023 Sep 19.
Some alcohol exclusion laws (AELs) allow health insurers to deny coverage to individuals injured due to being intoxicated. Evidence has shown that such AELs disincentivize health-care providers to screen for alcohol while they deter treatment utilization by people with an alcohol use disorder (AUD). Certain states have changed AELs to enhance the health of people with an AUD, but these changes are not well documented in the extant literature. This study examined the current status and historical trends in AELs across US states.
We conducted a systematic legal analysis in 2023 to examine how state alcohol exclusion laws vary across the United States. These laws allow or prohibit insurers from denying coverage for injuries or deaths related to alcohol use. We classified the states into three categories: (1) States that explicitly permit alcohol exclusions, (2) States that explicitly ban alcohol exclusions, and (3) States that have no clear policy on alcohol exclusions.
We found that 18 states still have alcohol exclusion laws, down from 37 in 2004. Meanwhile, the number of states that have explicitly banned AELs and prohibited insurers from applying alcohol exclusions (AEs) to their policies has increased from 3 to 15 in the same period. The remaining 17 states have no clear laws on AEs. We also noted that five states that repealed their AELs did not adopt any specific prohibition on AEs, and four states limited their prohibition to policies that cover hospital, medical, or surgical expenses.
Our systematic mapping reveals that some states have prohibited AELs in response to their detrimental effects. However, some states maintain these policies, and none has effectively outlawed AEs in the last 10 years, despite their possible role in reinforcing stigma.
一些酒精排除法允许健康保险公司拒绝为因醉酒受伤的个人提供保险。有证据表明，此类酒精排除法会抑制医疗保健提供者进行酒精筛查，同时阻碍酒精使用障碍（AUD）患者接受治疗。某些州已对酒精排除法进行了修改，以改善酒精使用障碍患者的健康状况，但现有文献对此类变化的记录并不充分。本研究调查了美国各州酒精排除法的现状和历史趋势。
我们在2023年进行了一项系统的法律分析，以研究各州的酒精排除法在美国各地的差异。这些法律允许或禁止保险公司拒绝为与酒精使用相关的伤害或死亡提供保险。我们将各州分为三类：（1）明确允许酒精排除的州；（2）明确禁止酒精排除的州；（3）对酒精排除没有明确政策的州。
我们发现，仍有18个州存在酒精排除法，低于2004年的37个州。与此同时，明确禁止酒精排除法并禁止保险公司在其政策中应用酒精排除条款的州数量同期从3个增加到了15个。其余17个州对酒精排除没有明确法律规定。我们还注意到，五个废除酒精排除法的州没有对酒精排除条款采取任何具体禁令，四个州将其禁令限制在涵盖医院、医疗或手术费用的政策上。
我们的系统梳理表明，一些州已因酒精排除法的有害影响而禁止了此类法律。然而，一些州仍维持这些政策，而且在过去10年里，尽管酒精排除条款可能会加剧污名化，但没有一个州有效地将其定为非法。
