New Jersey's 45 mandates - which include requiring insurers to cover pap tests, mammograms, prostate screenings for men, autism testing for children and 48-hour hospital stays after birth - add an estimated 5 percent to the cost of health care in the state. A dozen states have more mandates than New Jersey.
Gov. Jon S. Corzine, a Democrat, favors the mandates. Republican challenger Chris Christie, the former U.S. attorney in New Jersey, wants to loosen the regulations and allow companies to offer no-frills policies.
The squabble over mandates - with mammograms at the center - is a thinly veiled battle for women voters that Corzine appears to be winning. Though the governor still trails in polls, he's gained ground on Christie in the past month, particularly among women who identify themselves as independent voters.
Christie, who in August led among independent women 28 percent in one poll, now trails Corzine by 1 percentage point among that group, which accounts for about 15 percent of New Jersey voters, according to Monmouth University Polling Institute Director Patrick Murray.
Corzine also leads Christie among all women, a group that tends to vote Democratic and one the governor carried in 2005. Women make up about 52 percent of New Jersey voters.
The debate over health insurance, one of the campaign's first sustained conversations over a pocketbook issue, began with Christie's plan to help drive down costs by allowing insurers to offer mandate-free coverage. Democrats quickly assailed the idea, claiming it would roll back hard-fought protections won in the Legislature.
Two of the mandates involve mammograms. The state requires insurers to cover yearly mammograms for women beginning at age 40 and doctor-recommended tests for younger women with a family history of breast cancer.
"Perhaps (Christie) doesn't understand that selling a mandate-free health insurance policy would mean that women over 40 are not going to be guaranteed mammograms paid for by their insurance companies, and certainly not women under 40 with the prerequisites," said Sen. Loretta Weinberg, a Teaneck Democrat who is running for lieutenant governor alongside Corzine. Christie countered that he would never sign legislation that would deny mammograms after his own mother survived breast cancer diagnosed by a mammogram when she was 47.
"My plan to try to make health insurance more affordable is geared entirely to people who are currently uninsured and literally have to hop from emergency room to emergency room to get care," he said.
Julius Hobson, a health care expert with the Washington law firm Bryan Cave, said mandates are a boon for consumers but an added cost to insurance companies and businesses buying health care for their employees. Policies with mandates offer better protection because they cover more preventative care and early diagnostics, he said, but the added cost can be significant, especially in a difficult economy.
Hobson said most companies would opt to keep the cheaper, mandate-free insurance, which still would be unaffordable to most uninsured people, he said.
"No frills policies are not big on preventative care and wellness," said Hobson. "In the no-frills policy, you could get a mammogram, but your copay would probably be much greater" - perhaps as high as 80 percent, if it were covered at all.
"They both have pros and cons," Marguerite Johnson, 71, of Lawnside, said of the politicians' plans. She said health care is one of the most important issues to her family and she generally supports Corzine's position. "I can agree and disagree with both of them on this issue."
Johnson, a pastor's wife who heard the candidates speak at a Black Ministers Council forum in Orange, said she favors getting more uninsured people covered but is concerned about the quality of coverage for those with lower-cost plans.
Christie, who insists his position is not costing him votes among women, has gone on the offensive, holding forums with small groups of women and launching a Web ad with five breast cancer survivors who say they will vote for him. The ad followed an unflattering video by the Corzine campaign in which Christie appeared dismissive of a breast cancer survivor voicing concerns about mandate-free insurance.
The Corzine campaign launched a TV ad telling voters that Christie supports insurance companies that deny coverage for mammograms.
An irate Christie shot back: "This is scaring people to try to win an election. The governor should have to answer for this disgraceful conduct on his part."
The candidates' hold partisan positions on President Obama's health care reform plan. Corzine supports the president's plan, while Christie says he has concerns about possible cuts in Medicare.
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