Last year, colorectal cancer took nearly 50,000 lives in the United States, including 940 in Washington alone. According to the American Cancer Society, it was the second-highest cause of cancer deaths in the state, behind only lung cancer.

The good news is that screening for cancerous polyps and follow-up laboratory tests can lead to early detection and reduce the mortality rate from colorectal cancer, especially for people over 50.

It's hard to deny the value of that screening, and in 2007, the Washington Legislature took matters a step further, passing a law mandating that health insurance plans sold in Washington cover the procedure when it is recommended by a patient's physician.

The Office of the Insurance Commissioner keeps track of health insurance mandates. According to its tally, Washington requires that health insurance policies sold here cover 14 specific medical procedures, offer three others as options, and comply with 10 mandates that give consumers access to providers.

In addition, the state's health insurers must meet 10 federal mandates, of which five overlap with state mandates. State law also includes six other provisions related to enrollment, continuation of coverage and other issues.

The Council for Affordable Health Insurance, a group funded by the insurance industry, came up with a much higher tally in a recent report. It counted 57 mandates, which would place Washington in a tie with New Mexico and behind only Rhode Island, 70; Minnesota, 68; Maryland, 66; and Virginia, 60.

The insurance commissioner's office disputes the group's figure.

Whatever the number, health insurance mandates have become an issue in the fight over health care reform.

State health officials and Gov. Chris Gregoire defend mandates — especially those requiring coverage of preventive health care — as both cost-effective and essential to comprehensive health coverage.

Critics argue that many people, especially young adults, don't need a full menu of health care options. And they say Washington's health insurance mandates raise the cost of coverage for all Washington residents.

In 2007, the Legislature passed several health care-related bills, including the cancer screening measure and a mental health parity bill requiring that coverage for mental health care be on a par with coverage for other health services.

Business groups complained that new mandates would drive up premium costs and make it impossible for small businesses to offer health coverage for their workers.

The Washington State Republican Party platform calls for more choice.

"Our health care system should be focused on individual responsibility and healthy living, the ability to choose a health care plan to meet individual needs, and the ability of people to choose their own doctor," it says. "Citizens can best accomplish these goals when the state promotes competition among health care providers and avoids health care mandates."

Republicans have pushed, so far unsuccessfully, for changes that would allow "mandate-lite" policies for young adults and small businesses.

State Insurance Commissioner Mike Kreidler says most studies show health insurance mandates add about 3 percent to the cost of health insurance.

The insurance industry council pegs the effect of mandated benefits much higher, at between a 20 percent and a 50 percent increase in cost, depending on the state.

Requiring coverage of such preventive measures as colorectal cancer screening saves money as well as lives, Kreidler said.

"There are trade-offs involved. If you wind up with someone who isn't diagnosed early, it is a much more expensive and invasive procedure."

It's one thing to criticize mandates, he said, but few seem willing to say which they would eliminate.

"During the (2008) governor's debates it came up," he said. "Every time Gregoire would ask (Republican Dino) Rossi which mandates should be eliminated, he would never answer. It's easy to point at mandates and say they are driving up the cost of health care, but which ones would you want to get rid of?"