Autism Insurance Coverage
In America, complex and important issues find their way to Congress and state legislatures. On the list of complex and important issues, healthcare vies for top billing.
Every year, the Legislature addresses insurance mandate bills. Mandate bills seek to force private health insurers to cover some illness or segment of the population or alternative provider. Groups with that illness and healthcare providers who treat that illness put forward compelling human-interest stories: in many instances, truly heart-rending stories. Faced with those heart-rending stories, politicians routinely force insurers to cover those illnesses. I believe the number of government-mandated coverage items in the US insurance market now approaches 2,000.
Government should do whatever it can to help promote better healthcare. So, government must constantly answer the question: does this mandate promote better healthcare?
We all want a health insurance policy that covers everything. We can’t pay for it, we don’t want to pay for it, and we don’t really expect to pay for it. But the reality, of course, is that someone has to pay for it. If government determines that some treatment must be provided regardless of cost, the better policy is for government to then pay for that treatment – spreading the cost over the entire tax base. By contrast, pushing the cost onto the insurance market makes insurance less available – thereby decreasing the availability of healthcare to our citizens.
It is easy for a politician to declare that citizens should have a few more bells and whistles on their insurance policies. Politicians live to declare that every citizen should have a Cadillac-like insurance policy. But, the reality, is that those declarations mean that more people end up walking.
Some people would be happy to have (and be able to afford) a Honda-like policy. And, given the huge potential market that exists for basic coverage, many insurers would love to offer Honda-like health insurance policies. But, Governmental mandates preclude such marketplace responsiveness. Remember, Government has declared that all policies must be Cadillac-like; no citizen should have anything less. As a result no citizen can get anything less, even if they don’t have a prayer of getting the Cadillac plan.
This year’s big mandate is SB 43 – Insurance Coverage for Autism Spectrum Disorders, Clay’s Law. Autism clearly pegs the meter when it comes to heart-rending stories. At this point, we all know a family (or several) with autistic children. The difficulties they face likely cannot be appreciated by people without autistic children. Fortunately, as this bill notes, wonderful advances in autism treatment have been made. So, how do we best ensure that Utah families benefit from those advances?
The legislature will address whether an insurance mandate is the way to go to help our citizens obtain better healthcare. As I explained above, mandates actually decrease the availability of health insurance. Mandates work great for the people whose employers provide health insurance (unless the increased cost of the mandates forces the employer to drop coverage). But, they’re lousy for everyone else who struggles to find affordable insurance (including uninsured people who have the very illnesses addressed by the mandates). Thus, overall, mandates do more collective harm than good.
If Government believes that citizens absolutely must have something, Government should fund it, instead of conveniently (and quietly) passing the costs off to the market. (And, remember, in the case of mandates to cover certain illnesses, Government is only telling the private sector to provide coverage for the select portion of the population that has health insurance; everyone else with the illness is left out in an even-colder cold, as treatment costs rise and insurance availability decreases.). If politicians determine that people must have X, politicians need to step up to the plate and make sure that ALL citizens get X, and politicians need to be willing to pay the cost to make sure that happens.
As things currently stand with mandates, politicians decree that SOME privileged people get X (while the politicians quietly push the costs elsewhere). At the same time, when citizens tell politicians that they can’t afford health insurance, politicians – with no sense of hypocrisy – beat up on insurers for rising costs. It’s bad government, bad economics, and ultimately bad healthcare. It is politicized “stealthcare.”
If the Legislature determines that the treatments covered by SB 43 must be provided, then Utah should fund the treatments. Likely, the State’s answer here, and with other mandates, will be that it can’t afford to cover the mandate. That’s not true. The State can cover any mandate. It simply would have to take money from less important items in the budget or, if it couldn’t do that, take more money from citizens. We know how to balance a budget, and we know how to impose taxes. Rather than transparently face that music, though, it’s much too easy for politicians to quietly force those costs into the market (and then wring their hands over the increasing cost of insurance). Instead of the State’s broad tax base paying for the services that have been declared necessary, the costs are spread among a decreasing percentage of the population that has health insurance. And why is that insured population decreasing? See discussion above regarding mandates and costs.
By raising economic issues and governmental process concerns, I mean no disrespect or lack of concern for families facing autism or any other illness the Legislature has considered or will consider. Your situations are very real and very concerning. I am trying to do what is best overall in the complex and important arena of healthcare. The challenges are vexing. I acknowledge that everyone involved in these discussions is trying their best. I lay out my thinking on this blog, so that it can be challenged and, where appropriate, changed. To the advocates of SB 43: I believe that your involvement (and passionate advocacy) will help us do what is best.
Every year, the Legislature addresses insurance mandate bills. Mandate bills seek to force private health insurers to cover some illness or segment of the population or alternative provider. Groups with that illness and healthcare providers who treat that illness put forward compelling human-interest stories: in many instances, truly heart-rending stories. Faced with those heart-rending stories, politicians routinely force insurers to cover those illnesses. I believe the number of government-mandated coverage items in the US insurance market now approaches 2,000.
Government should do whatever it can to help promote better healthcare. So, government must constantly answer the question: does this mandate promote better healthcare?
We all want a health insurance policy that covers everything. We can’t pay for it, we don’t want to pay for it, and we don’t really expect to pay for it. But the reality, of course, is that someone has to pay for it. If government determines that some treatment must be provided regardless of cost, the better policy is for government to then pay for that treatment – spreading the cost over the entire tax base. By contrast, pushing the cost onto the insurance market makes insurance less available – thereby decreasing the availability of healthcare to our citizens.
It is easy for a politician to declare that citizens should have a few more bells and whistles on their insurance policies. Politicians live to declare that every citizen should have a Cadillac-like insurance policy. But, the reality, is that those declarations mean that more people end up walking.
Some people would be happy to have (and be able to afford) a Honda-like policy. And, given the huge potential market that exists for basic coverage, many insurers would love to offer Honda-like health insurance policies. But, Governmental mandates preclude such marketplace responsiveness. Remember, Government has declared that all policies must be Cadillac-like; no citizen should have anything less. As a result no citizen can get anything less, even if they don’t have a prayer of getting the Cadillac plan.
This year’s big mandate is SB 43 – Insurance Coverage for Autism Spectrum Disorders, Clay’s Law. Autism clearly pegs the meter when it comes to heart-rending stories. At this point, we all know a family (or several) with autistic children. The difficulties they face likely cannot be appreciated by people without autistic children. Fortunately, as this bill notes, wonderful advances in autism treatment have been made. So, how do we best ensure that Utah families benefit from those advances?
The legislature will address whether an insurance mandate is the way to go to help our citizens obtain better healthcare. As I explained above, mandates actually decrease the availability of health insurance. Mandates work great for the people whose employers provide health insurance (unless the increased cost of the mandates forces the employer to drop coverage). But, they’re lousy for everyone else who struggles to find affordable insurance (including uninsured people who have the very illnesses addressed by the mandates). Thus, overall, mandates do more collective harm than good.
If Government believes that citizens absolutely must have something, Government should fund it, instead of conveniently (and quietly) passing the costs off to the market. (And, remember, in the case of mandates to cover certain illnesses, Government is only telling the private sector to provide coverage for the select portion of the population that has health insurance; everyone else with the illness is left out in an even-colder cold, as treatment costs rise and insurance availability decreases.). If politicians determine that people must have X, politicians need to step up to the plate and make sure that ALL citizens get X, and politicians need to be willing to pay the cost to make sure that happens.
As things currently stand with mandates, politicians decree that SOME privileged people get X (while the politicians quietly push the costs elsewhere). At the same time, when citizens tell politicians that they can’t afford health insurance, politicians – with no sense of hypocrisy – beat up on insurers for rising costs. It’s bad government, bad economics, and ultimately bad healthcare. It is politicized “stealthcare.”
If the Legislature determines that the treatments covered by SB 43 must be provided, then Utah should fund the treatments. Likely, the State’s answer here, and with other mandates, will be that it can’t afford to cover the mandate. That’s not true. The State can cover any mandate. It simply would have to take money from less important items in the budget or, if it couldn’t do that, take more money from citizens. We know how to balance a budget, and we know how to impose taxes. Rather than transparently face that music, though, it’s much too easy for politicians to quietly force those costs into the market (and then wring their hands over the increasing cost of insurance). Instead of the State’s broad tax base paying for the services that have been declared necessary, the costs are spread among a decreasing percentage of the population that has health insurance. And why is that insured population decreasing? See discussion above regarding mandates and costs.
By raising economic issues and governmental process concerns, I mean no disrespect or lack of concern for families facing autism or any other illness the Legislature has considered or will consider. Your situations are very real and very concerning. I am trying to do what is best overall in the complex and important arena of healthcare. The challenges are vexing. I acknowledge that everyone involved in these discussions is trying their best. I lay out my thinking on this blog, so that it can be challenged and, where appropriate, changed. To the advocates of SB 43: I believe that your involvement (and passionate advocacy) will help us do what is best.
posted by steve u. at 2/06/2009
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20 Comments:
THANK YOU SENATOR!
My youngest is autistic. I would love to have had his therapy covered when he was younger (he is now 15). This bill would have forced it, but at what cost? How many people who could barely afford health insurance now will be forced to drop it because of the $40 per month increase?
Our children deserve the best care we can give them, but not at the expense of others. Create a fund for autism treatments. Add a 0.05% sales tax. Just do not do it as an unfunded mandate.
I appreciate your circumspect thinking. It's easy for causes that tug at our heart-strings to get everyone on the bandwagon. After all, what heartless person would say "no" to a program to benefit "special education," for example? Yet even our programs of compassion need to be dealt with thoughtfully, sometimes with restraint, and not at the expense of the overall good.
Steve, you fail to acknowledge one important reality about this situation: the large degree to which taxpayers _already_ bear the costs of serious health conditions that health insurers refuse to cover. If care is mandated for serious health conditions such as autism, wouldn't you agree that although insurance premiums will rise to some degree, there will also be some reduction in, for example, Medicaid costs associated with people who are presently uninsured and end up obtaining taxpayer funded medical treatment for essential care?
Margaret, you raise a good point – avoided future costs. (And, given the complexity of the healthcare challenge, I should say that there are MANY dimensions of the issue that I don’t address in this post).
Arguing that we avoid greater costs in the future, by addressing issues early, I have always worked to increase funding for early-intervention (birth to 3 years old). Surely, increased availability of autism treatment likewise will avoid many future costs. In both instances, just to provide one example, educational costs would drop significantly with early help (not to even mention productivity gains and the immeasurable benefits of improved lives).
However, along the lines I describe in the post above, early-intervention help is government funded, not insurance mandated. As a result, all Utahns can benefit from it, and we don’t force people off insurance in the process. By contrast, SB 43 doesn’t propose taxpayer-funded treatment of autism; rather, it mandates treatment for just part of the population, and it shifts the treatment costs elsewhere. Those costs then make health insurance less available overall.
Mandates don’t decrease taxpayers’ costs. Rather, by making insurance less affordable and, therefore, less available, mandates ultimately force more people onto government programs and charity care.
Thank you for your response Steve. I agree, healthcare reform is complex and changes in one aspect of the way we deliver and finance healthcare have impacts in other ways that may be foreseen and unforeseen. In the end, the problems we are dealing with make me think it is inevitable that we'll end up with universal healthcare sooner rather than later. The form that takes is not something we know. But, for better or worse, it seems there is little appetite for single payer in this country. We'll probably end up with some extension of either our employer based approach or, perhaps, an extension of how we currently provide Medicare supplemental coverage utilizing private insurers.
I'm concerned, however, that allowing insurers and providers to "compete" will simply perpetuate more of what we've seen in the past couple of decades: spiraling medical costs and insurers competing with each other to run from the worst medical risks in the population. I just don't see how we can avoid rationing as an important component of holding down healthcare costs. And I don't see how we can avoid requiring universal coverage as a way of preventing insurers from running away from the worst healthcare risks.
I agree with much of what you have written. The bill is appealing, but I've been thinking that similar arguments could be made for other conditions, and wondering why autism seems to be treated differently.
Senator
I appreciate that you are willing to publish your ideas so that a discussion can be had about this important topic. I appologize if my response is somewhat long. I guess I a very passionate about this topic.
I am a parent of an autistic child and am trying to fund the treatment of my child privately. It is costing me approximately $35,000 per year just for the intensive behavioral therapy. I am a middle income person. My wife has entered the workforce, we have exhausted our savings and are currently incurring a large amount of debt.
Would you do this for your child, knowing that there is a treatment available that has a 70% success rate of normalizing your child? I'm sure you would if at all possible. Unfortunately, we are a 1% minority that actually accomplish this.
We have enrolled our son in every early intervention program available to us through the state education system, as well as Medicaid and the Pingree school. We are approximately number 2000 on the Medicaid list. We might make it into the Pingree school for Autism next year (2 years after applying).
By age 3, my son was still non-verbal, after attending all of the current early intervention available to us. Within 6 months of us starting our private program our son is now speaking in 3 - 5 word sentences (on par for his age). Of course, there are many other issues to work throuh. Intensive behavioral therapy is usually a 4-year program.
My concern with having a state funded program is two fold. First, they don't seem to work as noted above. Medicaid always has strings attached to the program. Second, as we have seen this legislative session, state funding for health programs can disappear very rapidly.
In contrast, for states that have researched the bill and passed legislation, the average cost of health insurance would increase on average .501% - .7% or about $ 1.35 per month. That's a soda per month for most people.
Below is the link for a FAQ from Arizona. http://www.azautisminsurance.org/files/Fact%20Sheet-Insurance%20coverage-1-21-08.pdf
The majority of research indicates that Autism is a health condition, just like cancer or diabetes. Why not treat it as one.
Autism primarily has something to do with the person's immune system, thus the need for special diets and the linkage of vaccinations as a possible trigger for Autism.
People are willing to pay insurance in order to 'insure' that if the need for cancer treatment ever arises it will be available to them. I'm sure an actuary at an insurance company would love to cut cancer coverage out of their policies. Think of the billions that would save them.
Wouldn't it be reasonable to have insurance that there would be coverage if your new baby were to have Autism?
Another fact that you may or may not be aware of is that with intense behavoral therapy, a child has a 50% - 70% recovery rate.
There are very few medical condidions that can achive that kind of success rates. And think about it. This recovery is a recovery that improves the quality of life for a person's ENTIRE life. It doesn't just extend a life a few years.
I am not usually a fan of government mandates, however there are times when certain sectors of business must be regulated to meet to the needs of the public. The insurance industry (auto, home, health) is just one of many. There are many other industries such as utilities and other public services.
Yes, Autism is a cause, a cause. A cause for a group of 1 in 150 people in this state. It is a crisis that is not going away. It may cost the insured person an extra $1.35 per month, but it will save all of us $ 3 million over the life of each child that is not helped.
Give an Autistic person the chance to lead a good life, not a life trapped inside of themselves. Insure them, don't make it a government program that has a very slim chance of success.
Kurt,
Though I'd imagine you were tempted to use a much different tone, I thank you for patiently explaining your situation. It breaks my heart -- as do a few other things we deal with up here. I am so pleased to hear about your son's progress. As you say, though, you are making incredible sacrifices to pursue the treatment. Many others can't do that.
I approach this topic delicately -- knowing that I can't begin to understand the difficulties that are involved.
Every mandate only costs a little. And every mandated item of coverage addresses something important. But, when those mandates are added up, insurance is made unaffordable.
I hate when politicians simply say "no" to a real problem without offering positive ideas. Here is my idea. I could support a mandatory autism rider. That would mean that autism coverage could be added by the policyholder, but that decision would not affect rates in the overall market for those individuals and businesses who choose not to add the rider.
Steve,
On the surface, I like the idea of an insurance rider. My main concern with this approach is that the insurance company would be able to set their own rates on a rider. Since the insurance companies are already reluctant to cover Autism services, they could set the rates so high that a small business wouldn't be able to afford them. This would basically be a net-zero for those who need the insurance.
I was able to attend the Senate HHS committee meeting today for Autism.
James Sorenson testified today about polling CEO's of small businesses and finding that every CEO he talked with was in support of adding autism to their policies.
It made me wonder how many employees would support autism treatment as part of their group policy if they were just educated about the treatment of autism and understood the devastating effect it is having on families, and could have on their own family. Again, they would be sacrificing a soft drink a month to have autism benefits added to the policy.
There are always groups of people that would argue against their rates going up, but I wonder if they would be the minority.
I'm sure that these same people would want to have their life flight bill paid after they were in a serious accident. I'm also sure that many of these people don't even blink an eye when their $80 - $120 cell phone bill comes in the mail.
For those that may truly lose their insurance because of this bill (I would like to truly understand how many this would affect), I can empathise whith them. My lack of autism insurance may very well drive me into bankruptcy.
Another lady in the committee meeting talked about having a child with cancer that went through treatments of chemotherapy, only to find out her child was Autistic.
She said that it cost her $15,000 for the cancer treatment. She said that her group policy paid over $250,000.
The cost of Autism treatment seemed unattainable to her and was more disheartening than the cancer treatments for her child.
The autism treatment cost, although similar to her cancer treatment costs, would in effect have given her her child back.
I would prefer that insurance companies would just pick up Autism insurance and make it an offering to employers and their employees just like they do for other medical illnesses. They should run the autism illness through their actuarial models and assign an equitable cost/risk factor just like they do for Cancer or HIV. This would be the perfect solution in a perfect world.
Unfortunately, when they will not take this upon themselves, they need to be regulated. This is where government needs to step in and correct the issue.
Steve,
Just to get my facts straight it was Fraser Bullock not James Sorenson that testified. Sorry about that. I only heard Sorenson way back in the corner...
Senator Urquhart – how refreshing to have someone in your position candidly discuss his/her position on an issue. Thank you for inserting some much-needed transparency into the system. First let me say that I’m not one of your constituents. I’m a business owner in Utah County, and parent in the autism community who is closely following this proposed bill.
I believe there are a few fundamental flaws in the points you’ve laid out. First, government = the people (the true source of funds). Market = people (again, the true source of revenue). They are one in the same. Government doesn’t pay for things out of its good nature – it simply raises taxes to pay for them. So, the “market” is truly the source of funds, in either approach. A rebuttal to that from you could be – well, then less people will pay the entire bill if it’s covered by taxes. Actually, since the top 20% of wage earners actually pay 80% of the overall tax burden, and a significant % of the population does not pay any taxes – then that argument you make may also be made in support of having it covered by insurance.
Also, there are no “privileged few” – just all of us who carry the sort of plans that fall within this legislation (1 out of 3). The Obama administration has already drafted legislation that will cover the remaining 2/3rds of plans. Thus, all will be covered (again – spreading out the cost further). You do raise an interesting point about politicians quietly pushing costs elsewhere – but it does not apply in this instance. Isn’t that like complaining about steroid-using baseball players when discussing the record of a clean baseball player? It seems to follow the old debate trick called “sandbagging”.
Insurance companies, with their sophisticated actuarial studies and financial management, have, for centuries, proven more adept at managing costs and generating an ROI (significant in offsetting related expenses) than any government employees or politicians. As Fraser Bullock (credited with the most financially successful Winter Olympics in history), and Lorrie Unumb (law professor and policy analyst in Washington) so clearly explained – this is by far the most financially feasible manner ever discovered in which treatment for children with autism can be managed and provided.
As a small business owner (less than 20 people) who has seen annual insurance increases of 11% and 17% for each of the last two years, respectively, I’m thrilled to finally see a less than 1% increase for something that will truly provide a significant benefit for children. There are two of us, in my little company, who have had children with autism. Both of our productivity levels would soar with the removal of the burdens added due to our insurance not covering treatment for autism. And as the statement from Indiana exclaimed (a state that passed similar legislation 6 years ago – although, unlike this bill, their bill had no financial limitations) – “the financial benefit to the state has been immeasurable”. I think their 6 years of positive experience carries more credibility than my personal opinion.
As always, I’d love to hear more of your thoughts. I personally know many of your constituents who support this bill and hope that you represent them accordingly.
Hi Senator Urquhart,
I appreciate your thoughts on mandates and specifically Clay’s Law, SB 43. I am the mom of Clay Whiffen, of which Clay’s Law was named. Clay was diagnosed with autism at the age of two, He couldn’t talk, screamed and tantrumed all day, walked around on his toes and beat his head against the floor repeatedly. He didn’t even know who I was.
The pediatric psychiatrist prescribed a medically necessary, evidence based treatment for Clay called Applied Behavior Analysis (ABA), but it is a very expensive program and is out-of-reach for most families. ABA is endorsed by the US Surgeon General, American Academy of Pediatrics, and National Academy of Sciences as a first line treatment for autism. However, unlike diabetes, cancer, and other medical illnesses, the diagnosis and treatment of autism, despite being classified as a neurobiological illness, is not covered by most insurance companies. In fact, in many cases it is specifically excluded as a diagnosis – meaning that in the event that our child has a stroke, speech therapy would be covered, but it would not be covered after an autism diagnosis. This is clearly discrimination and needs to stop. And this is why Senator Howard Stephenson, one of the most conservative senators in our state, and who also has never voted for a mandate in his entire political career, believes passionately in this bill and is our fearless senate sponsor.
My son Clay was re-evaluated after completing a full ABA program when he was four years old by a neuropsychologist. Through extensive testing, she determined that he no longer met the criteria for a diagnosis of autism or any diagnosis on the autism spectrum. Today, my son is a typical third-grader who is at the top of his class academically, just took third place overall in a state gymnastics competition, and who loves teasing his brothers and playing with his many friends.
Let’s talk numbers for a moment. According to the CDC 1 in 150 children are diagnosed with autism. According to a recent Harvard study, if we don’t take care of this problem, we will be paying $3.2 million over the lifetime of EACH individual with autism. This is billions of dollars Utah taxpayers will be paying to take care of these children who will eventually become adults and will become wards of the state. The Council for Affordable Health Insurance (which is made up of insurance companies, actuaries, providers, and small businesses) came out with a report in 2008 that analyzed autism mandates in 10 states. The report concluded that in each of those states, autism insurance mandates increased premiums BY LESS THAN 1%. Actuarial studies done in other states back up this claim showing an approximate .97 to $1.25 increase per policyholder, per month.
So the question really comes down to this, do we pay a negligible rise in insurance premiums, or do we pay billions of dollars in taxes for the long term care of these individuals? Do we save families from going bankrupt and/or divorcing trying to provide evidence based, medically necessary treatment for their kids? Do we save kids lives, or just shuffle them aside because we don’t believe government should intervene?
It is time we update our insurance policies to include autism. If an injustice is happening to this degree, it is our right and our human duty to intervene and help the thousands of children who deserve to live normal, fulfilling lives.
Please Senator Urquhart, there are 1 out of 133 kids in your district - 1 out of 79 boys in your district who don’t have voices. It’s time we do the right thing.
Thank you.
Leeann Whiffen
Steve,
I appreciate your willingness to discuss this topic.
I'm typically not one to enter the public arena and open up on topics like this, but I have read your comments and feel the need to share some of my own. I ask that you'll look past my brazen and politically unlearned style. Hopefully I can effectively communicate my thoughts.
I am understanding more and more the complexity involved in this issue and respect your position. Previous to reading you comments, I wondered how any senator/legislator in his/her right mind couldn't/wouldn't support this bill. I learned a lot from your comments and appreciated understanding the 'other side' of this issue.
Most of all I appreciated very much your willingness to listen and your open-mindedness to learn more on the issue. That's a great trait to have as a public servant. Frankly, more should be so open.
I truly hope that sentiment is genuine because I feel that if we step back away from a canned political position on a topic as benign as 'mandate bills' and look at this issue outside of that box, it becomes easy to get behind and support, which is the right thing in this instance.
I am not a constituent but have very strong opinions on this matter and thought I'd take a moment to voice them here, since you're gracious enough to allow for it, because your vote affects me very personally.
Others have done a good job telling you about the merits of the bill. I'll leave that to them and others.
I offer my opinions as a fitting example of one of the 'heart-rending' stories you allude to in your comments. Here's our story (most of which you can access from the link in my name above): I have an autistic son. We're fighting the same battle as Kurt (previous comment) and many, many others. We are paying $25,000 a year, nearly 50% of our gross income, for four hours of therapy a week. It is all we can do in our situation. We've seen improvements, however we know what we're doing is just not enough for our three year old. It is recommended that kids in our son's situation have between 20-25 hours of therapy a week. How can we ever ever do this without help? How can anyone?
There are days where we cry ourselves to sleep in frustration over a system that will schill out countless thousands of dollars for Viagra, but refuses to cover honest, hard-working people who are paying them to do just that. Now, I know that's probably not a fair comparison, and I may be showing a little too much of my heritage in that last comment but maybe you can sense a bit of my frustration.
Steve, I'm sure you're a decent person and you're probably looking to do the right thing. Again, I can understand a political position such as you've taken in many situations, and often I think it could be the right one. This one is not the one to hang your campaign slogan on. It is too widespread to throw in the bucket with the rest of them. You need to deal with this one head-on. Once you do, you should see that this is one to get behind and support. Its the real thing. :-)
I'll be anxious to see how you vote on Wednesday.
Best,
M. McGhie
Three quick points. First, the advocates of this bill, with so much at stake, have given us all a perfect example of civility. Second, I strongly suspect that the bill will pass the Senate as drafted; in part, because of the strong, civil advocacy. Third, yes, I am aware that the smarter political position is to support mandates.
Leeann, hooray for Clay’s progress! Your joy must be without end. Thankfully, we seem to be making significant gains regarding autism. I salute your efforts and the efforts of everyone who want to find the best way to address this issue.
I want to reemphasize that my opposition to the bill is based on the fact that mandates make insurance less available overall. I would support having the State pay for autism treatment – so that the cost is spread over the broader tax base, treatment would be available to all, and treatment would not make insurance less available. Also, I would support a mandatory rider, meaning that insurance companies would have to offer the treatment as an optional coverage item; that would make autism coverage available, but would not make insurance less obtainable overall.
Senator, I find your angle of opposition to be somewhat intriguing. Perhaps you can discuss your thoughts on the principle at hand itself, as opposed to the practicalities (or lack thereof) in how to best raise funds for autism treatment.
I laid down my thoughts in this blog post, asserting that government has no moral right to dictate what private companies should do in their transactions with mutual consent. You admit here in your post that health care is a hot topic, and it indeed is. But does that mean we should continue to cede ground?
Clay's Law supporters are quick to point out (as you are here) the many other government mandates for insurance coverage as pretext for "just one more", in the name of autism treatment. But where do we draw the line, if ever? Do we continue to use the encroachment of bigger government to justify even bigger government?
I'd be interested to hear your thoughts on the principle of government insurance mandates in general, and where government derives its power to compel private insurance companies to offer certain services to its customers.
Steve, I appreciate your stance because as a small business owner, I am looking to add a group health insurance policy to cover my employees. The problem I have however, is that the costs are enormous. I don't think people realize that every dollar matters for small businesses. Forcing us to keep paying a little extra, and a little extra every year is untenable. I have some employees right now that don't have ANY insurance at all. I'd love to try to change that by offering health insurance, but when you start tacking on all these mandates and cost increases, it just delays the possibility for me of providing health insurance to my employees.
Clearly having some people without insurance (like my situation now) is worse than having some insurance that is more affordable. Thank you for keeping a lid on insurance.
I want to make one more statement: my health insurance premiums alone are already more than my house payment is. These costs are already ridiculous, thank you for not burdening us further.
Dear Senator,
Thank you for your considerate dialogue.
My concerns regarding insurance riders are similar to those previously mentioned. I'd agree that it may be preferable to initiate a state-funded program rather than an insurance mandate, but for the life of me I just cannot imagine that this would ever come to pass. Certainly we can't just do nothing??
This is a crisis. Autism is such a serious, life-long medical condition. There are so many who are getting little to no help. I understand that the complexity of this issue is probably beyond my grasp, but shouldn't it boil down to the simple fact that something must be done to help all these young human beings?
Michelle,
You and I agree that something must be done. Early treatment can improve lives dramatically and save the State loads of money. But that still leaves the question of what we should do.
Last year, the State made some advances on autism (e.g., the registry). I believe the State wants to make more advances. We currently are in the public process of figuring out what those advances should be and can be. And, again, I want to emphasize how helpful the advocates are being in that processes. They are pushing very hard and very effectively. That's exactly as it should be.
As I have expressed, I believe that mandates harm society, by making health care less available overall. That gives me a responsibility beyond saying "no" to the current proposal on the table. Agreeing that the State should help with treatment, but not liking the current proposal, I need to work to figure out something better.
I am working to do that. The reality, though, is that more responsible alternatives involve tough and controversial decisions. (That is part of the reason the current proposal is on the table; government will always reach for the easy solution, especially if it involves passing the buck).
Hi Steve,
I have withheld any further comments on you blog in order to give others the opportunity to voice their opinions.
I think I can understand your posiition on Autism becoming a State program. It would make the most sense to have a broader base of people carry the burden for ALL of the Autisic children.
I do, however, think we both can agree that this will not happen any time soon. We have shrinking budgets in all of the public sectors including health and human services and education. Yes, we could reprioritize money to go towards the treatment of Autism, but again there would be sacrifices to other programs. Most likely the ones I noted above.
I applaud the creation of an Autism registry. I do, however, work for one of the major health insurance providers in the state, and typically a health and wellness registry is set up for identifying best practices/protocols for the treatment of a person, and to identify when a person is not receiving the proper treatment. For example a diabetic not purchasing medication for a couple of months or not attending their perscribed visits.
I fail to see how a registry can even be beneficial for Autistic children, until they are actually getting treatment. I do know that if the company I work for were to cover autism, they would very quickly set up their own health and wellness registry. Maybe that could save some state funds right there.
There is one huge concern that we all should have, including small business owners, insureds, uninsureds, etc. It is that the Autism rates are on a very steep growth curve. There is a tidal wave of children (1 in 150) between the ages of 1 and 4 that will be hitting the public education system. The education system will need to find a way to handle this. It will require additional aids in the classrooms, more special education teachers, different teaching methodologies, etc..
It is a federal law that these children be guaranteed a least restrictive learning environment. The state WILL have to deal with this at a very high cost to all of us. I believe this is called a Federal Mandate.
And yes, I do believe that every child have the right to a fair education. I believe that is yet another Federal Mandate.
There are mandates that are necessary for the better being of all of us.
Now, putting all of the Social Progam issues aside.
Why do I think Autism should be covered by insurance, rather than being treated as a social program.
1. Autism is a medical condition with a proven treatment and should be treated as such. These children are being descriminated against. Other groups may be able to argue that they also are being descriminated against. If they have a valid disease that has a cure, they probably are.
2. There are many medical conditions that ARE covered that have a much lower or NO recovery rate than the autism recovery rate of 50% - 70%. Fibromyalgia, for example. We aren't really sure what this is, let alone how to cure it. There is insurance coverage for it. HIV and cancers are covered, yet have no cure or a very low life expectancy.
3. It is true that only 30% of the state populus will be affected, but 30% is better than 0%.
4. There are concerns that families will be forced to lose their insurance due to this bill. I have yet to hear a statistic on how many families that would be. Would it be similar to the 1 in 150 that are currently uninsured? A person posted that their insurance costs them more than their house. My lack of Autism insurance costs me $3500 a month plus my $450 per month insurance plan that doesn't cover what it should be covering. A $3950 per month payment would buy a pretty nice house in my opinion.
5. Cost to the insured is minimal (less than 1%). Indiana has had a law such as this for 8 years. They report that the rise in rates due to autism is minimal compared to the overall rise in cost of insurance in general.
5. A social program won't work because it already hasn't worked. Autism isn't a new issue. The legislature has been grappling with this for several years. The best they have come up with is a registry and a medicade fund that I am currently #2000 on the list.
Please reconsider your stance on this law. You know as well as I do that we are looking at least 4 to 6 years down the road before a sufficient social program could be put in place for autism. How many children could have their lives re-claimed during this time?
Thank you for your time and willingness to discuss this important issue.
As a parent of two handicapped children, one who has Down Syndrome and is also autistic, I am against this bill. I am self employed and pay $1080 a month for insurance. I just got my notice for the yearly raise and it went up $124 a month. I will now have to pay over $1200 a month just for insurance. It is going to come to a point where I can't keep paying for insurance.
Government mandating what insurance covers is just the same as a tax. They are just letting the insurance companies collect the tax.
We have avoided taking any government handouts because we don't think that is what government is supposed to provide. Where do people get the idea that government is supposed to provide all of these services for us?
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