A Wichita legislator says he will try to jumpstart the now-stalled debate over whether to require health insurers to cover autism.
“I don’t know how far I’ll get, but some important issues have been raised and I think they ought to be addressed more than they have been,” said Rep. Nile Dillmore, ranking Democrat on the House Insurance Committee.
On the last day of the regular legislative session, Dillmore introduced a motion to send House Bill 2367, now in committee, to the full House for debate.
The House is expected to vote on Dillmore’s motion on Wednesday, the first day in this year’s veto session.
The bill would require state-regulated health insurers to cover the diagnosis and treatment of autism, a neurological disorder that interferes with a person’s ability to communicate and interact with others. Early interventions — behavior, speech and occupational therapies — have been shown to reduce the effects of the disorder. There is no known cure.
As many as one in 150 children are thought to have autism.
The bill is separate from the state’s Medicaid-funded autism waiver program, which underwrites services for 45 pre-school children with autism each year. An additional 224 children are on a waiting list for those services.
Autism advocates support the bill. They say it would reduce the disorder’s toll on children.
The state’s insurance lobby opposes the bill, saying it’s unnecessary and has warned that it would drive up premium costs, which, in turn, would force some employers to drop their coverage.
Legislators aren’t sure which side to believe.
“I think there’s a lot of genuine concern about the bill,” said Rep. Clark Shultz, R-Lindsborg, chairman of the House Insurance Committee. “Legislators have questions; they want more time to gather more information and, basically, more time to deal with the bill.”
Shultz said his committee heard testimony on the bill shortly before it adjourned for the remainder of the session.
“We got it really late,” he said. “It’s a pretty significant bill, but we didn’t have the opportunity to work it.”
In late January, the Senate Financial Institutions and Insurance Committee heard testimony on an identical bill, Senate Bill 12. Afterward, the committee’s chairwoman, Sen. Ruth Teichman, R-Stafford, declined to take further action.
“I think more study is needed,” Teichman said. “The bill’s proponents think it’s been studied enough.”
But shelving the debate for another year, Dillmore said, would likely lead to some children not receiving services they need, causing their conditions to worsen.
“There’s been considerable testimony that other states’ experiences with covering autism have not created magnitude of problems that the insurance industry would like us to believe,” Dillmore said.
In earlier hearings, lobbyists representing health insurers said an autism-coverage mandate would, on average, cause individual and small-group premiums to increase by 2.5 percent to 3 percent.
Michael Wasmer, a member of the state’s Autism Task Force, disputed the industry’s claim.
“That’s what they say, but when you do a detailed analysis of the actual data — as we have had done by an independent actuarial firm — the increase is less than 1 percent,” Wasmer said.
“About half the children with autism who are diagnosed early and who receive appropriate services will ‘mainstream’ in a public school,” he said. “When access to treatment is denied, only 2 percent of the children advance to this level.”
The mandate’s benefits, Wasmer said, will far outweigh its costs.
“By waiting another year, we’re going to lose the opportunity to help a fair number of children become productive members of society,” he said. “It will be up to the parents to pay for the services as best they can out of their own pocket. For those who can’t, their children will be lost.”
Wasmer’s daughter, now 10, was diagnosed as autistic when she was 2.
“When she was 2-and-a-half years old, she couldn’t speak, there was no socialization whatsoever, and she threw tantrums at the drop of a hat,” he said. “Today, she’s in fourth grade making straight A’s and she has a good circle of friends.”
Wasmer, a veterinarian, said he and his wife paid for the treatments their daughter needed after their health insurance ruled they weren’t covered.
“We were fortunate,” he said.
Other states
Among autism advocates, Wasmer said, Minnesota and Indiana are often cited for having the most inclusive autism-coverage policies.
Carol Cutter, chief deputy commissioner for health and legislative affairs at the Indiana Department of Insurance, said measuring the mandate’s impact on premiums has been difficult.
“It’s not been as scary as it was made out to be, but it’s had an impact on costs. No question,” Cutter said.
But the impact is skewed, she said, because the mandate affects only the state-regulated individual and small-group markets, which account for only 26 percent of the state’s overall market. The mandate does not affect major employers’ self-insured plans.
In recent years, Cutter said, many families with autistic children who are not covered by their employers’ large-group plans have sought insurance through an individual or small-group plan that, because of the mandate, will cover their children.
An HMO affected by the mandate, she said, reported handling about 300 autism claims in 2005; more than 1,500 in 2008.
The same company, Cutter said, reported a 12 percent increase in its average premium in the “last couple years.”
Autism coverage, she said, was one of many factors contributing to the overall increase.
How much of the increase was driven by the mandate is unclear. The insurance company, Cutter said, hasn’t released such a finding.
“I guess, at this point, I should point out that Indiana isn’t exactly known for good health,” Cutter said. “We’re usually in the top 10 when it comes to obesity and people who smoke.”
Cutter declined to name the company, noting that it shared its autism-coverage data on the condition that it not be identified.
John Gross, director of health care policy at the Minnesota Department of Commerce, said Minnesota’s experience has been similar to Indiana’s.
“Because of an attorney general’s ruling several years ago, Blue Cross Blue Shield covers autism,” Gross said. “The debate we’re having now is whether the state employee’s insurance plan should as well. It’s been a rough road.”
No one, he said, disputes that “the earlier services are provided, the better the chances for major improvements in a child’s life. But the problem you get into is that the mandate only affects the state-regulated plans. In Minnesota, that’s about 20 percent of the market.
“The other thing is that it’s expensive,” Gross said. “In Minnesota, the per-child estimate is $75,000 per year.”
Though Gross and Cutter defended the policy, saying it was “the right thing to do,” they encouraged Kansas to limit coverage to treatments that are prescribed by a physician and are evidence-based.
“There have to be controls,” Cutter said. “In Indiana, the insurance company can review — and dispute — the treatment plan.”
Cost estimates
According to a Kansas Health Policy Authority analysis, the proposed mandate would likely cost the state employee’s health insurance plan $3.8 million in the fiscal year that begins July 1.
The health policy authority declined to predict the mandate’s effect on the state’s individual and small-group markets.
Kansas Insurance Commissioner Sandy Praeger told KHI News Service said she would have a hard time supporting the mandate.
“I think people whose kids are affected by autism ought to have access to services; there are some darn good therapies out there that can have a dramatic impact on these kids’ lives,” Praeger said.
“But, policy-wise, the mandate would apply to only the individual and small-group markets and those are markets that are really struggling to hold on to insurance,” she said. “And people need to realize that if they work for a large employer, they’re probably self-insured and the mandate won’t apply to them.”
A better approach, Praeger said, would be for the state to assume responsibility for the needed services.
“There could be a pilot project that figures out what works, how to implement it statewide and how to pay for it,” she said. “We could tax cigarettes.”
Legislative resistance
Sen. Karin Brownlee, R-Olathe, said she’s warned parents not to expect the mandate.
“In Kansas, the Legislature does not embrace mandates quickly,” she said. “It just doesn’t.”
Several legislators, she said, were worried the mandate would cause desperate families to push for treatments that promise more than they deliver.
“I think we ought to enhance the services that are in place now,” she said. “And I think whatever we do should be tied to evidence-based practices. The research has to show that it works.”
Wasmer said the bill includes several safeguards against fly-by-night treatments.
“This not an open-ended bill,” Wasmer said. “For a treatment to be covered it has to be prescribed by a physician, and the treatments we’re talking about are evidence based. The language in the bill is consistent with those in other states.”
Dillmore said the odds of the Republican-controlled House passing a mandate that is opposed by the insurance lobby are slim.
“Even if we’re successful in the House, it’d still have to get though the Senate in a very short amount of time,” he said. “There’s a long way to go before it gets to the governor’s desk, but if we can at least have a decent debate in the House, it’ll keep the momentum going into next year.”
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.