Autism advocates 'beg' for Senate vote

Posted July 15, 2014

— Dozens of children with autism and their families converged on the legislature Tuesday, urging Senate leaders to vote on whether to require insurers to offer better coverage for the disorder.

In May 2013, the House approved a proposal that would require insurers to cover applied behavior analysis, or ABA, a widely accepted therapy that advocates say is one of the best early intervention techniques for autism, saving the state millions or billions of dollars in later treatment costs.

The legislation, House Bill 498, has been sitting in the Senate Insurance Committee ever since. Senate leaders say they're wary of adding any additional mandates to health insurance.

House lawmakers tried again this year by adding the language to a regulatory reform omnibus, Senate Bill 493. But Senate leaders sent that proposal to their Ways and Means Committee, which almost never meets. 

Autism is more prevalent in North Carolina than nationally. According to the group Autism Speaks, the organizer of Tuesday's event, one in 58 children in the state had some type of autism spectrum disorder in 2010, compared with one in 68 nationally. 

Thirty-seven other states have enacted laws requiring coverage of ABA since 2001, as mounting evidence has shown the therapy's effectiveness. North Carolina is one of the few states that doesn't currently require coverage.  

Under the legislation, the child must have been diagnosed by the age of 8. The treatment must be determined to be medically necessary by a psychologist or doctor. Providers would have to be licensed and regulated by the state, and the cost of the treatment cannot exceed $36,000 per year.

According to Autism Speaks president Liz Feld, adding ABA coverage has added only an average of $3.72 per year to insurance premiums in states that require it.

She said North Carolina's largest insurer, Blue Cross Blue Shield of North Carolina, has been giving Senate leaders "bad information," overestimating the likely cost of the change.

BCBSNC says Feld and other advocates are cherry-picking their data.  "This is a misleading figure based on incomplete data from only a handful of states. In fact, the mandate could cost millions," responded CEO Brad Wilson. 

In an open letter to Feld, Wilson said the North Carolina Chamber of Commerce and other business lobbies also oppose the change. 

"When we discuss the 'most vulnerable' in our state, we must recognize the families and small businesses are already struggling to afford their health insurance. They simply can't afford additional health insurance mandates at this time - no matter how well intentioned those mandates might be," Wilson said.

Feld said her group compiled its numbers from actual claims in states that require the coverage. Much of the data was provided by Blue Cross, she said.  

"Don't buy it," Feld urged Senate leaders. "Stand up for these families." 

On stage in the third-floor legislative auditorium, Feld was surrounded by families wearing blue T-shirts that read, "Keep Calm and Shine On." Many of the children were dressed in royal blue super-hero capes.

Families like these have been a regular sight at the legislature this session, asking senators to reconsider blocking the bills. Feld said the proposal has been in the works for six years but has been sent to one study committee after another despite advocates' best efforts.

"It is absolutely outrageous that these families should have to come three hours on a bus to beg for a vote," she said. "Please don't go home for the summer without providing autism coverage for the families here and for 60,000 people across the state of North Carolina."

House Speaker Thom Tillis has been an outspoken supporter of the legislation, as have many other members of the House leadership. But with relations between the House and the Senate frostier than they've been in a decade, that may not help the bill's chances.

Feld implored lawmakers not to allow children with autism to become "mired in politics."

"Bring this bill up for a vote," she urged. "There is nothing political about autism."  

The State Health Plan, which covers some 670,000 people in North Carolina, recently voted to add ABA coverage as of Jan. 1, 2015. After an extensive cost analysis, managers for the plan, which is administered by Blue Cross, say the additional coverage will not require a premium increase next year. 



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  • Brian Hill Jul 16, 2014
    user avatar

    Autism is not a disease to be cured, especially by mundanes.

    Autism is simply neurodiversity.

    Despite the name, autism speaks does not speak for us. No taxpayer money should be spend on this psuedoscience.

    See here for more information : http://thecaffeinatedautistic.wordpress.com/so-what-is-the-problem-with-autism-speaks/

  • ohmygosh Jul 16, 2014

    Any links to these "analysis" ? Do these include hard data with real cases showing that the future benefits indeed exceed the cost in constant dollars?

  • Matt Wood Jul 16, 2014
    user avatar

    View quoted thread

    I'd say the 37 other states that have passed laws requiring the coverage since 2001 could give you the answer to that. Oh wait, these people already provided that 13 years worth of data but for some reason you won't believe it...

  • ohmygosh Jul 16, 2014

    Can anybody prove that it saves money later? We have been told this about many, many programs. The long term economic benefits never seems to materialize.

  • Todd Jenkins Jul 16, 2014
    user avatar

    View quoted thread

    I guess you don't believe in spending a little money when the child is younger to save a whole lot of money later. I bet you are still using incandescent light bulbs also.

  • primetimeben Jul 15, 2014

    Ok. So you can't afford your premiums. Try paying more than a house payment a month (over $1200) for aba therapy for your child. If you have doctors that say that the child needs that why shouldn't insurance help cover it. I work 2 full time jobs and my wife works one and we are not on any government assistance and do not want any. But if something is been proven to help and with great results let the high priced insurance help pay. I guess the right politician has not gotten a child with autism yet.

  • Joseph Smith Jul 15, 2014
    user avatar

    I can barely afford my premiums now. Just another assault on the middle class. Property taxes up,sales taxes up groceries up. where does it end??

  • Will Sonnett Jul 15, 2014
    user avatar

    Certainly a "tug-at-the-heart-strings" issue but most likely a bottomless pit of funding. The term "autism" is attached to a myriad of physical, mental, developmental, and medical problems in today's society. Let's more specifically define the issue before we start flinging money at it.

  • Shelly McChesney Jul 15, 2014
    user avatar

    View quoted thread

    I'll help you understand. These kids are not "all on Medicaid" but currently most insurance does not cover the recommended therapy for Autism Spectrum Disorder and it's not cheap. It will save the state later because these children, IF provided with the recommended therapy at an early age (the sooner the better) can acquire the skills to become productive and self sufficient. I have a child with ASD and she has been in therapy for over 4 years. The improvements have been dramatic and I am thankful for that every day. One less battle for these folks to be able to get that done would be a Godsend.

  • 50s Child Jul 15, 2014

    Help me understand. If these women want "insurers" to be forced to pay for treatment....how is it going to "save the state millions and billions" later?

    We, uh, DO all have to have our own insurance, don't we? Or is what's not being said is that all these kids are on Medicaid? If so, then leave the insurers alone.