Autism coverage stalls legislative vote against Affordable Care Act

North Carolina would promise not to require health insurers to cover any new conditions or treatments for two years under a bill that stalled in an interim committee Tuesday. Although it will likely be amended, the measure was delayed because it would have forced lawmakers to choose between voting for the Affordable Care Act or against autism coverage.

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Mark Binker
Laura Leslie
RALEIGH, N.C. — For many of the lawmakers in the room, and at least one who was not present Tuesday, a bill dealing with the federal Affordable Care Act and insurance coverage was tied up by a potentially tough vote, political posturing and some basic disagreements between the state House and Senate. 

For Scott Taylor of Garner, it was about making sure that his son, Daniel, will be able to get the care he needs. 

"Daniel is 12," Taylor said. "At some point, he's not going to be a kid anymore."

In 2013, the state House passed a bill that would have required insurance companies to offer coverage for autism-related services. That measure stalled in the Senate but would be eligible for the "short" legislative session, which begins on Wednesday.

In the interim, a committee appointed to study the state's response to the Affordable Care Act crafted a two-pronged bill. One part of that measure would require insurers to display the added cost of the Affordable Care Act on people's insurance bills. The other part of the measure would commit the state to not imposing any new insurance mandates – requirements for coverage – for two years, starting in 2015.

With the fate of the existing autism bill uncertain, parents like Taylor and autism advocates feared the measure would delay the day insurance companies would have to pay for behavior therapies for their children.

"We were just afraid this was going to pass and exclude our ability to get fair insurance coverage. This would have pushed us back three years if that were the case," he said. 

That's why he was happy to see what amounted to a stalemate Tuesday night, as House and Senate leaders tried to work out a compromise after a strange day of political theater that could presage a rough-and-tumble session. 

Crafting an exception

The committee dealing with the Affordable Care Act bill was supposed to meet at 1 p.m., but it quickly became apparent that members of the state House were not showing up, depriving the committee of a quorum needed to function. 

Word in the legislative hallways was that that top House leaders, including Speaker Thom Tillis, did not want to force their members to vote for a bill that would anger those in the autism community. Tillis has worn a lapel pin featuring the logo for Autism Speaks in a campaign commercial, and it is an issue he appears ready to use during his U.S. Senate campaign.

But voting against the bill would mean voting against the state's response to the Affordable Care Act, what some call "Obamacare."

"That's a difficult position for a lot of my colleagues," said Rep. Charles Jeter, R-Mecklenburg. 

Senate leaders, who have shown little inclination to move the autism bill, said they were just trying to ensure stable insurance rates in the state for a period of time. 

"This is not a new idea," said Sen. Fletcher Hartsell, R-Cabarrus, who pointed to a similar measure from a decade ago.

He said the measure would not have interrupted any bill currently in progress, such as the autism bill.

Legally, the legislature cannot tie its own hands and could have taken up an autism insurance mandate, even if the ACA response bill passed. But in practice, lawmakers would have had political cover not to move on any such legislation.

When the committee reconvened at 4 p.m., there was once again a stalemate, with no quorum and little consensus on how to proceed. As the hour ticked by, small groups of legislators and lobbyists quickly huddled to craft a compromise.

As 5 p.m. approached, committee Co-chairman Jeff Collins announced to the crowd that it was obvious they would not get a quorum. Left unsaid was that many members were headed to pre-session fundraisers.

Collins, R-Nash, said the committee would reconvene at 9:30 a.m. Wednesday, just hours before the legislative session begins. 

"I have been told there is," Collins said, when asked if there was an agreement to exempt autism coverage from the insurance mandate moratorium. "I've heard a number of compromises that might be offered. I've not been part of that."

He added that he would have been happy with the bill unaltered.

Jeter said he expected the bill to be amended Wednesday morning to exempt autism spectrum disorders from the mandate moratorium. 

Asked for his take on the day, Hartsell initially played down any disagreement between the House and Senate, saying, "We were unable to get a quorum because of some conflicts."

But, he acknowledged, some of that of quorum might have been intentional.

"I think there were probably some misunderstandings about the contents of the potential legislation," he said. 

Meanwhile, that leaves one other bill – a measure that would require oral cancer drugs to receive equal insurance coverage with intravenous drugs – out in the cold for now. That measure has also passed the House and is pending in the Senate. 

Jeter cautioned that, once the measure left the interim committee, both the House and Senate could make amendments to exempt other items from the mandate moratorium. Of course, there would also be the opportunity to kill the bill as well. 

A rocky start to session? 

With the short session not even under way yet, does Tuesday's showdown portend a rocky session for the General Assembly? 

"I don't know that it is a precursor of anything at this point," Hartsell said. "I would hesitate to say that."

But how often has he seen members of a joint committee ditch specifically to deprive the panel of the ability to operate? 

"I've had experiences where a standing committee didn't show up," he said, "Of course, I've been around a while. It's not common, but we don't have committees very often that have 46 members." 

Jeter, too, cautioned not to read too much into Tuesday's posturing. 

"Making laws is never easy," he said. 

Despite both being controlled by Republicans, the House and Senate do not always see eye to eye. The insurance coverage issue is only one example of that.

But Jeter said it was healthier to have those differences on display and worked out publicly than forging behind-the-scenes deals that leave people guessing.

"Sometimes," he said, "it needs to be messy."


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