Blue Cross Blue Shield Adds Autism Benefits

Posted: Dec 29, 2008 09:57 PM

News9.com

OKLAHOMA CITY -- Blue Cross and Blue Shield of Oklahoma said it's adding benefits for children with autism. Many in the state hope this is a step in the direction to make all health care providers add autism benefits.

The company said benefits would cover evaluations and certain types of therapy without raising premiums too much. It will be available in 2010.

Advocates said Monday's announcement highlights the need to pass a law forcing all insurance companies to cover autism benefits.

"Blue Cross Blue Shield, with its customer base, will only reach a very small portion compared to what Nick's Law would do. But it does give us some validity that Nick's Law is necessary, we just wish we could do this to affect all of Oklahoma," Wayne Rohde with the Oklahoma Autism Coalition said.

Lawmakers will discuss the bill known as Nick's Law in February. It's named after Wayne Rohde's son who has autism.

Nick’s Law proponent skeptical of insurer’s new autism coverage

by Janice Francis-Smith
The Journal Record
December 30, 2008

OKLAHOMA CITY – After years of trying to force health insurance companies to cover costs related to autism, state Sen. Jay Paul Gumm responded with skepticism to the news that Blue Cross and Blue Shield of Oklahoma has decided to provide autism benefits.

“While I commend their effort, this appears to be an attempt to put the pin back in the grenade and forestall consideration of Nick’s Law in 2009,” said Gumm, D-Durant. Gumm was first in line to file a bill for the 2009 legislative session to require health insurance companies doing business in Oklahoma to provide autism benefits.

Senate Bill 1 is also known as Nick’s Law, named for the son of Edmond resident and head of the Oklahoma Autism Coalition Wayne Rohde.

State Sen. Patrick Anderson, R-Enid, and state Sen. Mary Easley, D-Tulsa, had also filed similar bills for consideration in 2009. Lawmakers anticipated a repeat of last year’s grass-roots effort, in which dozens of parents walked the halls of the state Capitol brandishing pictures of their autistic children, lobbying lawmakers to give Nick’s Law a chance.

In 2008, the battle came to a head in the House Economic Development and Financial Services Committee, which the chairman, state Rep. Ron Peterson, R-Broken Arrow, refused to hear the measure. Peterson, an insurance agent, maintained his position that insurance mandates drive up the cost of premiums.

Peterson withstood intense pressure throughout the 2008 session from the parents of autistic children who crowded the committee room and waited outside his office for a chance to speak to him. Though eligible to serve two more years in the Legislature, Peterson declined to run for re-election in November in favor of returning to the private sector.

In the end, the private market prevailed, said Oklahoma House Speaker Chris Benge, R-Tulsa, who had backed Peterson’s decision not to hear Nick’s Law in committee.

Today’s Blue Cross Blue Shield announcement is proof that when given the opportunity, the market works to encourage private companies like BCBS to provide services increasingly in demand within a community,” said Benge. “This debate has never been about a lack of desire to help families with autistic children whom we know are struggling to take care of their kids. We will be seeking ways to help these families without growing the uninsured population in this state or making it even harder for Oklahoma families already struggling to pay for health insurance now.”

Bev Binkowski, director of public affairs for Blue Cross and Blue Shield of Oklahoma, commended the Oklahoma Legislature for allowing the market to work.

“Rather than having a ‘one-size-fits-all’ mandate for all companies, we have been able to develop a benefit to meet the needs of our members,” said Binkowski. The company will provide “a clinically reasonable benefit” that will not dramatically increase premiums, she said.

Rohde said his group had already proven with actuarial studies that the benefits they requested would not significantly raise premiums. House Republican leaders had estimated the cost of the requested benefit would increase state employee health insurance costs by $6 million a year, but the autism advocacy groups had a study that showed the average premium would increase by $1.66 a month.

Rohde said he eagerly awaited details regarding the benefits Blue Cross and Blue Shield of Oklahoma would provide for autism treatment. Payment for behavioral therapies that have proven effective are critical aspect of the benefit parents have been clamoring for, he said. Rohde’s family pays about $5,000 per month on such treatments for their son Nick.

Gumm also questioned what benefits will be included in Blue Cross and Blue Shield’s new plan.

“While a step in the right direction, today’s announcement is only a small piece of the puzzle,” said Gumm. “We do not know caps on the benefit, we do not know precisely what therapies are covered.” The plan would not take effect until 2010, he added.

Neither Gumm nor Rohde took the news as evidence of the free market working.

“If it weren’t for the efforts of the parents (of autistic children in Oklahoma), Blue Cross and Blue Shield wouldn’t be making this announcement,” said Rohde. “This is a response to political pressure, not a response to market forces. Market forces are pushing the other way,” said Rohde, causing many insurance companies to cut back on benefits, not to add additional coverage.

Statement from Sen. Jay Paul Gumm on Blue Cross and Blue Shield Announcement

Oklahoma State Senate
Communications Division
State Capitol
Oklahoma City, Oklahoma 73105

For Immediate Release:
Statement from Sen. Jay Paul Gumm on Blue Cross and Blue Shield Announcement

“The announcement today by Blue Cross and Blue Shield is yet another clear and convincing piece of evidence that Nick’s Law should become Oklahoma’s law.

Blue Cross and Blue Shield says they have developed a benefit that ‘doesn’t unduly create a price impact’. That statement corresponds with the actuarial study we provided that shows we can help autistic children for mere pennies a day.

While a step in the right direction today’s announcement is only a small piece of the puzzle. We do not know caps on the benefit; we do not know precisely what therapies are covered; we do know thousands of Oklahoma families will remain uncovered; we do know it will be more than a year before this benefit becomes a reality. While I commend their effort this appears to be an attempt to put the pin back in the grenade and forestall consideration of Nick’s law in 2009.

All Oklahoma families deserve autism coverage and they are waiting for their government to stand up for them. We in Oklahoma cherish our children and this fight for them does not end with this attempt to relieve political and market pressures.”

OK House Speaker comments on BCBS press release

CONTACT:
Jennifer Monies, Press Secretary
Oklahoma House of Representatives
Office of House Speaker Chris Benge
Office: 405-962-7679
Cell: 405-550-8144
Email: jenniferm@okhouse.gov


OKLAHOMA CITY (Dec. 29, 2008) – House Speaker Chris Benge issued the following statement in response to the announcement made today that Blue Cross Blue Shield will offer additional autism coverage to insured groups in Oklahoma effective at the start of their next policy year:

“Today’s Blue Cross Blue Shield announcement is proof that when given the opportunity, the market works to encourage private companies like BCBS to provide services increasingly in demand within a community,” said House Speaker Chris Benge, R-Tulsa. “This debate has never been about a lack of desire to help families with autistic children whom we know are struggling to take care of their kids. We will be seeking ways to help these families without growing the uninsured population in this state or making it even harder for Oklahoma families already struggling to pay for health insurance now.”

Blue Cross and Blue Shield of Oklahoma Announces Autism Benefits

Blue Cross and Blue Shield of Oklahoma Announces Autism Benefits


TULSA, Okla., Dec. 29 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Oklahoma announced today the addition of an autism benefit to insured groups effective their next policy year. This change will not in any way affect the current medical coverage that has always been available to children with autism. Blue Cross and Blue Shield of Oklahoma is responding to market interests in the benefits and coverage of certain autism-related medically necessary services.

"We want to commend the Oklahoma Legislature for allowing the market to work," said Bev Binkowski, director, public affairs. "Rather than having a 'one-size-fits-all' mandate for all companies, we have been able to develop a benefit to meet the needs of our members."

Blue Cross and Blue Shield of Oklahoma will provide "a clinically reasonable benefit that doesn't unduly create a price impact on small employer groups and affect their ability to provide health care coverage to their employees," said Dr. Joe Nicholson, Blue Cross and Blue Shield of Oklahoma's chief medical officer and vice president of health care management. Benefit enhancements are expected to include evaluation and management procedures, speech, physical and occupational therapies. The health plan is targeting a January 2010 implementation date for this new benefit.

"Blue Cross and Blue Shield of Oklahoma has been able to develop a benefit that won't dramatically increase premiums," Binkowski said. "This decreases the likelihood that the increased benefit will result in employers dropping coverage and adding to the state's uninsured population."

"This action will allow us to provide a benefit for proven therapeutic services while research continues to identify effective treatments or medical solutions for children with autism," Nicholson said.

Blue Cross and Blue Shield of Oklahoma is a member of the Affordable Access to Health Care coalition. For more information, visit www.affordableaccesstohealthcare.org.


SOURCE Blue Cross and Blue Shield of Oklahoma

Senators file Nick's Law

Oklahoma State Senator Jay Paul Gumm, D-Durant filed Nick's Law SB 1 for the 2009 Legislative Session that starts Feb 2, 2009.

Also, Senator Patrick Anderson, R-Enid, refiled Nick's Law as SB 36. Senator Mary Easley, D-Tulsa, refiled Nick's Law as SB 46.

These three senators filed their bills shows a bi-partisan approach to address the need for insurance coverage for medically necessary treatments of autism.

We’re in this together

We’re in this together
Point of View Health coverage

BY DAVID BLATT

Published: November 16, 2008

With more than one in five non-elderly Oklahomans lacking health insurance and health care costs posing an ever-growing burden on businesses and families, identifying options to expand access to health insurance coverage is likely to be a major priority for Oklahoma policymakers during next year’s legislative session. This fall, legislators and others have been working as part of a House task force aimed at developing recommendations to chart a path forward.

We believe Oklahoma can best move forward by building upon the foundations of our mixed private-public health care system and upon programs and policies adopted in recent years. In particular, the state should continue to expand the Insure Oklahoma program, which provides a public subsidy for low-income employees and their spouses to purchase employer-sponsored insurance when that is offered, or to buy in directly to a public product when employer-sponsored coverage is unavailable.

Insure Oklahoma represents a flexible public-private partnership that can help small and medium-sized businesses provide coverage to their employees. While enrollment in Insure Oklahoma has been slow to grow, real progress seems likely if and when Oklahoma receives federal approval to move ahead with expanding the program to firms with up to 250 employees and employees up to 250 percent of the poverty level. At the same time, the Legislature should consider expanding eligibility for traditional Medicaid to adults below the poverty level. This would help cover a population that has very high rates of uninsured and often finds even the subsidized cost-sharing obligations of the Insure Oklahoma program to be unaffordable.

While recent policy initiatives are moving Oklahoma in the right direction, we must be extremely careful that efforts to expand coverage don’t come at the expense of eroding the quality of health insurance in the group and individual markets. Some are tempted to relax coverage standards and offer more choices for bare-bones, low-cost coverage. This is seen as especially attractive to the young and healthy, who currently may only be offered more benefits than they want at a cost they cannot afford or choose not to pay.

The basic problem with this approach is that affordable coverage for those with the greatest health care needs — especially women of child-bearing age, persons with chronic physical and mental health conditions and older workers — can only remain available is if there is a large, diverse pool that includes younger, healthier individuals. If that population is pulled out of the risk pool by the availability of bare-bone products, we could easily descend into a downward spiral where those who most need health care will be unable to find or afford it. That won’t solve our uninsured problem and it certainly won’t make us a healthier state.

Real solutions to the crisis of the uninsured in Oklahoma will occur only if everyone — the public and private sectors, young and old, high-income and low-income, healthy and sick — is working together toward our common goals of affordable, quality care.

Blatt is director of policy for the Oklahoma Policy Institute ( http://www.okpolicy.org/).

Oklahoman OP/Ed - Cost benefit Analysis needed

Cost-benefit analysis needed to examine issue
OUR VIEWS: Insurance mandates

Published: December 10, 2008

With two months to go before the start of the next legislative session, one of the loudest issues that will come before lawmakers is already making noise.

It’s the issue of forcing health insurance policies to cover autism treatments. Taking a larger view, it’s the issue of adding mandates to policies that make them more expensive and thus harder to afford by those already struggling to get coverage.

Battle lines on this issue were drawn in the 2008 session, in a tussle between the forces of emotion and the forces of reason. Back then we termed it a classic case of the irresistible force meeting the immovable object.

Parents of children with autism have a champion in state Sen. Jay Paul Gumm, D-Durant, who approaches the issue with almost evangelistic fervor. If he’s the good guy in this deal (and we don’t necessarily believe he is), then the men in black hats are Republican House members who believe the mandate train must be held up if not derailed.

Gumm says momentum is building for "Nick’s Law,” the mandate bill named for an Edmond boy who is autistic. Last year, Gumm couldn’t get a hearing for the bill in the Republican-controlled House, despite intense lobbying from the parent group and Gumm’s emotion-choked arguments.

A possible compromise — passing this mandate in exchange for a bill restricting future mandates — went nowhere. This reasonable approach may face just as much opposition as before. Gumm now has the burden of getting his bill through a Senate that will be controlled by Republicans for the first time in history.

The autism mandate would be the 37th the state forces on policyholders. Estimates on what the autism mandate would cost vary wildly — so much so that it’s difficult to believe either side’s numbers.

Nevertheless, mandates do add to the cost of insurance, and that reduces the number of people who can afford insurance in a state with a chronic uninsured problem.

Rep. Doug Cox, R-Grove, is a physician who initially supported Nick’s Law. He now opposes it on the basis of not wishing to worsen the uninsured problem.

We believe the first thing the Legislature should do vis-a-vis mandates is to pass a law requiring a cost-benefit analysis for all future mandates. That analysis should not be funded by the state. Absent a consensus on the cost of any particular mandate, it’s folly to keep adding dollars to policy premiums.

Lawmaker proposed mandate waiver

Lawmaker proposes mandate waiver

The Edmond Sun

December 06, 2008 01:02 am

— OKLAHOMA CITY (AP) — Legislation that would waive state health insurance mandates and permit insurers to create inexpensive “bare-bones” health insurance policies could significantly reduce the number of uninsured Oklahomans, a physician and state lawmaker said Friday.

Rep. Doug Cox, R-Grove, an emergency medicine physician at Integris Grove General Hospital, said he is drafting a measure that would waive a variety of mandated coverage for people in their 20s and 30s whose major health expense is accidental injuries.

Cox said he believes mandates drive up the cost of health insurance and make it unaffordable for many Oklahomans. Oklahoma has an estimated 600,000 uninsured residents, including 85,000 under the age of 18.

“Younger people are for the most part healthy,” Cox said. “It’s also the age range where they don’t really have the excess cash to use to buy things like insurance policies. So, let’s offer them a bare-bones policy.”

Cox’s proposal received the support of Insurance Commission Kim Holland, who said she endorses the plan to evaluate the state’s mandated coverage and develop affordable health insurance policies.

“I think it’s appropriate to take a second look and say, ‘Wow, do people really need all this,’” Holland said. “Affordability is the No. 1 reason that people say they don’t have insurance. We have to come up with more affordable health insurance options.”
Every state imposes health insurance mandates on insurers. Minnesota has the most with 64 and Idaho the least with just 15.

Oklahoma has 36 health insurance mandates for such procedures as immunizations for children, mammograms, breast reconstruction and prostate cancer screening. Some mandates, such as maternal health, are imposed by federal law and cannot be waived, Holland said.

Lawmakers plan to consider another mandate to cover the diagnosis and treatment of autism when the Legislature convenes in February.

Cox said waiving state mandates would allow health insurers to create high-deductible accident policies for young people. State-mandated coverage would still apply to people 40 and over, he said.

“As you get older, preventative tests become more important,” he said. “I think it will have some impact. Young people just don’t see the value of insurance. Young people don’t see the value until they need it — and then it’s too late.”

Holland said 70 percent of young adults aged 19-34 in Oklahoma do not have health insurance. “They’re young. They’re invincible. They’re looking at the immediate. They’re not thinking long-term,” she said. Holland said her agency is interested in developing insurance products to help people manage their health from a young age.
“There are ways that we can construct low-cost plans for them,” she said.

A health insurance mandate is a requirement that an insurer or health plan cover or offer coverage for health care providers, benefits and patient populations.

The Council for Affordable Health Insurance, a research and advocacy association of insurance carriers based in Alexandria, Va., says mandates make health insurance more comprehensive as well as more expensive by requiring insurers to pay for care consumers previously paid for out of their own pockets.

CAHI estimates that mandated benefits increase the cost of basic health coverage from a little less than 20 percent to more than 50 percent, depending on the state and its mandates.

Nick’s Law is Oklahoma Senate Bill 1

Nick’s Law is Oklahoma Senate Bill 1

By Bailey Dabney, Publisher
CLAREMORE DAILY PROGRESS

December 4, 2008 December 04, 2008 04:19 pm

— With health insurance, most Americans can reasonably expect their plan to pay for treatments that heal them when they are sick.
After all, that’s what insurance is for. Our premiums are due and are paid even when we are not sick.
If your child is autistic you still pay the premiums, but don’t be expecting a whole lot of care. It’s been argued that illegal aliens get better care than autistic citizens.
With a little help, that may be changing. Nick’s Law, or Senate Bill 1, would stop insurers from denying necessary care for autistics.
Opponents say that insurance premiums would have to go so high that more Oklahomans would lose their health insurance.
The facts don’t support that argument. According the Bill’s sponsor, Senator Jay Paul Gumm (D, Durant), an actuarial study revealed a cost per policy holder of $1.66 per month.
Senator Gumm believes he has the bipartisan support and the votes needed to pass it in both chambers, if it will be allowed to come up for a vote.
In April, Tulsa Representative Ron Peterson blocked hearing of the bill in the House. Peterson used to make his living in the insurance business. The largest sector of his financial support came from the insurance and pharmaceutical industries, both of which have seemingly waged war on the families of autistics for years.
He also blocked passage of Steffanie’s Law, a bill requiring coverage for certain cancer victims. Steffanie Collings, of Noble, died March 13th with $450,000 in medical bills.
Representative Peterson chose not to seek re-election after the current term, so his blockade should now be lifted.
If you believe that a health plan should not be required to cover treatments for Autistic patients, do you also believe that they should not cover cancer treatments? Apparently Rep. Peterson does. Would you support politicians who allow health plans discontinue insulin for diabetics? How about antibiotics for ear infections? Hernia surgery? Aids? What condition is next?
Claremore’s own Representative Tad Jones (R, Claremore) is now the House Floor Leader, an influential position to say the least. Our Senator, Sean Burrage has already pledged his support of Nick’s Law, and voted for it in the spring.
The ball will likely end up in Rep. Jones’ hands.
Will the former quarterback and new House Floor Leader exert his considerable influence or fumble? Let’s hope he gives Nick’s Law the chance to be voted on.

Copyright © 1999-2008 cnhi, inc.

Momentum, Editorial Support Grows for “Nick’s Law”

The State of Oklahoma

OFFICE OF SENATOR JAY PAUL GUMM

Atoka, Bryan, Coal, Johnston & Marshall Counties

December 4, 2008

FOR IMMEDIATE RELEASE

Contact: Senator Jay Paul Gumm

State Capitol: (405) 521-5586

Durant Office: (580) 924-4717

Mobile: (580) 920-6990

Momentum, Editorial Support Grows for “Nick’s Law”

Even Editorial Opposition Admits “Bill Will be Hard to Stop”

(For digital audio, go to http://www.oksenate.gov/ and select “News”)

OKLAHOMA CITY – While the legislative session will not get into full swing until February, momentum is already building for Senate Bill 1, also known “Nick’s Law.” The legislation would require health insurance companies to cover diagnosis and treatment of autism in children.

“I continue to hear from more families and child advocates who know this bill is the right thing to do,” said Senator Jay Paul Gumm, author of Nick’s Law. “Since the legislation was first introduced, we’ve seen a growing number of newspapers throughout the state voice editorial support for the measure.”

Autism is the fastest growing developmental disability in the United States, affecting one in every 150 children. Recent editorials, news reports and scholarly studies on the issue have pointed to the financial devastation caused to families after their insurance companies have refused to cover autism diagnosis and treatment.

To date, newspapers in Enid, Claremore, Edmond and Tulsa are among those that have published editorials expressing support for Nick’s Law. This week, even The Daily Oklahoman – which has been critical of Nick’s Law – wrote in an editorial that the “bill will be hard to stop.”

In 2008, the measure repeatedly passed the Oklahoma Senate with bipartisan support. Gumm, a Democrat from Durant, said there was bipartisan support in the House of Representatives, as well. A small group of House Republicans, led by now-former Rep. Ron Peterson worked to prevent even a vote on the bill.

“I’ve said it repeatedly: Autism strikes families from all walks of life, families from both political parties,” he said. “Conservative Republican lawmakers in other states have written, fought for and passed similar legislation. High-profile Republican governors already being talked about as presidential candidates have signed into law similar legislation.”

Gumm said Oklahoma’s families do not care who gets credit for passing Nick’s Law, they just want to see it become Oklahoma’s law. “I will be the first in line to give all the credit in the world to lawmakers of either party who will stand up for these families who are suffering,” he said.

In a national Associated Press story by medical writer Lindsey Tanner, a study published in the American Academy of Pediatrics magazine was detailed. The study documents the challenges faced by families with autistic children.

According to the story, these families endure health care costs that put “unprecedented financial strain” on families. Further, the report notes that when compared with parents of children with chronic health care needs other than autism, those with autistic children are three times more likely to have quit jobs or cut back on work hours to care for their children.

These families pay more for their children’s health care, spend more time providing or arranging for that care and are more likely to have financial challenges. Lost wages and high health care costs compound the struggles of these families, often leading to divorce.

“Every shred of evidence points to the fact that bills like Nick’s Law do make a huge difference in the lives of these children and their families and are unquestionably ‘pro-family,’” Gumm said. “This bill is not a complete solution – no one has claimed it is – but it is the foundation on which we can build while ultimately saving taxpayers’ dollars.

“To do nothing, is to condemn these children to a lifetime locked behind the walls of autism. To do nothing condemns these parents to a lifetime of unprecedented financial struggles. To do nothing condemns taxpayers to eventually picking up the tab. To do nothing is unconscionable.”

Study: Autism puts Unprecedented Financial Strain on Families

Monday , December 01, 2008

More than half a million U.S. children have autism with costly health care needs that often put an unprecedented financial strain on their families, national data show.

Compared with parents whose youngsters have chronic health care needs but not autism, those with autistic children are three times more likely to have to quit their jobs or reduce work hours to care for their kids. They pay more for their kids' health needs, spend more time providing or arranging for that care, and are more likely to have money difficulties, the study found.

"This is the first national survey that looked at the impact on families of having kids with special health care needs," said lead author Michael Kogan, a researcher with the government's Maternal and Child Health Bureau.

The results are from a nationally representative 2005-06 survey of nearly 40,000 children with special health care needs. These children have a broad range of chronic conditions, including physical and mental illness, requiring more extensive than usual medical care.

A total of 2,088 children with special health needs had autism, which translates to about 535,000 kids aged 3 to 17 nationwide, the study authors said. The study appears in December's Pediatrics, being released Monday.

Autism typically involves poor verbal communication, repetitive behaviors such as head-banging, and avoidance of physical or eye contact. Affected children often need many more types of treatment than kids with other chronic conditions, including speech and behavior therapy and sometimes medication. Kogan said that may explain the disproportionate strain on their families.
Jacquie Mace, whose 12-year-old son, Austin, has autism, said the study presents a "very realistic" picture of the challenges affected families face.

Mace said she spends "easily $15,000 to $20,000 out of pocket" yearly on supplies for behavior treatment she provides for her son. She's still working to pay off a $7,000 bill for dental work Austin had last year. He has to be sedated and hospitalized for dental care because he can't sit still in a chair, Mace explained. Austin's health insurance doesn't cover any of it, she said.
Some states require insurers to cover certain autism treatment while similar proposed measures are pending in others, including Illinois.

Mace hasn't had to quit her job helping local families find autism resources, but knows of many parents who've had to leave work to care for their autistic kids.

She is divorced — another common casualty, she said, of the challenges of caring for autistic kids.

Help Needed - Tulsa World Editorial

Help needed by: World's Editorial Writers
11/26/2008

Let's cover autism

Perhaps it is symbolic that the first bill filed in anticipation of the upcoming Oklahoma legislative session is a Senate bill that would require insurance companies to cover diagnosis and treatment of autism in children. Senate Bill 1 is entitled "Nick's Law," and is named for 11-year-old Nick Rohde of Edmond, who suffers from autism. Wayne Rohde, Nick's father, tried valiantly last session to get the measure out of a House committee only to be blocked at every turn. The bill, authored by Sen. Jay Paul Gumm, again will face stiff opposition from insurance interests who claim it would raise rates.

Isn't it instructive, however, that other states have enacted similar legislation with bipartisan support? The Republican House members who so stridently opposed the measure should look at the facts. The number of children with autism now exceeds the number of children with cancer, diabetes and AIDS combined. This is a real disorder, and families deserve all the support they can get.

It has been shown that intensive behavioral interventions, done early, can stop or even reverse some of the significant impairments related to autism. "These behavioral interventions are not experimental. Reports show that children who receive early, intensive behavioral treatment make substantial, sustained gains in IQ, language, academic performance and adaptive behavior. Unfortunately, insurance companies in Oklahoma are not required to provide coverage for these medically necessary interventions," said Broken Arrow resident Janet Borden, who discussed the subject in a well-reasoned and well-informed letter to the Tulsa World in June.

Former state Rep. Ron Peterson and House Speaker Chris Benge do not favor insurance mandates. Neither do we in some instances. But by forcing thousands of insured families to seek coverage for autism in the form of state services, mostly school-based, we believe legislators indeed are falling in with big insurance and against the interests of children with disabilities, the most vulnerable members of our society. For a change let's be progressive and humane and offer these families the help they deserve.

Legislature should take action on autism bill - Enid Eagle Editorial

Legislature should take action on autism bill

November 22, 2008 12:19 am—

A bill that would require insurance companies to cover diagnosis and treatment of autism in children has been filed for the 2009 legislative session. A similar bill filed last year didn’t make it out of committee.We’d like to see the Oklahoma State Legislature consider this bill, known as “Nick’s Law” and named after 11-year-old Edmond boy Nick Rohde, who suffers from autism.Right now insurance companies aren’t required to cover children with autism.

Families with autistic children often have to spend thousands of dollars in therapy for their children, and some children don’t receive the kind of therapy that can help them because their families simply can’t afford it. The Oklahoma measure has received support; however, it was stopped in the House of Representatives last year. It’s time for Oklahoma to take up some kind of action on autism insurance.

Other states have enacted autism insurance legislation. It’s passed in Louisiana and Florida. And in Illinois, the governor is expected to sign a bill that would require insurers to cover autism treatment up to $36,000 a year until a patient turns 21.Latest statistics show one in 150 children born in the United States will have some kind of autism.

More and better diagnoses of autism mean more families are facing the challenge of autism, but have little recourse in getting their children necessary help. Oklahoma legislators have many states to emulate when it comes to coming up with some kind of insurance protection for autism. It’s time they make the effort and get something done on behalf of these families.
Copyright © 1999-2008 cnhi, inc.

Senate Bill 1 - Nick's Law KSBI TV

Senate Bill 1 - Nick's Law
Friday, November 21, 2008; Posted: 4:12 p.m. (CDT)
Democratic Senator Jay Paul Gumm is trying to pass "Nick's Law" again this year.

The bill would require insurance companies to cover autism diagnosis and treatment.

Senate Bill 1 is named for Nick Rohde. He's an 11-year-old from Edmond who suffers from autism.

His father, Wayne Rohde, lobbied for the bill last year but it didn't pass a house committee.

He has higher hopes for this year.
Rohde says, "The elections did go significantly to the republicans. It was the republican house leadership that stopped this legislation last year."

He goes on to say, "But I'm hopeful they will do the right thing and take a very serious look at this and allow this type of legislation to go forward."

Rohde says similar legislation has been adopted in other states.

“Nick’s Law” will be “Senate Bill 1” for 2009 Session

The State of Oklahoma
OFFICE OF SENATOR JAY PAUL GUMM
Atoka, Bryan, Coal, Johnston & Marshall Counties

November 20, 2008


FOR IMMEDIATE RELEASE
Contact: Senator Jay Paul Gumm
State Capitol: (405) 521-5586
Durant Office: (580) 924-4717
Mobile : (580) 920-6990

“Nick’s Law” will be “Senate Bill 1” for 2009 Session
(For digital audio, go to http://webmail.central.cox.net/do/redirect?url=http%253A%252F%252Fwww.oksenate.gov%252F and select “News”)

OKLAHOMA CITY – The first Senate bill filed for the upcoming legislative session is “Nick’s Law.” Senator Jay Paul Gumm is the principal author of Senate Bill 1, which would require insurance companies to cover diagnosis and treatment of autism in children.
Gumm, a Democrat from Durant, first filed the bill in 2008. The measure won bipartisan support in the Senate, but it was stopped by a small group of Republican leaders in the House of Representatives. Gumm said then he would renew his fight for the bill, which he says is critical for children all over Oklahoma.
“Children with autism who do not receive therapy can be virtually cut off from the world for the rest of their lives,” he said. “The real tragedy is we know for a fact therapy can save them from that fate – unfortunately, thousands of Oklahoma children are denied treatment by insurance companies. This is a health issue and it is a moral issue.”
According to the Centers for Disease Control, one out of every 150 American children will be diagnosed with autism, a bio-neurological condition that appears in early childhood and impacts the ability to communicate and interact with others. While medical science has yet to determine the exact cause or cure, treatment has been proven to significantly improve outcomes.
Republicans and Democrats across the country have joined hands to enact autism insurance legislation like “Nick’s Law.” In July, Louisiana ’s Republican Gov. Bobby Jindal – one of the GOP’s “rising stars” – signed autism legislation that was sponsored by a Republican state representative from Baton Rouge .
Florida Gov. Charlie Crist, another high-profile Republican governor, signed that state’s autism bill in June – a bill passed by the Republican-controlled Florida Legislature.
Also, in Pennsylvania, Republican House Speaker Dennis O’Brien championed a measure – which passed the House unanimously and a Republican-controlled state Senate 49-1 – that will allow parents of autistic children to pay for behavioral therapy and related services with private health insurance.
“In state-after-state, bills requiring insurance to cover autism diagnosis and treatment are crossing the partisan divide,” Gumm said. “Several Republicans state representatives are already on record saying they will support the bill. Now, it is time for their leadership to join GOP lawmakers and governors across the nation and do the right thing for these families.”
Gumm’s legislation is named for 11-year-old Nick Rohde of Edmond , who suffers from autism. His father, Wayne Rohde, and other parents of autistic children spent, countless hours at the Capitol last year winning support for the bill. Earlier this fall, “Nick’s Law” was named the top 2009 legislative priority for the Oklahoma Institute for Child Advocacy.
“House Republican leaders have an amazing opportunity to become heroes by passing this bill, and no one will sing their praises louder than I will,” Gumm said. “All they have to do is live up to their ‘family values’ rhetoric and put the lives of these children ahead of insurance company profits.
“For just about every other Oklahoman, this is an easy choice.”

Insurers make pitch for health coverage mandate

By KEVIN FREKING, Associated Press Writer Kevin Freking, Associated Press Writer Wed Nov 19, 3:30 pm ET

WASHINGTON – The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions — but in return it wants lawmakers to mandate that everyone buy coverage.

Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage easier. That legislation is expected to closely track the proposals of President-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.
More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They'll remember it was the industry's opposition 15 years ago that helped scuttle former President Clinton's health plan.

The board of directors for America's Health Insurance Plans agreed to the trade-off Monday night. The board endorsed the proposal after a series of hearings in various states.
"We hope this will be a contribution to help members of Congress fashion their proposal," said Karen Ignagni, president and chief executive officer of the trade group. "We're going to provide all the technical background that we have assembled, all the experience we've assembled at the state level, and we're going to work very hard with members of Congress on both sides of the aisle. We want to make sure that whatever reforms are advanced, no one falls through the cracks."

Obama's health plan calls for a health insurance exchange, a sort of government-run shopping center where customers could go to select from private plans or a plan administered by the federal government. Any insurer that wants to participate in that exchange must accept all customers regardless of pre-existing health conditions, such as diabetes or heart disease.

Insurers will want to participate in the exchange because government subsidies will make it easier for millions of people to buy coverage from them. But the insurers say experience in the states shows the coverage guarantee often makes it harder for people to find coverage. That's because insurers raised premiums to meet the expense of covering all applicants with chronic health conditions.

"They ended up making the problem much worse," Ignagni said of the state efforts. "The data is clear about the need to have everyone part of the system."

Analysts say Massachusetts is an example where the coverage guarantee has worked well, but it's also a state that requires everyone to buy health coverage or suffer a tax penalty.
Some key Democratic lawmakers have already expressed support for an individual mandate. The concept was a centerpiece of Sen. Hillary Rodham Clinton's health care plan. It was also part of the blueprint offered last week by Sen. Max Baucus, chairman of the Senate Finance Committee.

Chris Jennings, senior health care adviser in the White House during the Clinton years, said it remains to be seen whether the industry will support other key components of health care reform. Nevertheless, he called it an important contribution to the coming debate.
"It sends the signal that broad health reform can happen," Jennings said. "There are so many in Washington who are the gloom and doom prophesiers who believe it's impossible."
However, Consumer Watchdog, a consumer advocacy group, called the insurers' position self-serving.

"If consumer's can't afford coverage or refuse to buy it, they'll face tax penalties. Turning the U.S. government into a collection agency for for-profit health insurers is not universal health care, its full employment for HMO executives," said Jerry Flanagan, the group's health care policy director.

Training in autism offered to officials

Training in autism offered to officials
By Staff Reports 11/7/2008

The Tulsa Autism Foundation will present free training for area first responders about dealing with people with autism during the performance of their jobs. The training features safety expert Dennis Debbaudt and will be held from 8:30 a.m. to 4 p.m. Monday at Tulsa Technology Center's Riverside Campus, 801 E. 91st St.

Debbaudt is the father of a young man with autism and is a professional investigator and law enforcement trainer. Research indicates that people with developmental disabilities are about seven times more likely than others to come into contact with police. Law enforcement officers, school resource officers, fire rescue and public safety workers, emergency medical response teams, emergency room workers, 911 dispatchers and criminal justice agency personnel are invited to take part in the training, which is a Council on Law Enforcement Education and Training accreditation course.

An additional session for families, teachers and other interested professionals will run from 6:30 to 8:30 p.m. Monday at the same site. For more information or to preregister, call the Tulsa Autism Foundation at 502-4823 or go online to tulsa world.com/autismtulsa.

Faught, McPeak re-elected to state House

Editor's Note. We congratulate Rep Faught on his victory. We hope that he will now help to work for passage of Nick's Law. We also congratulate Eugene Blankenship on a courageous campaign to speak for the children and adults with autism.


Faught, McPeak re-elected to state House
By Liz McMahanAssistant City Editor

November 05, 2008 02:19 am— Republican George Faught won his second term in the state House of Representatives Tuesday, this time by a bigger margin than two years ago.He won the District 14 race against Democrat Eugene Blankenship by more than 1,400 votes. Two years ago, Faught won by 670 votes over challenger Jeff Potts.“It seems like this race, in a lot of ways, was tougher than last time,” Faught told a group of more than 100 who had gathered at his victory party in Muskogee’s 7th and 8th Grade Center’s media center. Faught pledged to his supporters that he will not become a professional politician but will stay in touch with his people.“We’re still going to be who we are because that’s who we are,” he said.

Meanwhile, Jerry McPeak declared victory early in the evening in his District 13 race against Republican Debbie Lienhart. With McPeak taking about 70 percent of the vote, that race was never a contest during the evening.Speaking at the Democrat watch party at the Muskogee Fairgrounds, McPeak said he was both flattered and humbled by his win. “To win by this kind of margin, we had to get Republican votes as well as Democrats; we had to get city votes as well as rural ones,” McPeak said.While both McPeak and Faught savored their victories, both also started looking toward the next legislative session, saying it is filled with both challenges and opportunities.

McPeak said many of the challenges will come in the area of lower state revenues. While lower fuel prices are good for consumers, lower oil prices are bad for the state economy, he said.However, the state also is poised for great opportunity with its wind and other energy resources, McPeak said. Muskogee is especially well positioned to turn these challenges into opportunities with its access to transportation, especially navigation.

Faught also said Muskogee is well positioned for the future because of its port. Oklahoma should attract new business with its natural resources and low cost of living.He said he hopes the state Legislature will come together to address such issues as worker’s compensation reform and tort reform.

Blankenship said he congratulated Faught on the win. He said it was a good campaign and he hopes it drew Faught’s attention to some areas that need to be addressed.Blankenship said this was his first venture into politics and “This is not the end of a political career for me.”
Copyright © 1999-2008 cnhi, inc.

Name game: Senate challenger almost pulls it off

The Oklahoman Editorial
Published: November 7, 2008
Jim Reynolds, Republican state senator from Oklahoma City, won re-election this week to his third and final term — but just barely. Reynolds’ 13,826 votes were a mere 159 more than his challenger, David Boren.

That’s right, David Boren. Not the David Boren — the University of Oklahoma president, former governor and U.S. senator, father of U.S. Rep. Dan Boren — but the psychiatric nurse from Moore who had never run for public office.

Consider that when Reynolds first won election eight years ago, he beat an incumbent Democrat who had raised about five times as much money. Then in 2004, Reynolds beat his challenger with 57 percent of the vote. Yet this time, despite a big edge in fundraising and a solid record at the Capitol, he almost lost.

In a story in The Oklahoman last month, Boren said he decided to run after the Legislature failed to pass a law that would have mandated insurance coverage for autistic children. He said he wanted Oklahoma to be a leader in renewable energy and that he was concerned about mental health issues.

Little more was heard from him during the campaign. Much of the money he raised arrived in the final few weeks and came largely from attorneys and Democratic political action committees. One of those PACS funded last-minute attack ads against Reynolds, whose conservative record has been a good fit with District 43 constituents for eight years.

This time he really had to sweat. What’s in a name? Jim Reynolds might tell you plenty.

Remember those with autism - Edmond Sun OP/Ed

Published: November 03, 2008 11:19 pm
Remember those with autism

To the Editor:As elections grow near, we would like to thank the thousands who have fought to generate awareness of a disease that, according to the Centers for Disease Control, affects one out of every 150 children. That disease is called autism.

When everyone goes to the polls, keep in mind that according to actuarial studies, the cost for insurance coverage for autism in Oklahoma only would raise premiums by less than $2 per month, if at all.

Think about families spending all their retirements, their parent’s retirements and going bankrupt to pay for a disease that affects their children and is more prevalent than all pediatric cancers, AIDS and diabetes combined.

Lastly think about something one of our Republican House leaders said: “… why should we help these children when they are only going to end up in institutions ….” Then think how you would vote if Republican House leadership was referring to your child.

Then thank God, if they weren’t.

Robyne and Wayne Rohde, Edmond

UCO prepares future behavioral specialists

Program allows for national board certification

By MICHAEL MCNUTT
Published: October 27, 2008

EDMOND — More behavioral specialists to help tutor autistic children in public schools could be ready to provide services in the state in a couple years.

The University of Central Oklahoma is offering a degree program to prepare students to become nationally board certified behavior analysts who specialize in autism, a complex developmental disability that affects the ability to communicate and interact with others.

The post-graduate degree program is for those who already have a master’s degree or are in a master’s degree program, said Mary Sweet-Darter, a UCO associate professor of psychology who leads the program. It takes about two years to complete the coursework, she said.

Those completing the courses and 1,600 hours of internship are eligible to take a national test to become a board-certified behavioral analyst, she said. Twenty-three students are enrolled in the UCO program,

"We don’t want these services to be limited to the medical field or private practice,” Sweet-Darter said. "We want to get these skills into the public schools.”

"If you go right now into most public schools, you won’t see a one-on-one tutor with every small child with autism,” Sweet-Darter said. "You’ll see one teacher and one aide and they’re trying to teach several children with autism.”

Putting a price on autism in Oklahoma

Pilot program finds a lack of behavioral practitioners who can work with children

BY MICHAEL MCNUTT
Published: October 27, 2008

Oklahoma lacks enough therapists and behavioral specialists to take care of the state’s autistic children, according to the preliminary findings of a pilot program.

Thirty families selected to take part in the autism two-year pilot project each could spend up to $12,360 a year on services for their autistic child.

"What we discovered was there are so few providers of those services to these families that the spending on the behavior therapies was pretty small,” said Jim Nicholson, director of the developmental disabilities division of the state Department of Human Services. "There’s a lack of service providers that had that kind of specialty training.
"There aren’t enough, particularly, skilled behavioral practitioners,” he said.

Each family on average spent about $4,500 a year on services for their autistic child, he said.

The pilot program is to expire at the end of next month, sooner than expected because DHS officials "learned what we had hoped from the pilot,” Nicholson said. "The pilot did its job, and two years was enough.”

It’s unknown how many autistic children are in the state. According to the national Centers for Disease Control and Prevention, one in every 150 children in the U.S. is diagnosed with autism. It is considered the fastest-growing developmental disability. Research indicates early intervention can help.

A parent’s reaction
Deborah Decker of Norman, a parent whose family was chosen to take part in the study, said she is disappointed the program is ending.

"It just opened up a lot of avenues that we wouldn’t have had otherwise because it’s just so expensive,” said Decker, who developed a plan for her 6-year-old autistic son. "It was nice just to have that money to really do some intensive treatment with him.”

Parents in the program were told how the money could be spent and what services might be best for their child, Decker said. Each family drew up a budget on how the money would be spent.

Decker said her family spent about $7,000 a year and would have spent more had more services been available.
Most of the money her family spent was on applied behavioral analysis, which most insurance companies don’t cover, she said. Other expenses were for therapy for her son and occasional baby-sitting expenses.

She said she spent more than the program’s average because her family was able to hire applied behavioral analysis tutors from their public school district. Because of the applied behavior treatment, her son now can answer "yes” and "no” questions, she said.

Nicholson said the pilot program also looked at ways families with autistic children could support each other. But results showed parents were so exhausted from taking care of their own children they were too weary to take on the task of helping others, he said.

Of the 30 families selected to take part in the program, 15 were from the Oklahoma City area and 15 were from the Tulsa area.

Several parents who came to the state Capitol earlier this year to speak in favor of autism legislation said they pay thousands of dollars each month for treatment for their children, with some traveling out of state for help. In most cases insurance won’t cover all the fees.

Autism Group lobbies for more insurance coverage

Autism group lobbies for more insurance coverage
By Isadora Lapowsky
Monday, October 20th 2008, 1:22 PM
At a time when an increasing number of states are requiring health insurers to pay for behavioral therapy for autism, the action group Autism Speaks is pushing for broader adoption of such coverage.

The advocacy group reportedly is campaigning to have New Jersey, Virginia and Michigan enact laws guaranteeing coverage. If they do, they would join six states (Texas, Pennsylvania, Arizona, Florida, South Carolina and Louisiana) that have recently implemented the legislation.
RELATED: JENNY MCCARTHY AND AMANDA PEET ARGUE OVER AUTISM

By the end of 2009, the group plans to push for similar action in at least 10 other states. J.P. Wieske, an insurance lobbyist, called the effort "the hottest trend in mandates we've seen in a long time. It is hard to fight them."

In New York State, policies are prohibited from excluding coverage for the diagnosis and treatment of ASD, including autism.

For many lawmakers, the personal experiences tied to the bills make it difficult to reject them. Parents tell about how well behavior therapy has worked for their children, giving certain bills nicknames like "Steven's Law" and "Ryan's Law."

Lobbying for insurance coverage has now become one of Autism Speaks' top priorities. "It's the No. 1 thing we hear from parents," said Elizabeth Emken, the organization's vice president of government relations. "What's more difficult than knowing there's an effective treatment for your children, but you can't afford to offer it to them because it's not covered by insurance?"

Researchers, however, say that therapy may only be really effective for young children. "You could make a decent case for the little kids of up to 6 or 7 that [insurance mandates] would be appropriate," said Tristram Smith of the University of Rochester Medical Center in New York. Smith, who co-wrote a study on autistic children in 2000, said, "It would be hard to make that case for older kids."

Despite opposition, Autism Speaks is continuing its drive with extra force in this election year. Recent economic bailout measures approved by Congress included a requirement that health insurance companies provide equal coverage, in general, for physical and mental health. Though that does not always include people with autism, Emken sees the law as a good sign.

"We hope it sets the stage for the Congress and the next President to continue this effort to end discrimination in the health insurance marketplace," she said. "Whichever party is elected, autism will be on the table and be a major point of discussion. There may have to be a federal mandate."

OP/Ed Hope for autistic children with McCain-Palin

Hope for autistic with McCain-Palin

Published on Saturday, October 18, 2008 7:35 PM AKDT

Mat-Su Frontiersman - Wasilla, Alaska

Hello Alaska! We are writing from Oklahoma to thank everyone who has supported Governor Palin in her bid for the White House. Why is someone from Oklahoma writing to the town of Wasilla?We are writing not only as enthusiastic supporters of Senator McCain and Governor Palin, but as parents of a severely autistic child, who for the first time has heard from those running for highest office in the land discuss autism.As parents who work for a living, have good medical insurance, and want to care for our children, we are constantly forced to fight for every service offered by the public schools and pay out of pocket for the necessary medical treatments our children need because insurance companies in Oklahoma refuse to cover the cost of diagnosis and treatment of autism.

We nearly had a bill passed last session to mandate Oklahoma insurance companies cover the cost of behavioral, occupational, speech and physical therapies our children must have to lead independent lives, but four members of our Republican House Leadership refused to consider a bill known as Nick’s Law.

Nick’s Law passed through our Senate in a bipartisan manner four separate times, but was not given the opportunity to be heard in committee or on the floor. One of the members of our Republican House Leadership asked during caucus, “Why help these children? They are only going to end up in an institution anyway.”This is what we are up against in Oklahoma, Governor Palin. These are people from your own party talking this way about children who can’t speak for themselves.If Nick’s Law had made it to the floor, it would have passed. Big insurance money padding the pockets of our Republican House leadership spoke much louder than our 6,500-plus children in Oklahoma who need insurance coverage.

We aren’t asking for a handout. Hard-working Oklahomans just want this disease that affects more children than all pediatric cancers, AIDs and diabetes COMBINED to be covered under private-pay insurance.Actuarial studies for the state of Oklahoma show that the cost for each policyholder would be $1.66/month for single and $4.66/month for family policyholders.

Families living in Oklahoma are currently spending over $5,000 a month out of pocket so their children will not grow up to become wards of the state.I’m sure many, many Alaskans can relate to this growing issue.Please, Governor Palin, listen to us and listen for the lost voices of children who were born healthy and then taken away from us by this heartbreaking disease called autism.

Robyne and Wayne Rohde Edmond, Okla.

Parents Press for Coverage

Oct 19, 2:49 PM (ET)By CARLA K. JOHNSON

CHICAGO (AP) - In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana's lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states - Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana - passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren't working directly with Autism Speaks.
"This is the hottest trend in mandates we've seen in a long time," said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. "It is hard to fight them."
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they've tried. In two states, bills got nicknames like "Steven's Law" and "Ryan's Law," so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said "bubba" for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to "buy" privileges like going for a car ride.
Shayan's improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
"I pulled over to the side of the road," she said. "I had to call the police to drive behind me so I could drive safely home."
The Foroughs have health insurance, but it doesn't cover Shayan's therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state's insurance commissioner to issue a bulletin spelling out what was expected of insurers.
"It's no longer acceptable that blatant discrimination against people with autism occur," Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
Some states require behavior therapy coverage up to age 18 or 21. But the scientific evidence for ABA is strongest for the youngest, ages 2 to 5. Some researchers have reported on individual children with autism who no longer appeared disabled when they reached school age.
The most rigorous studies, though, show mixed results. A study published in 2000 showed that preschoolers who got intensive behavior therapy had greater gains in IQ than children who didn't get the therapy. But there was little difference in the two group's language development or the intensity of behavior problems. And the children most severely affected by autism showed no comparative gain.
Another study in preschoolers, published in 2005, showed little difference between an intensive ABA-based program run by therapists and less-intensive therapy from parents; children in both groups improved.
When it comes to older children, the research is sparse, said Tristram Smith of the University of Rochester Medical Center in New York, who co-authored the 2000 autism study.
"You could make a decent case for the little kids up to 6 or 7 that (insurance mandates) would be appropriate," Smith said. "I think it would be hard to make that case for older kids."
Another autism researcher, Laura Schreibman of the University of California at San Diego, said "fly-by-night" behavior therapists could defraud insurers with ineffective therapy.
"I would like to see insurance cover this kind of intervention because it's documented to be effective," she said. "But insurance companies have every right to monitor whether it's working. If it's been two years and there are no gains, an insurance company should be saying, 'What are we paying for here?'"
The Council for Affordable Health Insurance, the industry lobbying arm, estimates autism mandates increase the cost of insurance by less than 1 percent by themselves, but when combined with other requirements make insurance less affordable.
Susan Pisano, a spokeswoman for America's Health Insurance Plans, said the industry has been wary of laws ordering a specific treatment because when new scientific evidence emerges, the mandate remains frozen. And she questions whether behavior therapy is medical or educational.
The American Academy of Pediatrics includes ABA therapy in its clinical report on autism, but describes it as an "educational intervention."
"There has been an effort to transfer the response to autism from school systems to the health care system," Pisano said.
Nevertheless, some big companies and the U.S. military are providing ABA-based autism therapy as a benefit.
The U.S. military's Tricare health insurance program not only covers up to $2,500 a month for the therapy, but also recently expanded the definition of who can provide it to make it more accessible. And some self-insured companies, including Microsoft and Home Depot, pay for autism behavior therapy.

Autism Insurance Named “Top Priority” for Child Advocacy Group

The State of Oklahoma

OFFICE OF SENATOR JAY PAUL GUMM

Atoka, Bryan, Coal, Johnston & Marshall Counties

October 10, 2008

FOR IMMEDIATE RELEASE

Contact: Senator Jay Paul Gumm

State Capitol: (405) 521-5586

Durant: (580) 924-2221

Mobile: (580) 920-6990

Autism Insurance Named “Top Priority” for Child Advocacy Group

OKLAHOMA CITY – The effort to require health insurance to cover diagnosis and treatment of autism in children received another grassroots boost this week from one of Oklahoma’s most respected child advocacy organizations.

At its legislative fall forum, the Oklahoma Institute for Child Advocacy (OICA) placed the issue at the top of its priorities for the 2009 session of the Oklahoma Legislature. The forum, held on the campus of the University of Central Oklahoma in Edmond, brought together child advocates and lawmakers to discuss a variety of issues important to Oklahoma’s children.

Senator Jay Paul Gumm is the author of “Nick’s Law,” the bill that would have required health insurance to cover diagnosis and treatment of autism. A Democrat from Durant, Gumm participated in a panel discussion on special needs children during the two-day event. OICA, he said, has an unmatched reputation in standing up for children.

“The Oklahoma Institute for Child Advocacy is a strong and effective voice speaking for children who often have no voice,” he said. “They have been on board with ‘Nick’s Law’ since we started this effort. I am honored to stand alongside them and the parents of children with autism as we continue this battle next year.”

“Nick’s Law” – named for Nick Rohde, a 10-year-old Edmond boy with autism – passed the Oklahoma Senate on bipartisan votes on four separate occasions in 2008. Each time, House Republican leaders would not allow the proposal even to be considered by representatives.

“There is a grassroots groundswell of support for this legislation,” Gumm said. “We see it in Oklahoma and we have seen it in other states. Republican legislators and governors in other states have championed bills like ‘Nick’s Law,’ and we had strong support from many Republicans in the Oklahoma Senate.

“In the entire nation, it was only the Republican leadership in the Oklahoma House of Representatives that made the issue partisan.”

Gumm said there is significant support for the bill among rank-and-file members of the House Republican caucus. “We knew there were enough votes to pass the bill if Republican leaders had just given it a fair hearing and allowed their members to vote their conscience,” he said.

Four Republican representatives – Reps. Doug Cox of Grove, David Dank of Oklahoma City, Charlie Joyner of Midwest City, and Scott Martin of Norman – even signed a petition to force a vote on “Nick’s Law” during the 2008 session. Then, after a House Republican meeting, no other GOP lawmakers would sign despite many having expressed support for the bill.

House leaders recently conducted a legislative study on autism and the state services provided to families struggling with the bio-neurological condition. Parents of autistic children who attended the study meetings expressed frustration that the private insurance component was hardly discussed.

“House leaders chose to ignore the ‘elephant in the room,’ and that is the role insurance must play in the battle against the epidemic of autism,” Gumm said. “They have desperately tried to make a case against ‘Nick’s Law,’ and despite all their efforts, the bill still came out as the top priority of the most respected child advocacy organization in the state.

“Oklahomans are very good at seeing through smoke screens.”

Gumm said a new version of “Nick’s Law” is already written and will be introduced “at the first possible moment” for consideration during the 2009 session. He said he is becoming more hopeful every day the bill will pass next year.

“Parents of children with autism know what it takes to overcome challenges,” he said. “The legislative obstacles put in their path by a handful of powerful legislators is nothing compared to what they have already overcome in caring for their children.

“When you get to know these parents, you understand far more about ‘family values’ than you can ever learn from the empty rhetoric of politicians who either cannot or will not stand for those who have no voice.”

"IF I WERE HIM I'D REALLY BE TICKED"

SMALL TALK

By John A. Small

News Editor

Johnston County Capital-Democrat

Tishomingo, OK

"IF I WERE HIM I'D REALLY BE TICKED"

You know, you really can’t blame our state Senator, Jay Paul Gumm (D-Durant), for taking umbrage over last week’s announcement by some of his Republican colleagues concerning their plans to conduct interim studies focusing on the issue of autism in Oklahoma.

Here’s a man who, for the better part of the most recent legislative session, carried that particular banner higher than anyone at the State Capitol, only to have the rug yanked out from under his feet by House Republicans who apparently couldn’t find it in their hearts to give the issue the fair hearing it deserved. And only now do some of those same House Republicans step up to the plate, albeit in a manner clearly designed to make themselves look like the good guys.

For the one or two of you who may not have heard about any of this, Gumm was the principal author of Senate Bill 1537 – better known as “Nick’s Law,” so named in honor of 10-year-old Nick Rohde, an autistic child from Edmond. This proposed legislation would have required health insurance to cover diagnosis and treatment of autism.

The bio-neurological disorder occurs in one in 150 births and affects up to 1.5 million Americans. The cost of life-long care can be reduced by two-thirds with early diagnosis and intervention; in a decade the annual national care costs will reportedly be somewhere around the $200 billion mark.

As I understand it, 18 other states in this country have already passed legislation similar to Nick’s Law. And it’s obvious from the number of articles and television reports I’ve seen in the national media over the past year or two that the issue has grown into one of major concern nationwide.

Nick’s Law passed the Oklahoma Senate on a bipartisan vote on March 10. But in spite of the hard work of Senator Gumm, the pleas from parents of autistic children and a fair amount of editorial support from newspapers across the state, the measure was killed by House Republican leadership; efforts to resurrect the proposal as an amendment to another bill later in the session fared no better.

Opponents repeatedly cited fears that such a mandate would increase insurance costs and drive up the number of uninsured Oklahomans. The release of a 10-page study by a nationally recognized expert demonstrated that such fears were unfounded, but this did not dissuade House Republicans in their efforts to kill the measure.

A subsequent press release issued by the Oklahoma Council of Public Affairs (OCPA) – which, from what I’ve seen, tends to be against anything that would benefit the majority of Oklahomans – seemingly betrayed the true intentions of the most vocal opponent to Gumm’s measure. That article, essentially a “puff piece” profile of Rep. Ron Peterson (R-Broken Arrow), praised Peterson’s opposition to the bill as a defense of free enterprise; to me that seems a little like saying that the skyrocketing price of gas is a good thing because it stimulates the personal economies of the fatcat oil company executives.

Anyway, the 2008 session ended without Nick’s law getting the hearing it deserved in the House. To his credit, Gumm has vowed to continue the fight; the news earlier this month that Peterson isn’t seeking re-election will hopefully prove beneficial in that regard.

That said, last week’s news of the Republican-sponsored interim studies seems little more than a slap in the face to those families who stand to benefit – who deserve to benefit – from the legislation Gumm proposed.

It’s unlikely that these studies are going to provide any new information that hasn’t already been covered during Gumm’s effort to pass Nick’s Law. And the GOP’s sudden interest in the issue at this point is little more than a poorly disguised attempt at political posturing, thereby adding insult to the injury already suffered by those families.

The House Republican leadership ought to be ashamed of itself.

(Copyright © 2008, by John A. Small)

Another $700 Billion to pay?

Bailey Dabney

October 2, 2008 October 06, 2008 12:17 pm—

With the nation in turmoil over the reckless driving on Wall Street, we may have another national emergency just around the corner. Are you ready to support several hundred thousand or more children once they hit 18 years of age? I mean full-time support; room, board, food, medical, and transportation?

We have already started paying this growing expense due to an exploding population of children suffering with autism passing through our public education system.

According to a press release I received last week, Oklahoma is reviewing its autism services regarding children and education. We need to do more than chime in on this issue. It affects every child, regardless if they have a special needs label or not.

According to the National Education Association (NEA) rankings of the states 2006 and estimated 2007 school statistics Oklahoma ranks 48th for both per-pupil expenditures of $6,944 and average teacher salary at $38,772. The regional average for per-student spending stood at $8,084 and the regional average for teacher pay was $41,613. While it may cost a little less to buy a house in Oklahoma than California, the cost of educating a child does not.

With costs running two or three million per person for the care of an individual with autism and the latest conservative statistics showing our country has around a quarter of a million people with autism we have another $700 billion assessment our taxpayers will be expected to fund. Educating a child with autism is about three times what it costs toeducate a child who receives no special education according to the Government Accountability Office.

This is one of the highest per-pupil expenditures in the public school system. This is an increase of more than 500 percent in the last ten years. If we fail to educate this population of children now, we will pay much more as they age. Government estimates identify 1-in-150 children in the United States with autism. Some say there is no autism epidemic; that it has always been a part of our society; liberal labeling has caused this increase.Yet, there are not 1-in-150 adults with autism in this country. This is a growing problem.

Two things we need our elected representatives to look into; require insurance companies to cover the costs of treating autism, including a highly qualified Applied Behavior Analysis (ABA) therapy as well as bio-medical interventions, which are the only methods that can boast success stories. And, equip our schools with highly qualified ABA programs that have results of mainstreaming 47 percent of the children to the regular education arena. Other states have done this or are in the process of passing such legislation.

The evidence of properly implemented ABA therapy with autistic children to learn an extensive range of skills is irrefutable and stands up to rigorous scientific scrutiny. Decades of research into the effectiveness of ABA have shown that the children who do not cross back into general education still showed marked improvement in cognitive skills. This could be the difference between being able to support oneself as an adult or being supported for life by the government, which is you and me.

This past April, the American Academy of Pediatrics President Renee R. Jenkins, M.D., FAAP, said “The Academy is committed to working with researchers and treatment groups like Defeat Autism Now! To get closer to finding answers to the multiple causes of autism and determining effective therapies.” Defeat Autism Now! is the medical arm of the Autism Research Institute, a non-profit organization, established in 1967. They provide research-based information to parents and professionals around the world.

The combination of an appropriate, highly qualified education and a nourishing biomedical approach to the autism epidemic may relieve half or more of their disability. These young US citizens’ education will determine whether or not they will be employable, independent contributing members of our society. This will also relieve society at large of the several million dollars per person in tax dollar support if we fail to properly educate them.

Oklahoma Legislature, the parents of autistic children welcome you to this issue. Your arrival is not a moment too soon. We’ll hope your next press release on this subject details your support.

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