Thursday, June 19, 2008

Journal Record Pitts: Mandated health insurance coverage needs study


Pitts: Mandated health insurance coverage needs study
June 9, 2008

Interim studies, particularly in election years, often are proposed for legislative measures to avoid a potentially unpopular but objectively justifiable vote on a specific bill or issue.

Such was likely the case for state Sen. Jay Paul Gumm’s bill to mandate health insurance coverage for the diagnosis and treatment of autism. His Senate Bill 1537 died in the Economic Development and Financial Services Committee of the Oklahoma House of Representatives when the chairman, state Rep. Ron Peterson, R-Broken Arrow, refused to hear it.

Last-minute efforts in the closing days of the legislative session to force consideration of the bill failed but an interim study to determine its cost to health insurance ratepayers was approved by Speaker of the House Chris Benge, R-Tulsa, who reportedly said parents of autistic children will be included.

Without question the issue is an anecdotally emotional one for those who must deal with the heart-wrenching and costly care of an autistic child. It also makes for insurance-company-bashing quotes on the six o’clock TV “soap” news.

It is virtually impossible to visit with even the most reasonable and cogent parent of such a child for even a few minutes without realizing and sympathizing with the mental, emotional and financial stress they endure. Unfortunately this poignancy often blurs objectivity in considering the real effect of such legislation.

Gumm’s bill is part of a national movement to get states to mandate health insurance coverage for autistic children. Conflicting studies have been cited regarding increased health insurance costs to ratepayers and in some cases such as Oklahoma the same study is being used by Gumm and Peterson to prove such a law will or will not result in higher health insurance rates.

The study was done by James Bouder of the Vista Foundation, a Pennsylvania-based autism advocacy group. The senator says it shows passage of his bill “would not spike insurance costs and ultimately would save taxpayers millions.” He added it shows the cost would be less than one-half penny for every dollar in premium costs.

“Such a negligible cost would not drive up the number of uninsured Oklahomans while providing needed benefits to families struggling to care for their autistic children.” Gumm said.

Not so, Peterson insists.
“If all of the 1,894 (about 30 percent of the 6,289 estimated by the federal Center for Disease Control and Prevention) autistic children covered by mandate policies received the full $75,000 in annual benefits the Bouder study acknowledges are possible under SB 1537, Oklahomans could pay an additional $142 million per year for insurance. That translates into a 5.22-percent increase in rates.”

That could seriously affect individual rate payers’ health insurance and employers’ ability to provide group health insurance. To be sure, whatever the cost is, it will not be borne by the insurance companies.

Even the Bouder study acknowledges that “100 percent of likely, increased costs attributable to services provided under SB 1537 will be passed on to private insurance ratepayers.”

Democrats are attempting to make the bill a partisan election issue, blaming House Republican leaders for refusing to hear the bill in committee while claiming many Republican members supported the measure, a curious and unproven claim but a typical political approach.

Both parties are good at blocking legislation in committee. In the Senate, Democrats prevented a committee hearing on Peterson’s bill to require actuarial studies of all proposed mandated health insurance coverages before they could be enacted.

The Bouder study and the different resulting claims about it demonstrate that an objective and independent actuarial examination of the costs to Oklahoma ratepayers is the right path to follow. Passing legislation with such potential impact on Oklahoma’s health insured in the heat of emotional demonstrations and protests would have been unwise.

While the economic impact of such legislation on Oklahomans with or needing health insurance is of vital importance, legislators should not overlook the possible social and long-term costs of failure to treat autistic children.

William O. Pitts may be reached by phone at (405) 278-2880 or by e-mailing

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