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.