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.