Sunday, May 31, 2009

Texas passes expansion of Insurance Coverage

Texas Legislature Passes Expansion
Of Insurance Coverage for Texas Children with Autism

Effective Date:
May 31, 2009 Contact: Mike Bernoski, Executive Director
512-402-5842 Phone;

Austin, Texas – The Texas legislature showed their support today for families by passing a measure to expand the age of mandatory insurance coverage for children with autism from the time of diagnosis to the 10th birthday. HB451 expands on the existing law passed in 2007 which requires coverage for generally recognized autism services, including Applied Behavior Analysis. Parents of children with autism spectrum disorder celebrated today and are urging the Governor to sign this bill into law.

“It is hard to appreciate how much effort on the part of so many goes into passing a bill of this nature,” said Mike Bernoski, Executive Director of Texas Autism Advocacy. “The broad bipartisan support shows that Republicans and Democrats alike understand this is a family issue, and it moves Texas a significant step forward in its response to the growing crisis of autism.” This is Texas Autism Advocacy’s second successful push to secure better insurance coverage for children with autism.

This legislation, authored by representatives Dr. Alma Allen (D-Houston), Eddie Lucio III (D-Brownsville), and Senfronia Thompson (D-Houston), and carried in the Senate by Sen. Eddie Lucio Jr (D-Brownsville), author of the existing law which has been in effect since January 1, 2008, was a welcome relief to parents whose children were excluded by the first law because they were either too old or too young or the child of a teacher.

Taxpayers have something to cheer about as well. By expanding the number of children covered, the bill will triple the existing law’s $1.35 billion in lifetime savings to a projected $4.06 billion over the next 50 years.
“One in 150 children is diagnosed with autism. If we do not take care of our children now, we as Texans will suffer later,” Rep. Allen explained. “This bill will help the hardest working in Texas - those that deal with the challenges of raising a child with autism.”

“Early intervention has proven to be able to turn a child’s life completely around,” commented Senator Eddie Lucio Jr., “Now that we have a better understanding of the associated costs and benefits it is time to take the next step.

The Texas bill remains the only state insurance reform that has no dollar caps on the stipulated coverage which includes diagnostic testing, speech, OT, PT, as well as medical and behavior therapies.

Parents and teachers are eager for Governor Perry to sign the bill into law. This bill does not affect ERISA, Medicaid, or CHIP plans, however efforts are underway to address these plans as well.

To learn more about legislation and other initiatives, please visit

Texas Autism Advocacy’s mission: To seek to create systemic change by identifying practical solutions that will positively affect the lives of people affected by Autism Spectrum Disorders.

Saturday, May 30, 2009

What will it take?

Tulsa World OP/Ed

By Staff Reports
Published: 5/30/2009

Click here to see other comments.

Nevada became the 12th state to pass autism insurance mandates. New Mexico, Montana and Utah also passed legislation in 2009. Connecticut and New Jersey aren't far behind. Our legislators say, "Oklahoma is unique from other states regarding the uninsured." Florida, Louisiana, Arizona and Texas all have high uninsured rates. All have passed autism insurance legislation and all are red states.

Our opponents say there's a lack of qualified therapists in Oklahoma. There are many board certified behavior analysts who travel to Oklahoma to supervise and train tutors and develop and oversee treatment programs. States that have passed similar legislation have seen large influxes of medical practitioners once physicians and therapists realize they will be paid for their services. Recently, an autism therapist from Oklahoma City moved to Texas because she couldn't afford to practice in Oklahoma while having to depend on out-of-pocket payments from parents.

Republican legislators say Nick's Law is too costly. Two actuarial studies conclude that Nick's Law, which would mandate autism treatment for children in insurance plans, would have an impact of less than 1 percent. Yet legislators keep using an inflated study showing the cost could rise up to 19.8 percent. There isn't another study in the U.S. that supports that claim. How much longer can our children go without health care? How many more families need to go bankrupt? How many more divorces are necessary? We lose a child a day in Oklahoma to autism. What is it going to take, Oklahoma?

Robyne and Wayne Rohde. Edmond

Tuesday, May 26, 2009

Growing Old With Autism

Published: May 23, 2009

IN mid-2007, I set off to meet with geneticists, epidemiologists and doctors who specialize in researching and treating autism. I was seeking a novel therapy for my 42-year-old autistic younger brother Noah. I was also looking to discover how heightened awareness of autism — it is now among the most financially successful and mediagenic diseases ever, with hundreds of millions of dollars a year going to research, and regular press coverage — might have resulted in new and innovative programs for adult autistics like Noah.

Autism was already widely being described as an epidemic, affecting as many as 1 in 150 8-year-olds, according to the Centers for Disease Control and Prevention. We had come a long way since Noah got his diagnosis in the late ’60s, the so-called dark ages of autism, when many pediatricians believed they had never seen a case, and so-called refrigerator mothers were mistakenly blamed for their children’s withdrawn, antisocial condition.

But now, with autism described to me as “the disease of the decade” by Peter Bell, the executive vice president of programs and services for the advocacy group Autism Speaks, I thought perhaps there was hope, even for low-functioning adult autistics like Noah.

Noah has been my family’s focus for decades. As a baby, he had been very slow to turn over, crawl or walk, and each subsequent developmental milestone was even more delayed as he grew into adulthood. My parents did everything they could for him, moving us from New York to Los Angeles in the early 1970s to be closer to a pioneering autism program at the University of California at Los Angeles, opening their own day care center for the developmentally disabled, even creating a one-on-one assisted-living situation for Noah — years before this became common — so that they could delay institutionalizing him.

I toured those state hospital systems with my parents when we started looking for a place for a growing-up Noah. Those were terrifying visits: adult patients wearing helmets and restraints, howling and hitting themselves. This was during the ’70s when the scandals at state psychiatric hospitals like Letchworth Village in New York and Camarillo in California were making terrifying headlines. Clients at Camarillo were dying from neglect and improperly administered medications. We had to keep Noah out of that system for as long as we could.

Eventually, when he was 22, Noah had to leave home. He graduated from his special needs school on a bright, sunny Orange County day; he was beaming, handsome in his bright blue cap and gown.

But for the profoundly autistic, graduation is perhaps the saddest day in their lives. For those who cannot enter the work force, continue on to more education or find some sheltered workshop environment with adequate staffing, there are few options. Far too few programs and resources are allocated for adults with autism.
Noah has been in and out of sheltered workshops, but these are always under threat because of state budget deficits. Noah has been asked to leave some programs because he was too low-functioning.

For several years, we have been trying to find a day program where he might interact with others and perhaps perform some simple, menial job. We have long since given up any hope that he might continue in adulthood the behavioral therapies that are now considered standard for autistics; unless the family is willing to pay the bulk of the cost, there is very little out there for men and women like Noah.

For purposes of fund-raising and awareness-raising, autism has been portrayed as a childhood disease. The federal Department of Health and Human Services has characterized it as a “disorder of childhood.” There are practical reasons for this: early intervention has been shown to be the most effective therapy. The trend in autism treatment has been to steadily lower the age at which intensive intervention commences — as early as five months, according to some experts. Yet autism is not a degenerative condition; the vast majority of those 1 in 150 children who are afflicted will survive to adulthood.

As I spoke with the experts, I began to see that the focus on children had influenced not only the marketing of autism, but also research and treatment. It seemed the majority were interested in children only, the younger the better.

“The best time to look is at the early ages, when autism is developing,” Sophia Calimaro, vice president of research at Autism Speaks, told me a few months ago, explaining that was also where there had been the most treatment success. “I’m not making excuses, but that’s really why more research into adults with autism hasn’t been done.”

Low-functioning adult autistics are viewed with sympathy but not much scientific inquiry. No one has broken down how many dollars are actually flowing to adult autistics, but at the International Meeting for Autism Research in Seattle in May 2007, I counted more than 450 papers and presentations and three dozen talks on autism given by academics and specialists; of those, only two dealt with low-functioning adults, and neither included a cohort large enough to be statistically relevant.

The careful measurements of brain function, or dysfunction, were almost all done on children. A few cognitive and emotional development studies dealt with adults, but these were overwhelmingly focused on high-functioning autistics and people with Asperger’s syndrome.

Autism Speaks, the major sponsor of autism research projects, has not broken down the proportion of funds that go to adult-oriented research, but Mr. Bell, whose teenage son is autistic, laments that “it’s low, too low. ... We have to change the paradigm for those of us who have kids who are going to grow up and need more and better services.”

That change can’t come soon enough. Even with state-of-the-art early intervention — eight hours a day, seven days a week — many autistics will need support throughout their lives. The reality is that very few, perhaps only 10 percent, of those as severely autistic as Noah benefit from the current interventions to the point where they become functioning members of society.

If the current C.D.C. estimation of prevalence is correct, then there will be an awful lot of adult autistics who need lifetime support and care. Noah’s life has been a grim study in how scarce those resources are. Without them, his behavior has regressed.

A recent “psychological and psychopharmacological” report by the California Department of Developmental Services said Noah exhibited a “failure to develop peer relationships, a lack of social or emotional reciprocity,” and it described some of his “maladaptive behaviors” like “banging his head against solid surfaces, pinching himself and grabbing others.”

“Noah may also,” it noted, “intentionally spit at others, pinch or scratch others, dig his fingernails into others, and/or pull others’ hair. He may bite, head-butt and hit others; throw objects at others, and hit/slap his head when he is highly agitated.” He is a handful.

Now, imagine a few hundred thousand Noahs.

Karl Taro Greenfeld is the author, most recently, of “Boy Alone: A Brother’s Memoir.”

Sunday, May 24, 2009

Cost of Autism Mandate Projected in Reports

By Amy Lester, NEWS 9

Posted: May 20, 2009

Click here to link to the video

Nick Rohde, for whom the bill Nick's Law was named, learns new skills during a therapy session. It costs his family $1,000 each week for the therapy.

Supporters of Nick's Law argue the report requested by the House of Representatives is inaccurate and misleading to lawmakers.

Nick's father and autism advocate, Wayne Rohde, says he'll continue to fight for an autism mandate in Oklahoma.

The battle continues at the Capitol, but supporters of Nick's Law say if the bill doesn't pass this session, they'll keep trying.
OKLAHOMA CITY -- The debate surrounding insurance coverage for autism continues each legislative season, spurred on by reports projecting vastly different increases in health insurance premiums.

A bill called Nick's Law would force insurance companies to cover autism treatments and therapies. Opponents of the bill claim health insurance premiums will skyrocket, but supporters don't agree.

The Rohde family dishes out $1,000 a week, a high price to pay. That's the only option since their health insurance does not cover autism treatments or therapy for Nick, whom the bill is named after.

"Like other families, we spend a lot of money out-of-pocket, our pocket, and it gets difficult," Nick's father Wayne Rohde said.

Nick's father Wayne Rohde and Senator Jay Paul Gumm (D-District 6) have fought for the bill for two legislative sessions, unsuccessfully.

"Ultimately, the payoff is huge," Senator Gumm said. "There's a human payoff, in that these children have a chance to have a full and happy life as an adult."

At the center of the resistance against Nick's Law is how much it may raise insurance premiums.

Supporters point to a study which finds it could increase rates from .5 percent, or less than $2 each month, up to 1.5 percent.

Other states have experienced rate increases, which could mirror the potential increases Oklahoma would experience if Nick's Law is passed.

Opposing Reports for Oklahoma:

Reports % of Projected Increase

Opponent Report (Conducted by Thomas Cummins) up to 19.8%

Supporter Report (Conducted by State Employees Insurance Company up to 1%

Experienced Rate Increases in Other States with Autism Mandate:

State Rate of Increase Experienced

Arizona .55%

Pennsylvania $1 per member, per month

Louisiana $.74-$.93 per member, per month

The Council for Affordable Health Insurance projects autism mandates increase health insurance permiums by 1 percent.

Having the information from other states presented to them, Nick Law's supporters question the integrity of the study which reported Oklahoma would experience an 8 to 20 percent increase.

Speaker of the House Chris Benge stands behind the report, releasing the following statement:

"This report, unfortunately, confirms that adding this autism insurance mandate does in fact increase the cost of insurance and could lead to more Oklahoma families being forced to drop coverage."

Speaker Pro Tempore Kris Steele also supports the findings, but Nick's Law supporters want to know why their report calculates a much higher increase in premium costs.

"Each state is unique and the population of people that live in each state is unique and in Oklahoma, again we have the fourth highest number of uninsured and that contributes to what this would cost to the people who do have insurance," Representative Steele said.

Sen. Jay Paul Gumm, the author of Nick's Law, couldn't disagree more.

"It's a very, very small cost," Senator Gumm said. "Less than a cup of coffee a month for most premium payers."

Thomas Cummins, the actuary who conducted the study for the House of Representatives, believes his calculations are accurate.

Wayne Rohde, Nick's father, filed a complaint against him with the Actuarial Board for Counseling and Discipline. The board dismissed the complaint, claiming Cummins did not violate the Code of Professional Conduct.

Ten states have laws similar to Nick's Law.

Friday, May 22, 2009

Wednesday, May 20, 2009

Sen Wilson Concerned Senate Republicans Plan to Gut SB 1055 to Protect Insurance Industry…Again

Oklahoma State Senate

For Immediate Release: May 20, 2009

Wilson Concerned Senate Republicans Plan to Gut SB 1055 to Protect Insurance Industry…Again

A bill waiting to be heard on the Senate floor has been stripped down by Senate Republicans to protect the insurance industry, a pattern of behavior by the majority party that began quickly after they came into power for the first time in state history.

Senator Jim Wilson, one of the Senate’s watchdogs for insurance industry friendly bills, says the Senate Republicans appear to be ready to abandon consumer friendly health care reforms in the current version of SB1055, set to be heard before the legislature adjourns Sine Die on Friday. Those consumer friendly provisions included:

- Making it unlawful to pay bonuses to insurance executives or cancellation of policies or denial of claims; and

- Requiring insurance plans to spend 75% of the premiums they collect on actual medical care.

“Medicare spends 98 cents of every Medicare dollar on actual care," Senator Jim Wilson stated. “But in Oklahoma, big insurance only has to pay 60 cents of every dollar. I guess Senate Republicans feel that big insurance just isn't making enough profit on the backs of some of the most vulnerable Oklahomans.”

Wilson concluded by saying, “My question is quite simple: Is there anything more we can do to help out friends in the insurance industry? Perhaps they would like a wafer thin mint."

For more information contact:
Sen. Wilson's Office - 405-521-5574

Autism awareness plate doesn't reflect Republican priorities

Tuesday, May 19, 2009

Democratic Floor Leader Mike Brown
State Capitol Building, Rm. 545
Oklahoma City, OK 73105
(405) 557-7408
Contact: Karina Henderson, (405) 962-7819

Brown suggests special license plate
Autism awareness plate doesn't reflect Republican priorities

Oklahoma City (May 19, 2009) State Capitol – After the House passed SB2, a bill to add several special license plates to those already available from the state, Democratic Floor Leader Mike Brown questioned if the House Republicans accidentally omitted one plate.

The bill would create, among others, an Autism Awareness license plate, but Rep. Brown suggested it would be more true to House Republicans' priorities if they had also included an Erectile Dysfunction Awareness plate.

"Since my Republican colleagues already voted once that they don't believe insurance coverage for autism treatment is at least as important as coverage for erectile dysfunction therapies, I would have expected them to be consistent and promote erectile dysfunction awareness right alongside autism awareness," said Rep. Brown, D-Tahlequah.

In February, Rep. Brown proposed an amendment that would require no Oklahoma insurance carrier can provide coverage for erectile dysfunction unless they also provide coverage for autism spectrum disorders. The amendment, which was offered to HB1028 – a bill that adds provisions to how insurers time and process insurance claims – was voted down along strict partisan lines, 59-37.

"Every Republican in the House chamber that day, including the Republican author of the license plate bill, voted against my amendment. They are on the record as saying that sexual pleasure is more important than the health of children with autism and the struggles of their families," he stated.

"If that's your real priority when it comes to health care, well, I disagree – but I'd at least like to see some consistency out of my colleagues across the aisle."

SB2 passed the House today 89-2

Sunday, May 17, 2009

Autism specialists bill only a ‘small step,’ Democrats say

Edmond Sun

State Capitol News Service

OKLAHOMA CITY May 14, 2009 02:31 pm

— The Oklahoma Legislature remains divided on the issue of assisting families with autistic children, despite enactment of a new law designed to make services more available and affordable.

Even Democratic Gov. Brad Henry, who signed the law into effect May 4, expressed concern that the measure was only “one very small step” in the effort to help Oklahoma families dealing with autism.

Senate Bill 135, authored by Sen. Ron Justice, R-Chickasha, proposes to increase autism services and provide funding to train in-state specialists so families won’t have to travel out-of-state to obtain help.

The bill was one of several introduced this year in an attempt to increase care for autistic children. Like the other bills, SB 135 has caused much controversy between Democrats and Republicans.

Autism is a brain development disorder characterized by impaired social interaction and communication. Experts have testified that it afflicts as many as 1 out of 150 children, yet one study showed Oklahoma had only 10 autism treatment specialists.
Eighteen states have enacted some form of coverage mandate to make insurance companies help pay the cost of autism treatment. But the Oklahoma Legislature has balked at doing so, citing concerns that requiring coverage would increase health insurance premiums for everyone.

SB 135 does not force Oklahoma insurers to cover autism. Justice and most of his fellow Republicans insist it will provide relief for the families of autistic children by increasing the availability of in-state services. House and Senate Democrats generally disagree, claiming families will still be unable to afford services even if there are more specialists available to provide them.

In February, the Republican-controlled House Economic Development and Financial Services Committee voted down House Bill 1312, also known as “Nick’s Law,” which would have required insurance providers to cover autism treatment. The panel also voted to prohibit the Legislature from proposing similar measures until 2011.
Democrats offered a compromise — to put autism coverage in high-risk insurance pools as a last resort for families who can’t afford the coverage elsewhere.

Republicans again declined, and instead went forward with SB 135 and its House version, HB 2027. Subsequent votes tended to stick to party lines.

Henry and other Democrats generally don’t oppose the legislation, which they say is better than nothing. But they contend that attempts to solve the problem in reverse, by increasing services but not helping families pay for them.

“It’s all in the wrong order. It doesn’t provide any relief for families,” said Sen. Jay Paul Gumm (D-Durant), who tried unsuccessfully to amend SB 135 to include high-risk insurance benefits after Nick’s Law was shot down. “The glimmer of good in it is that it gives state recognition to apply state licensing therapies and encourages the training of therapists. But it creates a brain drain, because we’re going to train a bunch of therapists, and they’re going to move out of state since there isn’t a market here, and people won’t be able to afford the services.”

Democrats say the new specialists will be insignificant if autism is not added to high-risk insurance policies and families can’t afford the services. Some claim Republicans won’t budge on the issue because of financial ties and campaign commitments to insurance companies. Republicans dismiss such accusations.

Justice said the bill is actually the first step toward relief, since experts would advise how to best create affordable service and how to keep insurance costs from skyrocketing.

“To me, it’s the foundation,” Justice said. “If we don’t have the right experts who understand them (autistic people), we might waste all kinds of money. We have to know what we’re doing before we start spending.”

Nick’s Law was endorsed in the Senate four times last year, but was denied a hearing in the House.

Rep. Kris Steele, R-Shawnee, the House sponsor of HB 2027, said he agrees with other Republicans who oppose mandated coverage because it could raise insurance premiums for everyone, making health coverage less affordable. But Gumm said such concerns are unfounded, based on the financial impact of mandated coverage in other states.
“Why does California have cheaper premiums than we do when they have mandated coverage?” Gumm asked after a floor debate about autism coverage on May 6. “The evidence just is not there to support that claim.”

Currently, 18 states require mandated medical coverage for autistic children. More than 30 are considering measures to add the insurance requirement. Gumm and Henry have both pledged to keep fighting for passage of Nick’s Law.

When Henry signed SB 135, he challenged lawmakers to expand services to children with autism.

“To provide comprehensive assistance to the families of children with autism, we must also approve legislation extending insurance coverage to treatment of this developmental disability,” Henry said.

Said Gumm: “I will never stop fighting for these kids and their families. They’re too precious. The families are struggling too hard.”

RAY MARTIN is a senior journalism student at the University of Oklahoma who is writing a weekly legislative report for the Oklahoma Press Association.

Copyright © 1999-2008 cnhi, inc.

Sunday, May 10, 2009

Set the Record Straight on Nick's Law

A letter to the editor submitted to many newspapers across Oklahoma.

Dear Editor:
As the parents who have been at the forefront in trying to obtain healthcare coverage for the 6,500 children in our state with autism and who helped write Nick’s Law, we would like to set the record straight on this legislation.

Autism is a medical condition. It not only affects the child’s ability to speak, socialize and process information, but in many children, severe gastrointestinal issues, the central nervous system and the immune system are compromised.

Autism’s symptoms can be very mild to very severe. Autism is treatable and with treatment, many children can lose the autism diagnosis. The Centers for Disease Control (CDC) has reported that 1 in 150 children are diagnosed with autism. The CDC has reported a utism is more prevalent than all pediatric cancers, diabetes and Aids, combined. In Oklahoma we lose a child a day to autism (450-500 year).

Nick’s Law requires private insurance companies to cover medically necessary and clinically proven medical treatments for children who have been diagnosed with autism by a licensed healthcare professional. Self-insured and federal employers are not required to abide by Nick’s Law. Small business owners may choose to opt out of coverage under Nick’s Law.

The most effective therapy, Applied Behavior Analysis (ABA) has been endorsed by the American Association of Pediatrics, Surgeon General, National Science Foundation and the Department of Education. ABA is a covered therapy under Nick’s Law. Nick’s Law has a yearly cap of $36,000.

The earlier a child receives treatment, the less therapy the child will require as symptoms lessen and in many cases, eventually disappear.

Less than 10% of the children covered will use the yearly maximum. There is no lifetime cap. Oklahomans have been told Nick’s Law will raise insurance premiums. This simply isn’t true and is a myth that is perpetrated by our opponents and the insurance lobby.

Over 23 cost/benefit studies have been performed on the cost to policyholders for autism insurance coverage. Oklahoma had three cost/benefit studies prepared. One study was paid for by Oklahoma Republican House leadership. One study paid for by Oklahoma state’s insurance provider and one was prepared by an individual whose methodology has been published in the Journal of Autism & Developmental Disabilities and used by several states that have passed autism insurance legislation.

All of the 23 studies with the exception of the one paid for by Oklahoma Republican leadership conclude the cost to the individual policyholder to be less than 1 percent, including the two prepared specificall y for Oklahoma. Nick’s Law will reduce the burden of the educational system to provide medical therapies to children, bring providers to the state, increase competition among providers, and prevent taxpayers from shouldering the burden to care for these children.

Without Nick’s Law these children will end up wards of the state with the Oklahoma taxpayer footing the bill. Now that you know about Nick’s Law, call your representatives and senators and tell them what you think is best for Oklahoma.


Tuesday, May 5, 2009

Autism Bill Only “Relieves Political Pressure” – Senator Gumm

The State of Oklahoma
Atoka, Bryan, Coal, Johnston & Marshall Counties

May 5, 2009

Contact: Senator Jay Paul Gumm

State Capitol: (405) 521-5586
Durant Office: (580) 924-2221
Mobile: (580) 920-6990

Autism Bill Only “Relieves Political Pressure” – Senator Gumm

OKLAHOMA CITY – Following is a statement by Senator Jay Paul Gumm, D-Durant, author of “Nick’s Law” relating to the enactment of Senate Bill 135:

“Sadly, this bill will do nothing to relieve the pressure on families struggling to care for children with autism. The measure was designed to relieve political pressure on legislators who refuse to even consider ‘Nick’s Law,’ which would require health insurance to cover diagnosis and treatment of autism.

“There is nothing wrong with this bill, just like there is nothing wrong with a pack of shingles at a construction site. If you try to put the shingles on before you pour the foundation, you are doomed to failure. As Governor Henry wisely noted when he signed the bill, the foundation is insurance coverage of autism. Absent that, Senate Bill 135 is doomed to failure.

“The therapists that will be trained under this bill will be unable to make a living in Oklahoma because families still will be unable to afford the applied behavioral analysis therapies they offer – just as they are today. The reason is that there is nothing in Senate Bill 135 that would even remotely help families bear the cost of this critical treatment.

“More than one child per day in Oklahoma is being diagnosed with autism. That means more than one child per day is being lost because they are ‘aging out,’ getting too old for the therapies to reach. Again, this bill does nothing to help those children to day.

“For anyone to suggest that ‘relief is on the way,’ is simply not consistent with the bill. Statements like that are irresponsible and provide only the falsest of hopes to families who are begging lawmakers for real help. Families deserve better than the sham being perpetrated on them by legislators who have neither the courage nor willingness to support ‘Nick’s Law.’”

Monday, May 4, 2009

Gov. Henry signs autism services bill

The Associated Press
Published: May 4, 2009

click here to post on-line comments.

Gov. Brad Henry has signed legislation designed to increase the number of therapists who provide services to autistic children.

But Henry said Monday the measure is just a small step in the effort to help affected Oklahoma families. He urged lawmakers to pass legislation to mandate insurance coverage for the treatment of autism.

The bill calls for enactment of a licensing process for national board certified behavior analysts and enhancement of existing state programs that would train doctors to diagnose and treat autism.

But the governor says some people question whether it will actually produce significant new services if insurance doesn't cover the cost of treatment and parents can't afford to pay the bill.

Republican legislative leaders oppose insurance mandates and say they drive up the cost of health insurance.

Autism deserves coverage

by Jeff Mayo, General Manager and Associate Publisher
05.01.09 - 02:36 pm
Viagra? Covered. Autism? Nope.

Click to post comments online.

Most insurance companies operating in Oklahoma cover Viagra and other erectile dysfunction drugs, but few cover autism.

On Monday, Oklahoma House Democrats walked out of the legislative chambers after the Republican leadership refused to consider legislation that would mandate insurance companies pay for medical costs associated with autism.

Autism is a complex neurological disorder that inhibits a person’s ability to communicate and develop social relationships. It is often accompanied by extreme behavioral episodes. The Centers for Disease Control and Prevention (CDC) says autism now affects 1 in 150 children. The increase may be partially attributable to improved early identification in children ages 1-3, but the number is staggering.

In the past two years, six states—Texas, Pennsylvania, Arizona, Florida, South Carolina and Louisiana—passed laws requiring coverage of behavior therapy for autism. In addition to Oklahoma, three states—Kansas, Missouri and Michigan—are considering coverage in their legislative sessions this year.

The Democrats, walkout highlights a lack of debate on this topic and shows that the Republican House majority is not interested in debating critical issues facing Oklahomans.

Democrats have been pushing Nick’s Law for two years now. The law would require health insurance companies in Oklahoma to cover the diagnosis and treatment for autism. The law carries the name of an 11-year-old Edmond boy who has the condition.

The Republicans did pass a bill that would regulate behavioral analysts and increase training for autism therapists, but that will not have much effect if working Oklahomans can’t afford to pay for treatments out of pocket.

Cost estimates for covering autism show a range of one to three percent increase in insurance rates, depending on the study and coverage amounts.

Autism advocates say that treatments for autism are difficult to access, often inadequate, and frequently delayed. Denied coverage by private group health insurance companies, parents are often forced either to pay out-of-pocket or forego the treatments their children need.

Advocates go on to say that by improving outcomes for children with autism, mandated private insurance coverage will decrease the lifetime costs of treating and providing services and will actually result in an overall cost savings in the long-run.

The truly sad thing is that insurance companies will not cover this medical condition without a law mandating it.

The Republicans argue it’s just a matter of determining whether insurance companies can continue to provide insurance (read: make large profits) within state requirements. I do not believe it is that simple. We need to address this issue for the sake of creating better Oklahomans, not just maintaining profitable insurance companies.

Where is the “family values” party when autism strikes a child and bankrupts a family trying to get treatment? Republicans are quick to point to their conservative values that make us believe they want to promote a family’s well being, but defeating bills that would help children show otherwise.

This is an issue of addressing a medical emergency in our state. Without addressing autism at an early age just as we do enlarged tonsils, broken limbs and chickenpox, it is very likely treatment will cost more as the child’s condition worsens over time. These children, and their families, deserve better from us.
© 2009