Sestak Amendment Included in National Defense Authorization Act
Yesterday, the U.S. House of Representatives passed legislation expanding services for autism treatment for military families. The National Defense Authorization Act includes an amendment authored by Congressman Joe Sestak (D-PA) expanding insurance coverage for the children of service personnel under the military’s healthcare program (TRICARE).
“We are thrilled about this bill’s passage, which will expand much-needed quality care to families that have made tremendous sacrifices for our country,” said Lee Grossman, Autism Society President and CEO. “It also sets an example for insurance companies in the private sector, an important step toward getting all families and individuals affected by autism the appropriate, medically necessary care they need.”
The amendment including the autism provisions was introduced in the last session of Congress, and when it failed to pass then, our advocates in the autism and military communities refused to let the issue die. The ultimate passage of this important legislation would not have been possible without their tireless advocacy and the devotion of Congressman Sestak.
The current system providing autism services to military families, the Extended Care Health Option (ECHO), provides only limited coverage. Only five percent of eligible military children receive care because of excessive delays-- as long as two year waiting periods-- and arbitrary coverage denials. The new amendment will work to fix these problems by:
• Mandating coverage of autism spectrum disorders (ASD) under TRICARE, rather than the marginalized ECHO program.
• Requiring that treatment of ASDs be provided if a health care professional determines that it is medically necessary
• Ensuring that beneficiaries under the age of 5 who have developmental delays and are at risk for autism may not be denied access to medically necessary treatment.
• Requiring the Secretary of Defense to ensure that authorized providers of applied behavior analysis or other structured behavior programs are licensed or certified by a state, the Behavior Analyst Certification Board, or other accredited national certification board.
• Requiring the Secretary of Defense to ensure that all employees or subcontractors of authorized providers are also certified and meet minimum qualification standards.
• Quickly enacting the provisions 180 days after passage.
Friday, June 26, 2009
Wednesday, June 24, 2009
Gumm: Texas’ Continued Advancements in Autism Coverage Present Somber Comparison
Gumm: Texas’ Continued Advancements in Autism Coverage Present Somber Comparison
As Texas families this week celebrate the signing of legislation expanding the age of mandatory insurance coverage for children with autism, Sen. Jay Paul Gumm said Oklahoma families struggling to care for autistic children deserve better from their state Legislature.
Texas’ new law expands the age of mandatory insurance coverage for children with autism from the time of diagnosis to their 10th birthday. Gumm noted that Texas’ legislation was approved by a majority Republican Legislature and signed by a Republican governor.
“This shouldn’t be a partisan issue – our focus must be on improving quality of life for children with autism and helping families bear the cost of treatment,” said Gumm, D-Durant. “Now that we’ve seen other states effectively deal with this issue, it’s time for the Oklahoma Legislature to do what’s right for our families. We need to step forward and approve meaningful legislation that positively affects the lives of families struggling to care for autistic children.”
Gumm was the author of “Nick’s Law”, which would have required insurance companies to cover diagnosis and treatment of autism in children. Gumm also authored a proposal to require the Oklahoma Health Insurance High Risk Pool to cover treatment for autism, but both proposals were shelved in the 2009 session.
“Oklahoma and Texas are both conservative states, but we’re moving in opposite directions on this particular issue,” Gumm said. “It suggests that Texas leaders understand the importance of assisting families in need and that an honest examination of the plan’s potential risks has revealed it to be a prudent and morally sound proposal. 'Family values' must be more than a couple of words politicians use at election time; those words must reflect a commitment to policies that truly value families - including those families who have children with autism.”
For more information contact:
Sen. Jay Paul Gumm: 405-521-5586
Tuesday, June 23, 2009
Oklahomans consider legal action after autism settlement in Michigan
eCapitol News
Author: William W. Savage III
Date: 06/22/2009
(OK) In the wake of a Michigan court's landmark settlement regarding the denial of autism coverage, parents of Oklahoma children denied coverage in the same manner are considering the possibility of filing their own lawsuit locally.
"We've got several people who we're in the middle of studying [the cases of] about filing a suit against Blue Cross Blue Shield [of Oklahoma] and other insurance companies," said Wayne Rohde, the Edmond father who has spent the past two legislative sessions advocating a state mandate for autism coverage for insurance companies. "We've been looking at it for the last two or three weeks. We're in the process now of rounding up parents who have denials [and] clarifying their denial process."
Pursuing litigation became a more realistic option after Blue Cross Blue Shield of Michigan announced Friday the news of a settlement between the company and about 100 families who had joined in a class action suit against the state's largest insurer.
The $1 million settlement also includes a provision that BCBS of Michigan will cover the therapy at the center of the suit - applied behavioral analysis - for employers with group mental health policies, according to reports in the Detroit Free Press.
Coverage of ABA, as the therapy is known, was denied to the Michigan children on the basis that it constituted "experimental" treatment.
"The important part of this lawsuit is that a court through this settlement has determined that ABA services are not experimental, as Blue Cross Blue Shield and other insurance companies like to classify it," Rohde said. "That's what we've been debating for years. They've even gone to the length of calling [ABA] educational, meaning it's not their responsibility and it's the public schools' responsibility."
That was the position taken by BCBS Oklahoma on Monday when asked about the Michigan lawsuit and the company's announcement late in 2008 that it would provide new autism benefits.
Nicole Amend, senior supervisor of public relations for BCBS Oklahoma, said BCBS Michigan is a different company and that BCBS policies in Oklahoma "have a specific exclusion related to autism which is not affected by this court decision."
"I think we have to look at it as far as, at this time, we don't intend to change our policies in response to the Michigan lawsuit," Amend said, adding that BCBS Oklahoma "is actually the only insurance company" in the state currently expanding its autism coverage.
The company announced in December that it would begin covering previously excluded autism-related expenses. Monday, Amend provided details of the new coverage, which she said will begin Jan. 1, 2010.
Amend said children will be covered from birth up to age 6 for the primary diagnosis of autism spectrum disorders, with additional coverage of evaluation, management procedures, speech therapy, physical therapy and occupational therapy. The benefit will have an annual maximum of $25,000 and a lifetime maximum of $75,000, she said.
"Those [maximum] amounts were chosen to allow the most comprehensive benefit with minimum impact to our members' premiums," she said, adding that the new benefits should not have a significant impact on premiums. "They weren't just arbitrary numbers that we threw out there."
But, Amend said the items covered by the new benefit "are not" ABA therapies, which Rohde said represent 80 to 90 percent of treatment costs.
"Those will not be covered under the autism benefit," she said. "Those programs are considered to be behavioral and educational training and not medical treatments. These are more [like] training modification programs, on the theory that behavior is learned through the theory of the interaction of the individual and the environment.
"So, we don't see them as medical treatment," she said. "Health insurance would provide for [situations] such as, you break your foot, you would need medical attention for that."
Rohde called those statements "just foolish."
"It has 20-plus years of science behind it to prove it is a medical treatment," he said. "This [lawsuit] does lay some very important groundwork for what we have always known to be true."
Rohde said the U.S. Department of Education, the American Academy of Pediatricians, multiple surgeon generals and others "have all accepted ABA as the proven therapy."
But, Amend said BCBS Oklahoma disagrees.
"There has been no well-constructed, randomized clinical trial that demonstrate ABA as being a more effective treatment when compared to a control group," she said.
Rohde said he believes the Michigan settlement undercuts that argument.
"I just see a lot more lawsuits popping up if BCBS and other insurance companies continue to deny this type of coverage," he said. "The ball is in their court, so to speak."
Asked whether BCBS of Oklahoma feared or expected local litigation as a result of the Michigan decision, Amend said: "I would say we're definitely watching. As health care is in the news lately, it's a topic we are very aware of."
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Sunday, June 21, 2009
A Conservative Case for Nick's Law
As posted on Okie Pundit blog. Click here to read on the blog.
One of the most contentious issues for debate at the Oklahoma Legislature the past two sessions was about insurance mandates -specifically, autism insurance coverage known as Nick’s Law.
Over the last 2 years, we have seen 10 states pass autism insurance coverage legislation to join Texas, Indiana, and South Carolina. Now that 13 states have addressed the autism epidemic by providing insurance coverage for tens of thousands of children, Oklahoma is faced with over 6500+ children still without healthcare.
During the past legislative session, the House and Senate Leadership would not entertain discussion of Nick’s Law, rather they passed legislation that provides for new tax dollars to be used for potentially recruiting and training therapists to provide treatments for our children, while ignoring the fact that the reason for the acute shortage of therapists in Oklahoma is due to the inability to establish a reliable revenue source.
Therapists who have to rely on out of pocket payments from parents cannot survive. This has been proven time and time again in other states.
The underlying message that state after state echo with the passage of the autism insurance mandate is: It is the fiscally responsible thing to do for the taxpayers and the morally responsible thing to do for these children.
Because of the tremendous cost that parents provide for their sick children, the autism community has divorce rates of 80%, bankruptcy rates 5 times the norm, and the mental health of the family unit in decline.
These children will become adults soon. The majority of persons with autism are children under the age of 16. Once they become adults and without the medically necessary treatments and clinically proven therapies, their care will be on the shoulders of the taxpayers.
Some estimates are around $3.25 million per individual. There are currently 400+ children in Oklahoma being diagnosed with autism each year.
The cost of Nick’s Law has been supported by two specific cost/benefit studies concluding the potential cost to be less than 0.3% to 1.0%. And another 23 actuarial studies clearly concluding that the cost of other state’s legislation to be consistent with the cost/benefit impact studies of Nick’s Law. And there is no evidence in the other states that the number of uninsured has increased, nor have insurance premiums increased. Several of the states have uninsured numbers greater than Oklahoma.
This is a great test of the legislature to define what are true family value policies and act as true fiscal conservatives. The legislature needs to pass Nick’s Law and stop forcing the parents and these children into the state run and paid for health care system.
One of the most contentious issues for debate at the Oklahoma Legislature the past two sessions was about insurance mandates -specifically, autism insurance coverage known as Nick’s Law.
Over the last 2 years, we have seen 10 states pass autism insurance coverage legislation to join Texas, Indiana, and South Carolina. Now that 13 states have addressed the autism epidemic by providing insurance coverage for tens of thousands of children, Oklahoma is faced with over 6500+ children still without healthcare.
During the past legislative session, the House and Senate Leadership would not entertain discussion of Nick’s Law, rather they passed legislation that provides for new tax dollars to be used for potentially recruiting and training therapists to provide treatments for our children, while ignoring the fact that the reason for the acute shortage of therapists in Oklahoma is due to the inability to establish a reliable revenue source.
Therapists who have to rely on out of pocket payments from parents cannot survive. This has been proven time and time again in other states.
The underlying message that state after state echo with the passage of the autism insurance mandate is: It is the fiscally responsible thing to do for the taxpayers and the morally responsible thing to do for these children.
Because of the tremendous cost that parents provide for their sick children, the autism community has divorce rates of 80%, bankruptcy rates 5 times the norm, and the mental health of the family unit in decline.
These children will become adults soon. The majority of persons with autism are children under the age of 16. Once they become adults and without the medically necessary treatments and clinically proven therapies, their care will be on the shoulders of the taxpayers.
Some estimates are around $3.25 million per individual. There are currently 400+ children in Oklahoma being diagnosed with autism each year.
The cost of Nick’s Law has been supported by two specific cost/benefit studies concluding the potential cost to be less than 0.3% to 1.0%. And another 23 actuarial studies clearly concluding that the cost of other state’s legislation to be consistent with the cost/benefit impact studies of Nick’s Law. And there is no evidence in the other states that the number of uninsured has increased, nor have insurance premiums increased. Several of the states have uninsured numbers greater than Oklahoma.
This is a great test of the legislature to define what are true family value policies and act as true fiscal conservatives. The legislature needs to pass Nick’s Law and stop forcing the parents and these children into the state run and paid for health care system.
Friday, June 19, 2009
BCBS of Mich concedes class action law suit
Blue Cross Blue Shield of Michigan Forced to Pay for Behavioral Therapy for Autism In Landmark Case
Release issued by Mantese and Rossman, P.C., on June 19, 2009
Detroit, Michigan. The family of an autistic child filed a motion in federal court today to confirm settlement of a class action against Blue Cross Blue Shield of Michigan. The family alleged in the suit that the insurer wrongfully refused to cover behavioral therapy for children with autism spectrum disorder (ASD), on the baseless ground that the care was"experimental. "
Under the terms of the settlement reached at a court-ordered conference on Wednesday, June 17, 2009, Blue Cross [of Michigan] has agreed to reimburse all families who paid for behavioral therapy for their children after May 1, 2003, and who were covered under a Blue Cross Blue Shield of Michigan insurance policy. Blue Cross had earlier filed a motion seeking dismissal of virtually the entire case on legal grounds, but the Honorable Stephen J. Murphy III permitted the case to go forward and scheduled the matter for further proceedings, including a settlement conference before Magistrate Michael Hluchaniuk.
The settlement was reached in the case of Christopher Johns v. Blue Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the suit, the plaintiff alleged that Blue Cross' pattern and practice of characterizing the scientifically established Applied Behavioral Therapy as "experimental, " and thus as excluded under its insurance policies, was arbitrary, capricious, illegal and contradicted by many years of scientific validation.
Under the settlement, Blue Cross [of Michigan] will pay for behavioral therapy rendered to over 100 children in the last six years. Plaintiff's counsel, Gerard Mantese and John J. Conway, were pleased with the settlement.
Mr. Mantese and Mr. Conway issued a joint statement emphasizing:
"No insurer should ever take this approach to needed care for children. Applied Behavioral Analysis therapy is supported by science and is not 'experimental. ' Delays by insurers in authorizing this treatment, when it is covered by insurance policies, should not be tolerated. Research shows that children with autism spectrum disorder need this therapy early on in life and delaying treatment can irreversibly prevent them from achieving their full potential."
Mr. Mantese emphasized that the settlement includes even families who never submitted a claim to Blue Cross, but who obtained this care for their children and were covered by a Blue Cross policy. Mr. Conway believes that this is the first such settlement addressing Applied Behavioral Analysis (ABA) in the country.
ABA therapy is administered under the supervision of licensed psychologists and other professionals. ABA applies one hundred year old concepts of changing behavior through positive and negative reinforcements. The federal suit in which this settlement was achieved centered upon the ABA treatment provided by prestigious Beaumont Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori Warner.
The case settled shortly after Plaintiff's counsel obtained a court order requiring Blue Cross to produce file documents which validated the effectiveness of ABA therapy for treating children with autism spectrum disorder.
Among the documents in the Blue Cross files obtained by Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical Policy for 2005, which acknowledged the following:
Applied behavioral analysis (ABA) is currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others.
Blue Cross' own documents further acknowledged that:
The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions.
Mr. Mantese stated,
"After we compelled Blue Cross through motion practice to produce all materials supporting its position that this care was allegedly experimental, we received numerous file documents which actually established that ABA therapy works and is highly effective in increasing the functioning of these children."
Mr. Conway emphasized, "We are pleased that we were able to obtain a result which will require Blue Cross to pay for this important care and will alleviate some of the financial strain imposed on over a hundred families by having to pay for this care when it was covered under their insurance policies."
Contact information for the families' attorneys follows:
Gerard Mantese, Esq.
Mantese and Rossman, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell
John J. Conway, Esq.
John J. Conway, P.C.
645 Griswold St, Ste 3600
Detroit, MI 48226
313-961-6525 Office
313-574-2148 Cell
Release issued by Mantese and Rossman, P.C., on June 19, 2009
Detroit, Michigan. The family of an autistic child filed a motion in federal court today to confirm settlement of a class action against Blue Cross Blue Shield of Michigan. The family alleged in the suit that the insurer wrongfully refused to cover behavioral therapy for children with autism spectrum disorder (ASD), on the baseless ground that the care was"experimental. "
Under the terms of the settlement reached at a court-ordered conference on Wednesday, June 17, 2009, Blue Cross [of Michigan] has agreed to reimburse all families who paid for behavioral therapy for their children after May 1, 2003, and who were covered under a Blue Cross Blue Shield of Michigan insurance policy. Blue Cross had earlier filed a motion seeking dismissal of virtually the entire case on legal grounds, but the Honorable Stephen J. Murphy III permitted the case to go forward and scheduled the matter for further proceedings, including a settlement conference before Magistrate Michael Hluchaniuk.
The settlement was reached in the case of Christopher Johns v. Blue Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the suit, the plaintiff alleged that Blue Cross' pattern and practice of characterizing the scientifically established Applied Behavioral Therapy as "experimental, " and thus as excluded under its insurance policies, was arbitrary, capricious, illegal and contradicted by many years of scientific validation.
Under the settlement, Blue Cross [of Michigan] will pay for behavioral therapy rendered to over 100 children in the last six years. Plaintiff's counsel, Gerard Mantese and John J. Conway, were pleased with the settlement.
Mr. Mantese and Mr. Conway issued a joint statement emphasizing:
"No insurer should ever take this approach to needed care for children. Applied Behavioral Analysis therapy is supported by science and is not 'experimental. ' Delays by insurers in authorizing this treatment, when it is covered by insurance policies, should not be tolerated. Research shows that children with autism spectrum disorder need this therapy early on in life and delaying treatment can irreversibly prevent them from achieving their full potential."
Mr. Mantese emphasized that the settlement includes even families who never submitted a claim to Blue Cross, but who obtained this care for their children and were covered by a Blue Cross policy. Mr. Conway believes that this is the first such settlement addressing Applied Behavioral Analysis (ABA) in the country.
ABA therapy is administered under the supervision of licensed psychologists and other professionals. ABA applies one hundred year old concepts of changing behavior through positive and negative reinforcements. The federal suit in which this settlement was achieved centered upon the ABA treatment provided by prestigious Beaumont Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori Warner.
The case settled shortly after Plaintiff's counsel obtained a court order requiring Blue Cross to produce file documents which validated the effectiveness of ABA therapy for treating children with autism spectrum disorder.
Among the documents in the Blue Cross files obtained by Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical Policy for 2005, which acknowledged the following:
Applied behavioral analysis (ABA) is currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others.
Blue Cross' own documents further acknowledged that:
The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions.
Mr. Mantese stated,
"After we compelled Blue Cross through motion practice to produce all materials supporting its position that this care was allegedly experimental, we received numerous file documents which actually established that ABA therapy works and is highly effective in increasing the functioning of these children."
Mr. Conway emphasized, "We are pleased that we were able to obtain a result which will require Blue Cross to pay for this important care and will alleviate some of the financial strain imposed on over a hundred families by having to pay for this care when it was covered under their insurance policies."
Contact information for the families' attorneys follows:
Gerard Mantese, Esq.
Mantese and Rossman, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell
John J. Conway, Esq.
John J. Conway, P.C.
645 Griswold St, Ste 3600
Detroit, MI 48226
313-961-6525 Office
313-574-2148 Cell
Saturday, June 13, 2009
Wayne Rohde: A father with a cause
Norman Transcript
By M. Scott Carter
June 13, 2009 01:33 am
— Transcript Staff Writer
OKLAHOMA CITY -- Wayne Rohde didn't want this.
A self-described conservative Republican, Rohde and his wife, Robyne, came to Oklahoma about 10 years ago to be near Robyne's parents.
That was in 1999.
A short time later, Robyne gave birth to fraternal twins, Austin and Nick. Austin was born at 28.5 weeks; Nick was born at 30 weeks. And, like many other parents, Wayne and Robyne were busy with life and raising their boys.
"The boys were born in October, and they came home in December," Wayne said. "And it took them a while to catch up developmentally."
Things rocked along OK until Nick was about 20 months old.
"Then Nick hit a wall," Wayne said.
The pediatrician told them not to worry.
"We noticed that Nick couldn't eat crackers, or play with toys correctly," Wayne said. "We got concerned. The pediatrician said he'd be fine, he was just slow catching up."
The pediatrician was wrong.
Nick's development seemed to stop. And Wayne and his wife began a frantic search to find out what was wrong. Eventually, after more than a year, they would discover that Nick suffered from autism.
"I took over a year to make an appointment to see a therapist," he said. "If that would have been down to a month, chances are we could have recovered."
That diagnosis changed their lives.
"My wife wouldn't even say 'autism,'" Wayne said. "She called it the 'a-word.' And I had no idea what that meant. No one knew. We'd never went through anything like this before."
Because Nick's treatment was delayed, Rohde said, his recovery is much slower. "By delaying the diagnosis and treatment, well, one day is bad, but one year is horrible."
Rohde said it took so long to discover Nick's problem because there were no qualified professionals in Oklahoma. "Screening is one thing, but getting the proper diagnosis can take a long time."
There was little information available, he said.
"We were given two things, a copied piece of paper about autism and a prescription for Ritalin. That's modern medicine, 'There's a pill for that.'"
Then came the medical bills -- huge medical bills.
Bills that Wayne's medical insurance wouldn't pay.
Rhode estimates his family pays more than $5,000 a month to treat Nick.
"We got denial after denial," he said. "And, I guess it was at that point that I got mad as hell."
And it was at that point that Wayne Rohde changed from conservative businessman and father to hard-core political activist.
First he put his fist through a wall.
"The insurance companies were telling us 'no,' the banks were beating on our door. We were gonna loose the roof over our head. The car company was going, 'hey, we're sorry but where's our money?' It was more than I could take."
After his initial expression of rage, Wayne Rohde did something different -- he became an activist.
He and his wife surrounded themselves in research about autism coverage and he began approaching members of the state Legislature about changing state law to compel insurance companies to cover autism treatment.
"I kept asking why the insurance company won't pay," he said. "We're paying them thousands of dollars each month and they're not covering Nick. What's the deal?" Rohde continued his questions, then formed connections with parents across the country who had similar problems.
"I found families in other states," he said. "Loose networks of people."
Slowly, the groups made progress. Several years ago, Indiana was the first state in the country to require autism coverage, then in 2007, a similar bill in Texas became law.
"That gave me the green light," Wayne said.
Just like his son, Wayne hit a brick wall, too.
After convincing his brother to front him the money for plane tickets, Wayne traveled to other states as they conducted legislative hearings on autism coverage. He gathered data and information, then he traveled to 23rd and Lincoln.
"I spent six months visiting with legislative leaders on both sides of the aisle," he said. And while he found some lawmakers who would listen, Rohde said the state's Republican leaders flatly told him no. "The state GOP said 'no.' They said insurance rates would go up. I said that's disingenuous."
Putting his family life -- and his software company -- on hold, Rohde eventually would team with Durant Democratic state Senator J. Paul Gumm to develop Nick's Law, a legislative proposal that would require insurance companies in Oklahoma to cover autism treatment.
"I visited with Senator Gumm. He and his wife had just had a baby and his wife just happened to be researching autism," Wayne said. "The stars lined up and we took off."
Rohde, Gumm and others began their fight to pass Nick's Law. They started in 2007 and didn't expect to get very far.
"I knew that first year we would have to educate people," he said. "And I didn't expect the bill to pass."
The Legislature proved him right.
While Nick's Law generated a great deal of public debate -- and media coverage -- the measure failed to clear the House of Representatives.
But Wayne Rohde refused to give up.
After their initial political battle, Rohde and Gumm tried again. And this time, things got ugly. Instead of a debate about the issue, Rohde said Republican lawmakers turned rude and defensive.
"We did get further than people thought we would," he said. "And we got a lot of people interested."
And, in a strange twist of fate, one GOP critic helped in that effort.
Rohde said when state Rep. Ron Peterson slammed the door in the faces of a group of 20 parents of autistic children, "people got pissed off."
"It was all because of Rep. Peterson," he said. "After he slammed the door on us a lot of people contacted us and said, 'Wait a minute, these people are parents up here.'"
With public pressure growing, Rohde said some GOP members began to fight back.
"They would get really mad when a group of us would go up there and walk the hall. Some lawmakers said they were too busy to talk. We stopped one, who told us to make an appointment with his assistant. We tried that and the assistant said the lawmaker was too busy, could we come back in the summer? But session would have been over."
And while Rohde said some members of the Legislature were concerned and did listen, he said some many legislative leaders were 'just downright rude.'
"Rep. Gus Blackwell got really pissed off when I brought 20 parents into his office and two television stations," he said. "He was furious." Rohde had the same criticism for Edmond state Sen. Clark Jolley.
"Senator Jolley sent out e-mails saying I was unprofessional and not courteous," he said. "Well I say 'bite me, Senator, you're up here to represent your people and you won't even allow them to come into your office and talk to you, so bite me."
Later, Jolley would tell the Edmond Sun that Rohde's effort was "the greatest effort anybody has made to educate the Legislature about autism."
"There's a lot of education that will need to happen," he said. However, Jolley said he was "concerned" about forcing mandates on insurance companies as required by Nick's Law. "When asking for an insurance mandate, it's asking for coverage for something that not everybody needs," Jolley told the newspaper. "And you're asking for everybody else to bear the cost of it, and that's what universal health care is."
Jolley said in providing coverage for autism and other expensive health-care issues that may not be provided for by insurance companies, he would want to look at expanding pools of insurance, providing increased incentives for medical savings accounts and other options prior to having to enact a mandate.
"I would rather see us provide greater medical savings accounts," he said.
Rohde said Jolley was simply speaking for the insurance companies.
"I have come to understand that the Oklahoma Legislature isn't set up for the public good. It isn't set up for public input as other states are. In other states, they actually have committee hearings. But the Oklahoma Legislature isn't set up that way. All the outcomes have been predetermined."
Legislative leaders, he said, prevented Gumm and other supporters of Nick's Law from bringing in data and expert witnesses to testify at committee hearings.
"It's all set up for the lobbyists, because they are the only ones who can afford to be up here every day," he said. "Sure parents might come up here once in a while but they don't have a clue to what's going on. The GOP has dug in their heels on this issue."
During one meeting, Rohde said members of the Oklahoma Conservative Political Action Committee told him to move to a different state if he wanted better coverage.
"I was told to do that be the OCPAC," he said. "But we're not going to. We don't want to move away from our family. We're not going to punish our kids by moving."
Still, while Rhode hasn't gotten Nick's Law passed yet, he has been a driving force in educating the public about autism -- a complex developmental disability that typically appears in children before age 3, according to the Autism Society of America.
"It's a complex neurobiological disorder. It impacts areas of the brain responsible for social interaction and communication skills," Rohde said.
In fact, this weekend, the Defeat Autism Now conference is taking place at Norman. And though Rohde said he won't be able to make all of the two day event, he did plan on sitting in on several sessions.
And, he added, he'll continue his fight.
"I'm not giving up. Right now 13 states have passed an autism mandate. It's only a matter of time. I don't mind the fight. I'll step into the damn arena, because I know I'm on the right side."
M. Scott Carter 366-3545 scarter@normantranscript.com
Copyright © 1999-2008 cnhi, inc.
By M. Scott Carter
June 13, 2009 01:33 am
— Transcript Staff Writer
OKLAHOMA CITY -- Wayne Rohde didn't want this.
A self-described conservative Republican, Rohde and his wife, Robyne, came to Oklahoma about 10 years ago to be near Robyne's parents.
That was in 1999.
A short time later, Robyne gave birth to fraternal twins, Austin and Nick. Austin was born at 28.5 weeks; Nick was born at 30 weeks. And, like many other parents, Wayne and Robyne were busy with life and raising their boys.
"The boys were born in October, and they came home in December," Wayne said. "And it took them a while to catch up developmentally."
Things rocked along OK until Nick was about 20 months old.
"Then Nick hit a wall," Wayne said.
The pediatrician told them not to worry.
"We noticed that Nick couldn't eat crackers, or play with toys correctly," Wayne said. "We got concerned. The pediatrician said he'd be fine, he was just slow catching up."
The pediatrician was wrong.
Nick's development seemed to stop. And Wayne and his wife began a frantic search to find out what was wrong. Eventually, after more than a year, they would discover that Nick suffered from autism.
"I took over a year to make an appointment to see a therapist," he said. "If that would have been down to a month, chances are we could have recovered."
That diagnosis changed their lives.
"My wife wouldn't even say 'autism,'" Wayne said. "She called it the 'a-word.' And I had no idea what that meant. No one knew. We'd never went through anything like this before."
Because Nick's treatment was delayed, Rohde said, his recovery is much slower. "By delaying the diagnosis and treatment, well, one day is bad, but one year is horrible."
Rohde said it took so long to discover Nick's problem because there were no qualified professionals in Oklahoma. "Screening is one thing, but getting the proper diagnosis can take a long time."
There was little information available, he said.
"We were given two things, a copied piece of paper about autism and a prescription for Ritalin. That's modern medicine, 'There's a pill for that.'"
Then came the medical bills -- huge medical bills.
Bills that Wayne's medical insurance wouldn't pay.
Rhode estimates his family pays more than $5,000 a month to treat Nick.
"We got denial after denial," he said. "And, I guess it was at that point that I got mad as hell."
And it was at that point that Wayne Rohde changed from conservative businessman and father to hard-core political activist.
First he put his fist through a wall.
"The insurance companies were telling us 'no,' the banks were beating on our door. We were gonna loose the roof over our head. The car company was going, 'hey, we're sorry but where's our money?' It was more than I could take."
After his initial expression of rage, Wayne Rohde did something different -- he became an activist.
He and his wife surrounded themselves in research about autism coverage and he began approaching members of the state Legislature about changing state law to compel insurance companies to cover autism treatment.
"I kept asking why the insurance company won't pay," he said. "We're paying them thousands of dollars each month and they're not covering Nick. What's the deal?" Rohde continued his questions, then formed connections with parents across the country who had similar problems.
"I found families in other states," he said. "Loose networks of people."
Slowly, the groups made progress. Several years ago, Indiana was the first state in the country to require autism coverage, then in 2007, a similar bill in Texas became law.
"That gave me the green light," Wayne said.
Just like his son, Wayne hit a brick wall, too.
After convincing his brother to front him the money for plane tickets, Wayne traveled to other states as they conducted legislative hearings on autism coverage. He gathered data and information, then he traveled to 23rd and Lincoln.
"I spent six months visiting with legislative leaders on both sides of the aisle," he said. And while he found some lawmakers who would listen, Rohde said the state's Republican leaders flatly told him no. "The state GOP said 'no.' They said insurance rates would go up. I said that's disingenuous."
Putting his family life -- and his software company -- on hold, Rohde eventually would team with Durant Democratic state Senator J. Paul Gumm to develop Nick's Law, a legislative proposal that would require insurance companies in Oklahoma to cover autism treatment.
"I visited with Senator Gumm. He and his wife had just had a baby and his wife just happened to be researching autism," Wayne said. "The stars lined up and we took off."
Rohde, Gumm and others began their fight to pass Nick's Law. They started in 2007 and didn't expect to get very far.
"I knew that first year we would have to educate people," he said. "And I didn't expect the bill to pass."
The Legislature proved him right.
While Nick's Law generated a great deal of public debate -- and media coverage -- the measure failed to clear the House of Representatives.
But Wayne Rohde refused to give up.
After their initial political battle, Rohde and Gumm tried again. And this time, things got ugly. Instead of a debate about the issue, Rohde said Republican lawmakers turned rude and defensive.
"We did get further than people thought we would," he said. "And we got a lot of people interested."
And, in a strange twist of fate, one GOP critic helped in that effort.
Rohde said when state Rep. Ron Peterson slammed the door in the faces of a group of 20 parents of autistic children, "people got pissed off."
"It was all because of Rep. Peterson," he said. "After he slammed the door on us a lot of people contacted us and said, 'Wait a minute, these people are parents up here.'"
With public pressure growing, Rohde said some GOP members began to fight back.
"They would get really mad when a group of us would go up there and walk the hall. Some lawmakers said they were too busy to talk. We stopped one, who told us to make an appointment with his assistant. We tried that and the assistant said the lawmaker was too busy, could we come back in the summer? But session would have been over."
And while Rohde said some members of the Legislature were concerned and did listen, he said some many legislative leaders were 'just downright rude.'
"Rep. Gus Blackwell got really pissed off when I brought 20 parents into his office and two television stations," he said. "He was furious." Rohde had the same criticism for Edmond state Sen. Clark Jolley.
"Senator Jolley sent out e-mails saying I was unprofessional and not courteous," he said. "Well I say 'bite me, Senator, you're up here to represent your people and you won't even allow them to come into your office and talk to you, so bite me."
Later, Jolley would tell the Edmond Sun that Rohde's effort was "the greatest effort anybody has made to educate the Legislature about autism."
"There's a lot of education that will need to happen," he said. However, Jolley said he was "concerned" about forcing mandates on insurance companies as required by Nick's Law. "When asking for an insurance mandate, it's asking for coverage for something that not everybody needs," Jolley told the newspaper. "And you're asking for everybody else to bear the cost of it, and that's what universal health care is."
Jolley said in providing coverage for autism and other expensive health-care issues that may not be provided for by insurance companies, he would want to look at expanding pools of insurance, providing increased incentives for medical savings accounts and other options prior to having to enact a mandate.
"I would rather see us provide greater medical savings accounts," he said.
Rohde said Jolley was simply speaking for the insurance companies.
"I have come to understand that the Oklahoma Legislature isn't set up for the public good. It isn't set up for public input as other states are. In other states, they actually have committee hearings. But the Oklahoma Legislature isn't set up that way. All the outcomes have been predetermined."
Legislative leaders, he said, prevented Gumm and other supporters of Nick's Law from bringing in data and expert witnesses to testify at committee hearings.
"It's all set up for the lobbyists, because they are the only ones who can afford to be up here every day," he said. "Sure parents might come up here once in a while but they don't have a clue to what's going on. The GOP has dug in their heels on this issue."
During one meeting, Rohde said members of the Oklahoma Conservative Political Action Committee told him to move to a different state if he wanted better coverage.
"I was told to do that be the OCPAC," he said. "But we're not going to. We don't want to move away from our family. We're not going to punish our kids by moving."
Still, while Rhode hasn't gotten Nick's Law passed yet, he has been a driving force in educating the public about autism -- a complex developmental disability that typically appears in children before age 3, according to the Autism Society of America.
"It's a complex neurobiological disorder. It impacts areas of the brain responsible for social interaction and communication skills," Rohde said.
In fact, this weekend, the Defeat Autism Now conference is taking place at Norman. And though Rohde said he won't be able to make all of the two day event, he did plan on sitting in on several sessions.
And, he added, he'll continue his fight.
"I'm not giving up. Right now 13 states have passed an autism mandate. It's only a matter of time. I don't mind the fight. I'll step into the damn arena, because I know I'm on the right side."
M. Scott Carter 366-3545 scarter@normantranscript.com
Copyright © 1999-2008 cnhi, inc.
Wednesday, June 10, 2009
Wayne Rohde to speak in Edmond, OK
Edmond Democrats will meet this Thursday, June 11, in Room 110 of the Edmond Community Center, 28 E. Main in Edmond. The meeting will begin at 6:30.
Guest speaker at this month's meeting will be Wayne Rohde of Edmond. His son Nicholas is the inspiration for "Nick's Law," a proposal to mandate medical insurance coverage for children with autism in Oklahoma. The proposal has met with stiff opposition from Republican lawmakers.
The public is invited.
Guest speaker at this month's meeting will be Wayne Rohde of Edmond. His son Nicholas is the inspiration for "Nick's Law," a proposal to mandate medical insurance coverage for children with autism in Oklahoma. The proposal has met with stiff opposition from Republican lawmakers.
The public is invited.
Tuesday, June 9, 2009
Mich Autism Bill passes House Cmte
Michigan Autism Insurance Bill HB 4476 Unanimously Passes House Health Policy Committee-To Go To Floor Of the Michigan House
T
he Detroit Free Press reports that Michigan House Bill 4476 (2009) ( introduced 2/26/2009; Sponsor: Rep. Kathy Angerer + 4 co-sponsors)
Insurance; health care corporations; coverage for certain treatments related to autism was approved by a unanimous 19-0 vote in the Michigan House Health Policy Committee and now heads to the floor of the Democratic-led House. It is reported by The Detroit Free Press that the Senate side of the Michigan legislature may be expected to mount challenges to the bill.
T
he Detroit Free Press reports that Michigan House Bill 4476 (2009) ( introduced 2/26/2009; Sponsor: Rep. Kathy Angerer + 4 co-sponsors)
Insurance; health care corporations; coverage for certain treatments related to autism was approved by a unanimous 19-0 vote in the Michigan House Health Policy Committee and now heads to the floor of the Democratic-led House. It is reported by The Detroit Free Press that the Senate side of the Michigan legislature may be expected to mount challenges to the bill.
Thursday, June 4, 2009
Free Markets and Nick's Law
The free markets exist and prosper when there is accountability and transparency. There is none in the private insurance market in OK. There has been no insurance mandates passed in OK since 2001, yet our insurance has been increasing each year on an avgerage of 10% or more and not because of insurance mandates.
The insurance industry in OK has one of the lowest medical loss ratios in the nation. That means that they pay out the lowest percentage of premium dollars as claims. Is that free market principals?
The cost of Nick's Law (autism insurance legislation) has been shown to have a potential increase by two different studies of 0.3% to 1.0%. And there are 23 other independent studies that show similar mandates to be less than 1% in other states. Yet our House leadership hides behind a factually inaccurate report that concludes the cost to be as high as 19.8%. There is no supporting documentation or other studies anywhere to support this figure.
Other states are passing autism insurance mandates because of the tremendous cost savings to the taxpayers. Texas this past week expanded their autism insurance mandate. A very red state and very conservative. Their message. "This is a fiscally conservative approach to the taxpayers because it will save the state $4.06 billion over the next few decades".
By denying people who pay for health insurance, the coverage for a medical condition with medically necessary and clinically proven treatments, you are endorsing a movement for a gov't health care system.
The insurance industry made their bed, now it is time to sleep in it.
Parents and supporters of Nick's Law encourage private insurance coverage and want as many people as possible to enroll. Insure Oklahoma offers great subsidized programs for people to purchase health insurance.
I for one, do not want a single payer system from the gov't regarding autism. It has failed in England. We need specialized care, not a template care system. A single payer system might work for the general health, however, I have my doubts, but by continuing to allow an insurance industry to continue their discriminatory practices, we will get to that type of system courtesy of their actions.
There are only two industries in the US that enjoy anti-trust protections from our federal gov't. One is baseball and the other is the insurance industry. Do we really need another AIG?
The insurance industry in OK has one of the lowest medical loss ratios in the nation. That means that they pay out the lowest percentage of premium dollars as claims. Is that free market principals?
The cost of Nick's Law (autism insurance legislation) has been shown to have a potential increase by two different studies of 0.3% to 1.0%. And there are 23 other independent studies that show similar mandates to be less than 1% in other states. Yet our House leadership hides behind a factually inaccurate report that concludes the cost to be as high as 19.8%. There is no supporting documentation or other studies anywhere to support this figure.
Other states are passing autism insurance mandates because of the tremendous cost savings to the taxpayers. Texas this past week expanded their autism insurance mandate. A very red state and very conservative. Their message. "This is a fiscally conservative approach to the taxpayers because it will save the state $4.06 billion over the next few decades".
By denying people who pay for health insurance, the coverage for a medical condition with medically necessary and clinically proven treatments, you are endorsing a movement for a gov't health care system.
The insurance industry made their bed, now it is time to sleep in it.
Parents and supporters of Nick's Law encourage private insurance coverage and want as many people as possible to enroll. Insure Oklahoma offers great subsidized programs for people to purchase health insurance.
I for one, do not want a single payer system from the gov't regarding autism. It has failed in England. We need specialized care, not a template care system. A single payer system might work for the general health, however, I have my doubts, but by continuing to allow an insurance industry to continue their discriminatory practices, we will get to that type of system courtesy of their actions.
There are only two industries in the US that enjoy anti-trust protections from our federal gov't. One is baseball and the other is the insurance industry. Do we really need another AIG?
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