Missouri lawmakers seek to mandate autism coverage

Thursday, March 5, 2009

JEFFERSON CITY, Mo. -- Tom and Jenny Whitty have cashed out their children's college funds, maxed out several credit cards and taken out a second mortgage on their house -- all to pay for therapy for their two autistic children.

They are running out of money. And their private insurance won't cover the autism treatments.

"It seems insane. This isn't Viagra or a tummy tuck; this is my child's whole future," Jenny Witty said recently while pleading with lawmakers to mandate that insurers cover autism.

Missouri lawmakers have taken a first step toward a mandate, which insurance companies claim could have a side effect of driving up insurance costs for everyone.

The House Health Care Policy Committee on Wednesday endorsed legislation requiring group health insurance plans to cover up to $72,000 annually of autism services for children younger than age 11. Insurers would have to cover up to $36,000 annually for people age 11 to 21.

The House action came a day after the Senate Small Business, Insurance and Industry Committee endorsed legislation mandating childhood autism coverage that would apply to an even broader array of insurance providers.

Both chambers have to pass the same version of the legislation for it to go to Gov. Jay Nixon.

In the past two years, six states -- Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana -- passed laws requiring coverage of behavior therapy for autism, which can cost up to $50,000 a year per child.

An actuarial analysis of an earlier version of the Missouri Senate bill, conducted by the consulting firm Oliver Wyman for the advocacy group Autism Speaks, estimates that an autism insurance mandate would result in a less than 1 percent increase in the cost of health insurance premiums.

But the Missouri bills could cause a greater than 3 percent premium increase, asserted Shannon Cooper, a former state lawmaker who now lobbies for the industry group, America's Health Insurance Plans. He said that for every 1 percent increase in premiums, about 5,500 people no longer are able to afford health insurance.

The Missouri Senate bill could cost the insurance industry -- and their customers -- more than $200 million, Cooper said.

"In this economy, with the costs that are involved in this legislation, we're going to wind up causing a lot more people and children to go without insurance than those that will be served by this special interest legislation," said Calvin Call, executive director of the Missouri Insurance Coalition.

Insurance lobbyists suggest that if autism coverage is a priority for legislators, then they ought to find state money to cover it instead of mandating it through the private sector.

But advocates contend the increased premiums people would pay pale in comparison to the costs that families currently must pay out of pocket.

The Whittys, for example, pay about $40,000 annually for each of their two autistic children -- 4-year-old Simon and 3-year-old Max -- to receive behavioral, occupational and speech therapy in Kansas City. The family earns about $100,000 a year.

Because Tom Whitty works for a large company that falls under federal guidelines for self-insured health plans, the Missouri legislation cannot directly mandate insurance coverage for their family. But Jenny Whitty said the family is hopeful that self-insured companies would follow suit if autism coverage becomes the norm in Missouri.

"We really are desperate," she said. "We've already visited with a bankruptcy attorney. I hate to do that, but I also hate to have my kids not treated."


Autism bills are HB357 and SB167.

On the Net:

Legislature: http://www.moga.mo.gov

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