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 Gov. Jay Nixon |
Nixon said Thursday that coverage of the costly behavioral treatments should be an essential element of legislation that both the Democratic governor and Republican legislative leaders have pledged to make a priority next year.
He will speak about the legislation during a stop at 12:45 p.m. today at Dempster Hall on the Southeast Missouri State University campus in Cape Girardeau.
Nixon's proposal is similar to a bill passed earlier this year by the Senate that never came to a vote in the House. Insurance industry lobbyists had warned that mandating coverage of childhood autism would cause premiums to rise for other policyholders.
At issue is what's known as "applied behavioral analysis," which some parents say produces dramatic improvements in their autistic children but which can cost upward of $50,000 a year. Such services are not currently covered by Missouri insurers.
Fourteen states have laws mandating insurance coverage of "medically necessary, evidence-based autism therapies" such behavioral analysis services, according to the advocacy group Autism Speaks.
At Nixon's side as he announced his plan Thursday were Myles and Lora Hinkel and their 6-year-old son, Blake, who provided an example of the challenges of raising autistic children by attempting to rip a seal off the lectern during Nixon's news conference. Unable to speak until age 3, Blake now can talk in several-word sentences and read short words as a result of behavioral treatment services, Myles Hinkel said.
A local social services agency has helped the Hinkels pay for Blake's treatment. But that aid runs out next year, the father said, and the family is hoping for a state insurance mandate.
State insurance department director John Huff said the proposals backed by Nixon and the Senate would be affordable for consumers.
"Fundamentally, major life changing events -- like a diagnosis of autism -- is what insurance is all about," Huff said.
Nationally, about 1 in 150 children are diagnosed with an autism spectrum disorder, and Nixon said more than 30,000 people could have autism in Missouri.
An actuarial analysis conducted for Autism Speaks of a previous Missouri legislative proposal, which included a $72,000 annual benefit cap for autistic people younger than 21, estimated that an insurance mandate would result in a less than 1 percent increase in the cost of health insurance premiums. For an average group health insurance premium of $3,573 a person, that would equal a $27.10 increase, the study said.
Warnings on premiums
But the industry group America's Health Insurance Plans has warned of premium increases of greater than 3 percent, which it estimates would make health insurance unaffordable for thousands of people.
Calvin Call, executive director of the Missouri Insurance Coalition, said the industry has had no conversations with Nixon about an autism insurance requirement and still has concerns about its costs.
Nixon said he's not interested in compromising on four key elements. He said the bill must cover both the diagnosis and treatment of childhood autism, provide between $35,000 and $55,000 annually of behavioral services, cannot cap the number of treatment visits and must bar insurers from terminating coverage solely because of an autism diagnosis.
"This is not about trying to find a bill that every insurance lobbyist in Jefferson City can sign off on," Nixon said. "This is about doing something that is right, correct, proven and needs to get done."
Since the legislature adjourned in May, Nixon has repeatedly criticized both the insurance industry and Republican House leaders for not voting on the Senate's autism legislation.
But House Speaker Ron Richard, R-Joplin, said Nixon has not talked to him about the details he wants included in an autism bill. Richard has created an interim committee to craft autism insurance legislation and pledged it will be one of the first bills debated when lawmakers return in January.
"Our goal is still an affordable, transparent, workable solution," Richard said.
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God bless the children, but gosh darn it, the state and the federal government should not REQUIRE insurance companies to provide coverage. This is what has gotten us into this health care insurance pickle in the first place. The government keeps sticking their fingers into such things, causing the cost for all of us and the businesses that provide insurance for their employee to skyrocket - and it's the primary reason so many folks are uninsured. Wake up America, before it's too late, the government cannot 'craft' insurance legislation that will make things cheaper or better - it has never worked that way, and it never will.
I agree with the notion that government intervention cannot fix all problems. However, I know what the cost of autism is on a household. Not only money wise, but physically and emotionally. My son was diagnosed almost 9 years ago -- before anyone that I knew had even heard of autism. We found out really quickly that insurance was not going to pay for anything that had a diagnosis of autism attached to it. Since there is not an actual test for autism, we had to see specialists and have extremely expensive MRIs, EEGs, and blood work to rule out anything else that it could possibly be. The insurance was not wanting to pay for any of these tests, since the first diagnosis on the list was autism. Then a doctor in St. Louis said, "You are lucky we have found a disfigurement in his brain. It did not cause the autism, but now your insurance will cover his bills." Is that not the saddest thing in the world to hear? Congratulations, we have found something else wrong so that now we can get autism covered. Not all families get a break like that. They are stuck with thousands and thousands of dollars worth of bills. I have seen families take pay cuts or quit work entirely so that they can qualify for Medicaid because it paid more than private insurance.
You all are worried about premiums going up, but several of these families have had to receive state aid just to get by. You are paying for that!! The school districts are baring the brunt of most of this cost to teach these children. You are paying for that, too!! Maybe if insurance took more of a medical responsibility instead of saying it is an educational problem, we can get the help these children need and deserve. More and more children are diagnosed with autism everyday. Early intervention works. Families need the money to work with their children now, while they still have an opportunity to grow into functional adults. Otherwise, you will be paying for them as adults.