Gil Dupré, LAHP Chief Executive Officer
A compromise with health insurers boosted the odds of passage for a proposed law requiring health insurance coverage for the treatment of autistic children.
The House Insurance Committee approved the bill by an 8-0 vote in late April. Under the proposed law, mandated benefits for autism spectrum disorder would be capped at $36,000 a year and $144,000 lifetime. Employers who have fewer than 50 workers would not have to provide the coverage.
“I’m tickled pink with the committee’s vote,” said Shelley H. Reynolds of Baton Rouge, president of Unlocking Autism, a nonprofit founded to increase awareness of the disorder.
Reynolds has a 12-year-old son with autism.
Reynolds is optimistic about the bill’s chances of winning approval in both houses of the legislature.
Gil Dupré, chief executive officer of the Louisiana Association of Health Plans, said health insurers have agreed not to fight the amended legislation, which leaves supporters in “a very strong position.”
The amended bill stands a good chance of making it through the entire legislative process, Dupré said.
The legislation as amended will apply to less than a third of the companies that offer insurance to their employees. The law will not apply to individual plans or to large employers, most of which are self-insured.
Self-insured firms, which provide coverage for two-thirds of the employees with insurance, fall under the federal Employment Retirement Income Security Act, Dupré said.
“This is always the case on mandated benefits, the target of these. Those that are actually going to receive the benefit and be required to pay for them are the smaller number,” he said.
The health insurers’ withdrawal doesn’t mean the bill will be unopposed.
Louisiana Association of Business and Industry and the National Federation of Independent Business oppose the autism benefit. Both business groups have argued that this bill, and other proposed health insurance mandates, will drive up insurance costs. The federation has estimated that 20,000 employees lose their coverage for each 1 percent increase in health insurance costs.
Supporters of the bill said it would increase health insurance premiums by around 0.5 percent.
The Legislative Fiscal Office estimated the cost to the Office of Group Benefits, which covers state employees, at $15 million to $19 million over five years. For private employers, the estimated cost was anywhere from $78 million to $326 million for five years.
However, those amounts were based on a maximum benefit of $50,000 per year, the amount in the bill’s original version. The amounts were also based on requiring all health plans to provide the coverage, not just those with more than 50 employees.
Dupré said the increase in health insurance premiums would probably fall between 0.5 percent and 1 percent.
So the costs for the Office of Group Benefits will probably be somewhere between $10 million and $15 million for five years, he said. For private insured groups, the cost will be $50 million or more.
Autism is a developmental disorder that affects a person’s ability to communicate verbally and nonverbally. The disorder also affects a child’s social relationships and educational performance.
In Louisiana, the number of students with autism more than tripled between 1994 and 2005, according to the state Department of Education. The number rose from 621 during the 1994-95 school year to 2,138 in 2004-05.
Supporters of the bill said fewer than 500 of the autistic children would require the highest level of treatment, which could cost more than $20,000 per year.
Reynolds said while HB958 will not provide coverage for everyone, it is a good first step toward getting broad insurance coverage for autism treatment.
Once enough state-level support for the coverage has been built, proponents can take their effort to the federal level, she said.
Dr. Charles Schibler, a New Orleans gastroenterologist and the parent of an autistic child, said the coverage is needed.
Last year, his family spent around $58,000 for speech, occupational and behavioral therapy, the American Academy of Pediatrics’ recognized standard of care. Schibler’s insurance policy covered around $7,000 of the total.
Schibler’s insurance company told him that Applied Behavioral Analysis, or ABA, was considered an experimental treatment, and therefore not covered by his policy.
“But it’s not experimental, and the American Academy of Pediatrics says that’s what you’re supposed to do,” Schibler said. “So that’s the foremost authority, so you see where the issue is immediately.”
Schibler said Louisiana now has very few ABA-certified therapists, mainly because insurance doesn’t cover them.
In the past, the state has gotten the therapists because educational grants have funded the training, he said.
This is how parents of autistic children form a treatment team: First, they find one ABA therapist. Then they recruit four or five younger people who may be studying psychology, nursing or occupational therapy and bring them in to learn how to do the therapy. The costs for help can range from $12 an hour to $60.
Schibler believes the proposed legislation can change that.
“If you provide insurance coverage, guess what’s going to happen? They’re going to come into the state, and what you will see is that the prices that they charge will go down,” Schibler said.