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Missouri Autism Coverage
Families with autistic children appear likely to gain insurance coverage in Missouri next year, but how much coverage will be the focus of a heated debate that kicked off Tuesday.
In jammed hearing rooms, supporters of an insurance mandate urged legislative committees to make Missouri the 15th state, including Illinois, to require that all health insurance policies pay for diagnosis and treatment of the fast-growing brain disorder.
The issue has been on the front burner since Gov. Jay Nixon, a Democrat, criticized the Republican-led House for killing the bill last year. GOP leaders have promised to make it a priority this year. To get a jump on Nixon, both the House and Senate held autism hearings on the eve of Nixon’s “State of the State” speech, which he will deliver at 7 tonight and which is expected to highlight the issue.
In autistic children, the brain does not develop normally, causing an array of problems with communication and social interaction. National studies have found the disorder affects roughly one in 100 children — one in 83 in the St. Louis region, the highest rate in the country, according to an expert who testified Tuesday.
The good news, witnesses said, is that one-on-one therapy called applied behavioral analysis, or ABA, has been successful in treating autism, especially if the therapy begins at a young age.
Half of the children treated as preschoolers will enter first grade “indistinguishable from their peers,” said Lorri Unumb, senior counsel for a national group called Autism Speaks and the mother of an 8-year-old son with autism.
But the therapy is expensive, costing families tens of thousands of dollars a year, depending on the severity of the child’s disorder. Treatment involves three tiers — a consultant for three to six hours a month, a supervisor for six hours a week and a therapist in the home for as much as 40 hours a week.
Insurers agreed that the therapy can improve brain functioning, but they argued that it works well only for young children — say, younger than 7. The therapy has “very limited” efficacy for older children, said Dr. Blake Williamson, a vice president and senior medical director at Blue Cross Blue Shield of Kansas City.
Insurers oppose the bill’s guarantee of up to $72,000 in treatment for children and adults up to age 21. Instead, Williamson suggested a $32,000 annual benefit up to age 7, with lesser benefits after that.
But in focusing on ways to scale back the bill rather than kill it, the opponents’ position showed their recognition that the measure has broad bipartisan supportThe insurance industry generally opposes all mandates, contending that they increase costs for everyone, forcing some people to drop their coverage and some companies to quit providing insurance for employees.
Indeed, insurers said the autism mandate could raise premium costs in the state by at least 3 percent.
Advocates for the autism bills contested that point, saying that in states that require the coverage, costs have risen less than 1 percent.
However, David Smith, representing Anthem Blue Cross Blue Shield of Missouri, said those comparisons may not be valid. For example, he said that Indiana has more school programs for autistic children than Missouri does, and spends twice what Missouri does on such initiatives.
The one thing that was clear Tuesday was that Republicans and Democrats alike want to address the issue during this election year before going home to constituents who struggle with the disorder or know families who do.
Legislators heaped praise on the bills’ sponsors, Rep. Dwight Scharnhorst, R-St. Louis County, and Rep. Jason Grill, D-Parkville, for bringing the bills forward. In a sign of the popularity of the issue, Rep. Rob Schaaf, R-St. Joseph, ribbed Scharnhorst for accidentally failing to list Schaaf as a co-sponsor.
While the House bills are similar, Scharnhorst’s is broader, requiring $72,000 in benefits. Grill said he attempted a compromise, modeling his bill after a measure that passed the Senate last year. It would require coverage of up to $55,000 a year in treatment up to age 15.
Rep. Kevin Wilson, R-Neosho, heads the House committee that will craft a bill to send to the House floor for debate. Wilson said he wants to look at the age and benefit limits, as well as credentials required for therapists providing the service.
“We’re going to be aggressive but not rush something that’s not right,” Wilson said.
Still up in the air: whether to exempt or provide an opt-out provision for small businesses. Some of the proposals would let businesses with 50 or fewer employees seek exemptions if they could prove their premiums would rise by at least 5 percent as a result of the autism coverage.
“I know this bill’s going to pass this committee,” said Brad Jones, a lobbyist for the National Federation of Independent Businesses. “I just ask we keep the small business community in mind.”
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