Lawmakers push to mandate insurance coverage for autism

A bill that would require health insurance companies to cover diagnosis and treatment for autism is poised for passage next week by two Senate committees, a move intended to help youngsters get vital early therapy.

"We think it’s time to take action and make significant inroads on autism," Sen. Josh Green, Health Committee chairman, said Wednesday after conferring with Sen. Rosalyn Baker, chairwoman of the Consumer Protection Committee, at a joint hearing. "We do intend to move the bill forward."

A vote on Senate Bill 2631 is set for Tuesday during a joint meeting of the Health and Consumer Protection committees.

If the bill is ultimately passed and signed into law, Hawaii would join a growing number of states that are requiring private insurers to cover treatment for autism. At least 29 states have passed such legislation, most in the past five years, according to the National Conference of State Legislatures.

California, New York, Rhode Island, Virginia and West Virginia took action last year.

In its current wording, the bill would require coverage of screening, diagnosis and treatment of autism spectrum disorder for individuals through age 25 with a $50,000 annual cap on behavioral health treatment. It will be revised before the vote to include a lifetime cap as well and to clarify that only therapy by credentialed providers would be covered, said Green (D, Milolii-Waimea), a physician who introduced the measure.

Autism is a developmental brain disorder that hampers the ability to communicate and interact socially and can cause disruptive behavioral problems. The condition has no cure, but early intervention can help overcome its disabling aspects. The most common treatment involves intensive, individualized behavioral therapy, which has traditionally not been covered by medical insurance.

Hawaii legislators have considered mandating insurance coverage for autism in recent years but declined to act after the state auditor advised against the move in 2009. The auditor said educational and health services for children with autism were available through the Department of Education and the Department of Health. But the Health Department noted at the time that private insurance treatment is needed to supplement existing services, and advocates say treatment is limited in the public schools.

Insurers oppose the legislation as an "unfunded mandate" that could require them to pay for ineffective therapies.

"Since these services are already being provided through public entities, passage of this mandated benefit would represent a huge cost shift to the private sector, specifically to employers who provide the lion’s share of health care coverage in the state," Jennifer Diesman, vice president for government relations for Hawaii Medical Service Association, testified Wednesday. Kaiser Permanente Hawaii also submitted testimony in opposition.

Legislators heard from parents, behavioral therapists and Dr. William Bolman, president of the Autism Society of Hawaii, who argued that while therapy may be costly, it transforms lives and ends up saving money in the long run because otherwise people with autism can end up as lifetime wards of the state. The lifetime cost, both direct and indirect, of caring for a person with autism was pegged at $3.2 million in a Harvard School of Public Health Study.

"All the research shows that throwing a lot of money into treatment early, that’s the most effective," said Bob Badger, an attorney whose son started treatment before age 3 and made great progress. "It’s the cheapest way out and it’s the right thing to do."

Also testifying Wednesday was Lorri Unumb, vice president of state government affairs for Autism Speaks and author of one of the first autism insurance laws, passed in South Carolina in 2007. In the five states that first required autism insurance, premium costs rose on average 25 cents per month per member as a result, Unumb said.

"I gave up my legal career to advocate full time for individuals with autism when I saw the inequity in the insurance arena," Unumb said. She and her husband spent $75,000 a year on therapy for her son, now 10, that wasn’t covered by insurance, but most families can’t afford that, she said.

The number of people diagnosed with autism spectrum disorder has shot up in recent decades, and the Centers for Disease Control estimates 1 out of 110 children in the United States has the condition.

In Hawaii, the number of students with autism spectrum disorder in the public school system has risen nearly 28 percent since 2006, to 1,298 students age 3 to 21 as of Dec. 1, 2010, according the state Department of Education. That represents less than 1 percent of overall enrollment.

Sherri Henriques choked up as she told legislators of the challenges her family has faced in getting help for her son, who crossed the room to sit beside her when she broke down, leaning his head into her shoulder.

"It has been an extremely difficult journey and has put a burden on our family emotionally and financially," Henriques said. "Most of the cost of various treatments and therapies that our son has received has been paid by my husband and me. We have depleted all of our personal savings, our IRAs. … The great news is that our son, now 8 years old, is doing very well. He is no longer receiving special education services and is excelling in a regular public school classroom."