The Lane County Mental Health Advisory/Local Alcohol and Drug Planning Committee's Developmental Disabilites Sub-committee has sent a letter to the Lane County legislative committee asking them to reverse their opposition to SB 555 (Autism Insurance Mandate) and support it.

SB 555 Adds new definitions and requirements for health insurance coverage of autism spectrum disorders.

The letter was written by sub-committee member Dr. Mario Petersen and does an excellent job of laying out the argument for passage of this bill. Tim Mueller is the Chair of the sub-committee.

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March 29, 2011

Lane County Legislative Committee Members

RE: Autism Health Insurance Reform, House Bill (HB) 2214 & Senate Bill (SB) 555.

As members of the Lane County Mental Health Advisory Committee/Local Alcohol and Drug Planning Committee, we are requesting that the county’s Legislative Committee re-consider the position taken regarding the bills entitled Autism Health Insurance Reform, HB 2214 & SB 555. It is our understanding that the committee voted in opposition to these bills with the concern that these bills would result in an increase in the health insurance premiums for county employees.   In this request, we present a brief introduction to the problem of Autism in our community, followed by a few key points to support our request.

Brief statement of the problem:

Autism is a complex neurologic disorder that results in impairment in communication skills and social interaction.   There is ample evidence showing that this disorder is caused by abnormal brain function. There is no real cure for the basic symptoms.  On the other side, there is ample scientific evidence that some treatments are effective in decreasing or ameliorating some of the symptoms.  Treatment is often refused by health carriers with the argument that Autism is an educational diagnosis.   Alternatively, insurance companies claim that Autism is a mental disorder that is not covered by standard insurance coverage. Or, in spite of an abundance of data proving that intensive behavioral treatments, like Applied Behavior Analysis (ABA),   can be effective, insurance companies do not pay for these treatments with the argument that they are experimental. 

Facts:

1.     Autism prevalence is 1 of every 150 children.

2.     Autism is a lifelong condition, and currently there is no cure.

3.     Autism spectrum disorders include severe forms of autism and milder forms such as Asperger syndrome and Pervasive Developmental Disorder.

4.     Intervention during the first years of life is more effective and has been shown to have significant economic benefits.

5.     There is no single treatment for Autism.  Treatments should be done based on individual needs, and may include behavioral treatments, such as occupational therapy, speech language therapy and alternative communcation systems, and medications.

6.     Intensive behavioral treatments, like Applied Behavior Analysis (ABA), one of the best studied methods, have been proved to be effective in decreasing some of the symptoms, and in some cases achieving normal function.

We are requesting that the county’s Legislative Committee reconsider the decision made previously and give support to HB 2214 & SB 555.

As we understand it, the main argument presented to the Board to vote against supporting these bills was based on the concern that a mandate to the insurance companies to cover treatment for autism was going to result in an increase in the health insurance premiums for the county employees.

We postulate that this analysis is incomplete and additional arguments should be considered.  We strongly encourage the Board of Commissioners to support these bills for the following reasons:

Support makes sense from the economic point of view.  Though it implies an increase in cost during the first few years of life, it saves in the long run.  Jacobson, et al. showed that early intervention, at a cost of $ 33,000 to $50,000 per year, results in a saving of $187,000 to $203,000 per child for ages 3–22 years, and from $656,000 to $1,082,000 per child for ages 3–55 years.[1]  Society is already paying for some of the services to these children, but instead of paying during early childhood when it is more effective, the taxpayers are paying in school services and social security, Medicaid, etc.  

The cost increase per member is about $ 0.66 per month based on experience in South Carolina and Minnesota.  The estimated cost by St. Charles Medical Center in Bend, Oregon is similar (Senate Health Care, Human Services and Rural Health Committee Hearing on 2/16/2011).

Lane County employees will have to pay anyway.   PacificSource, the insurance company that covers Lane County employes, has a court mandate to provide such services.  Therefore, the employees of Lane County would be among the few who pay for a health insurance that covers appropriate services for people with autism.  In fact, PacificSource is supporting these bills.

These bills are not only for Lane County Employees.  Though we understand the economic concern of the Board, it is important to look at the impact of these bills on the whole community of Lane County.  There are hundreds of families and children that will benefit from these bills. The impact of these bills on the families affected by autism disorders should be considered. If these bills do not pass, families with members with autism will have an incentive to change to PacificSource as the only local insurance company that covers these services for people with autism..

It is the right thing to do. Even if the above points were not valid, it is the right thing to do.  Children with autism and related disorders can be a heavy load of work to the families.  Autism often results in families quitting jobs to stay home to take care of their children.  Children with these conditions demand a lot of energy, time and emotional resources from their parents.  As professionals that take care of children with autism we see on a daily basis the frustration of the families who can't get appropriate treatment for their children due to lack of economic resources.  Imagine living in this home (real case seen recently by Dr. Mario Petersen):  “Patient A is a 9 year old boy with autism and intellectual disability.  He comes for a team evaluation.  At home he is engaging in self-stimulating behaviors most of the time; he spits at walls or furniture all the time, to the point that all the furniture in the house is ruined by the constant moisture.  When he wants something he screams.  He often hits and kicks his caretakers.  He can’t be left alone for a minute because he can run away. He eats only a limited amount of foods.  In the clinic he puts his head down and spits constantly on his wheelchair. When he wanted a toy he kicked his mother and spit at the doctor.  Mom states that this is his usual behavior”.  Every specialist would agree that the treatment for this child is intensive behavioral treatment.  The use of medication will not result in a better outcome.

On top of the demands from the care of the child the families have to fight constantly with the health insurance companies.  Many other states have already recognized the need for the insurance companies to cover services for children with autism:[2]

a.     South Carolina, 2008 cover Behavior Therapy until age 15.

b.      Texas, 2007-specific for ABA until age 10.

c.     Indiana, 2001, not by law, Department of Insurance mandates behavior services, treats as any other medical condition.

d.     Arizona, 2009,.

e.     Louisiana, 2009.  Has a cap per year and lifetime for ABA.

f.       Pennsylvania, 2008, has a cap per year.

g.     Minnesota, 2000, not by legislation.  The state sued Blue Cross Blue Shield of Minnesota to provide services for children with autism.

h.     Even private companies like Microsoft, Home Depot and Eli Lilly cover treatment for autism.

Given the reasons presented above we feel strongly that the Lane County Legislative Committee should support these bills.

On behalf of the Mental Health Advisory/Local Alcohol and Drug Planning Committee, I appreciate your consideration of this important issue and look forward to a positive response.

Sincerely,

 Tim Mueller, Vice-chair

 Mario César Petersen, MD

Member of the Developmental Disabilities Sub-Committee,

Associate Professor of Pediatrics

Child Development and Rehabilitation Center.

Oregon Health Science University

Email: petersem@ohsu.edu;  Phone: 541-346-2600, 

901 E . 18 th Ave. Eugene, Oregon 97403