Pennsylvania May Require Insurers to Pay for Autism Treatment
Legislation proposed by the Philadelphia Republican has drawn fire from the Pennsylvania Chamber of Business and Industry, which argues it would be the most expensive health insurance mandate in state history.Governor Rendell of Pennsylvania supports the bill, but of course many business owners object strongly. In a sense, this bill could become a slippery slope for many types of treatments not now covered under typical insurance. Given the incredible costs of healthcare insurance, such concerns are understandable.The bill passed in the House by a vote of 194-0. It isn't expected to be considered in the Senate until fall.
It's also tough to imagine any bill that would cover the costs of the many alternative treatments now favored by families coping with autism. Could or would such a bill cover, for example, biomedical treatment? Play therapy? As-yet-unproven therapies such as hyperbaric oxygen? These are the types of treatments which are not covered by Medicaid or offered through the schools - and they're unlikely to be covered by any new legislation.
Do you support the idea of health insurance covering the costs of autism treatment? If so, which treatments would you want covered? Are you concerned that there might be a backlash from employers concerned about the rising costs of healthcare?
Comments
I have worked with Dennis O’Brien on this bill, in addition to several of my colleagues, for several years. IT’S ABOUT TIME!!!!!!!!!!!!!!!!!!!!!!
We’re tired of being discriminated against, we’re tired of the insurance lobby, and most of all, we’re tired of being denied insurance from an insurance company that has a $1 billion surplus!
THANK YOU SPEAKER O’BRIEN!!!!!!!!!
AutismLink
Where I live you can choose what your healthcare plann covers:I always have the most expensive,and so far I benefit from it big time:could not affort all the treatments I had so far.But I live in Holland and all is different here.Kids are insured free of charge on their parents insurance.And the law says:you have to be insured,at least the minimal things are covered then.There are no non insured people here.
I hope that that bill passes:high time.
This reeks like discimination.
Again in our country against the law:no one gets excluded:insurance companies cannot refuse anyone.Even people with the most costly diseases.
High time your system changes.Spend the money that goes to wars on healthcare.
Have a great day.
Biomedical treatments, especially lab testing, compounded nutritional supplements for kids with restricted diets, and chelation when testing indicates it is warranted.
HBOT, assistive communication devices and speech, physical and occupational therapy.
Play & social skills development & sensory integration therapy.
Pay for what works, intensively, as young as possible. Save billions on drugs that don’t and lifetime care facilities.
Expensive? Not in comparison to doing nothing. It’s the only way out of the economic nightmare these untreated kids are bringing to the future of us all.
I have supported passage of this legislation for years. The article you quoted did not spell out is what the bill covers, nor did it adequately address the PA’s insurance industry. To see the bill, go to http://www.legis.state.pa.us/cfdocs/billinfo/billinfo.cfm?syear=2007&sind=0&body=H&type=B&BN=1150
HB1150 will pay for traditional medical treatments such as OT, PT, Speech but will cover behavioral therapies such as ABA. The benefit will be capped at $36,000 per year. (South Carolina recently passed a similar law that caps benefit at $50,000 per year.) Treatments that are as-yet-not scientifically proven will not be covered. There is no way to get legislation passed for treatments that have not been scientifically peer reviewed and researched.
HB1150 is designed to improve the lives of children with ASD. In PA, the only system that funds services is Medical Assistance through the Department of Public Welfare – a socialized medicine approach that is not working. The system does not meet children’s needs nor does it pay enough to draw a sufficient number of behavioral health providers to PA.
The PA Chamber of Business has strongly come out against HB1150. Here is PA, we have an extremely predatory insurance industry. Everyone’s premiums have been skyrocketing and the cost of insurance is crippling to business. The difference is PA’s premiums appear to be higher. Why? Medical underwriting. They allow insurance companies to come in, collect extensive health histories (not just ages and sex), and quote prices based on the employees health history.
The PA Chamber is fighting something that they perceive will raise costs but they aren’t fighting the very thing that is crippling their members – medical underwriting.
The cost of HB1150 to policyholders will be nominal. It is estimated (based on insurance coverage provided in other states) at less than 1%. That is approximately $40-$50 per YEAR.
That is not an excessive amount considering the pricetag for not meeting a generation of children’s needs.
I agree with your first writer, thank you Speaker O’Brien! This is an idea that’s time has come!
The state of Texas just passed a similar compromise insurance bill that would cover children up to age five. This effort was met by great resistance by the business lobby. I am glad that there appears to be some relief on the way in recognizing autism as a medical condition, and that the appropriate measures are now being enacted to provide some insurance assistance.
The Federal Medicaid law for children (known as EPSDT, an acronym for Early, Periodic, Screening, Diagnostic, and Treatment Services) already mandates PA Medicaid (and all other state Medicaid agencies) should be covering anything “necessary to correct or ameliorate” autism–or any other condition. See http://caselaw.findlaw.com/casecode/uscodes/42/chapters/7/subchapters/xix/sections/section_1396d.html. Off-label Hyperbaric Oxygen Therapy (HBOT) is quite effective for autism, and there are already a number of references in the medical literature. At the same time, HBOT should already be covered by PA Medicaid, since PA Medicaid has already paid for HBOT for another brain-injured child. This was not an accident or an anomaly as the coverage was mandated by a court decision. A copy of the court decision can be downloaded from http://groups.yahoo.com/group/medicaidforhbot/files/ .
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While I agree with the spirit of the bill and think that therapies and costs for children who have signficant needs such as sensory, behavioral, communication, social and other, it is equitible to push for that only for those children with a specific disability label. All children with the same, similar or greater needs should have thier needs met for the same reasons. Children don’t need to be stereotyped and put into categorical box with labels, they should been seen as individuals and their needs should be met based ob what they need as an individual and not by labels.
Bravo and thank you for finally realizing that autism spectrum disorder is a neurological disorder and not a developmental disorder. The difference in the wording is what the insurance companies thrive on to avoid treatments necessary for those with autism. We need to see the whole picture and not just through rose colored glasses. In the long run, as a society, we can have the necessary treatments for this condition and avoid long term disabilities. This issue is mainly about who is going to foot the bill, and it seems that the insurance companies doesn’t want to be responsible. This smells of discrimination. Thank you.