Legislators working for autism coverage without mandates

Published: Tuesday, Feb. 7 2012 9:14 p.m. MST

The Utah State Capitol Building, January 25, 2011.

Tom Smart, Deseret News

Enlarge photo»

SALT LAKE CITY — Legislative leaders say they're trying to work out a compromise between a bill to mandate health insurance coverage for autism, and another bill that seeks to discourage any insurance mandates in Utah.

That compromise likely will not be similar to laws now in effect in 29 other states that do require health insurance plans to pay for treatment for autism spectrum disorders, said Utah House Majority Whip Greg Hughes, R-Draper.

While details of that plan have yet to be worked out, he said, it would likely involve a fund to which health care insurers would make voluntary contributions to help families pay for their children's treatment, Hughes said.

Noting that he's personally spoken with many parents who have had to mortgage their homes or sell cars and other valuables to get their children the help they need, Hughes said: "We will do something. We can't step away from that."

HB69, which is sponsored by Rep. Ronda Menlove, R-Garfield, would require autism, Asperger's and similar disorders first diagnosed in childhood to be covered just as most other medical conditions.

While SB138 — sponsored Sen. Todd Weiler, R-Woods Cross — does not directly oppose HB69, it is an effort to keep insurance coverage mandate proposals from going forward, Weiler said. His proposal would require the state to pay for any increased costs that insurance mandates might bring to Utah public education employees.

Some autism advocates, such as Mirella Petersen of the Utah Autism Coalition, have argued that SB138 would increase the cost estimate, or fiscal note, for HB69, making it less likely to pass.

Weiler responded: "If the costs (resulting from HB69) are low, then the fiscal note bill be low. They can't have it both ways."

The Office of the Legislative Fiscal Analyst put the cost of HB69 to just state and public education employees at $8.8 million. It estimated that amount could cover around 208 children.

University of Utah autism researcher Judy Zimmerman recently concluded a study showing about 1 in 77 8-year-olds in Utah has been diagnosed with an autism spectrum disorder.

Those figures don't include costs to private insurers. SelectHealth, the insurance division of Intermountain Healthcare, has made only rough estimates, spokesman Spencer Sutherland said.

"This has the potential of costing tens of millions of dollars a year, and possibly hundreds of millions of dollars a year," Spencer said. "It results in higher premiums for all of our members."

Autismspeaks.org, an advocacy group, which has been pushing HB69-style legislation nationwide, has estimated increased premium costs in other states — per person per year — at around $20 to $30.

Around 15 bills that propose different insurance mandates are now before legislators, Weiler said. It's important to put the brakes on some of them, he said, because in 2014 federal health care reform will make all state mandates permanent.

Hughes and Menlove said an alternative bill being worked out would address issues that a mandate does not.

For one, even if it went into effect, HB69 would only cover only about a third of Utahns — those covered by small to medium group policies, Menlove said.

The law would not affect another third of Utahns, who are under larger group plans that are federally regulated, she said, or those covered by Medicaid or CHIP.

Hughes hopes the compromise can "find a more global solution." Voluntary contributions from both state and federally regulated insurers would go into a fund to help families pay for treatment, he said. In addition, the compromise would include a pilot program within PEHP, the Public Employees Health Program, to state and public education employees, Hughes added.

Email: lbrubaker@desnews.com

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