HappyChucks   For Families Navigating the Autism Waters

Last month I wrote about the Arizona Autism Insurance Bill (Steven's Law) passing the Senate's Health & Appropriations Committee by unanimous vote. Last week the bill passed the House, and this week the Senate followed suit. All that remains is for the governor to sign the bill into law, and we will have insurance coverage for everyone on the autism spectrum – cue the trumpets and the ticker-tape parade to start the party. Well, maybe it's not quite that easy...

Since this looks like it's destined to become a reality, I wanted to talk about some of the positive effects we'll see from Steven's Law, as well as some possible unintended consequences. These thoughts aren't in any particular order – more of a stream of consciousness writing.

Full disclosure: I'm a free-market capitalist, with an undergrad degree in finance and a master's degree in business administration. I left a job with a Fortune 500 company to go into business for myself, where my family's well being depends 100% on my ability to provide recognized value in an industry where many are seen as commodities (one no different from another.) The point is I don't generally agree with government regulation of private business, unless not doing so would cause the public great harm.

Who's covered? People who work for companies with more than 50 employees. Unfortunately Arizona has a very high rate of self employed and small businesses; these people will not be covered.

How many people will be affected? I don't know... How many people in Arizona with children on the autism spectrum work for larger companies? It has to be a fairly significant number, otherwise the law would be virtually useless. But how many actually – 2,500 families? 10,000? 25,000? The larger the number, the more effect it will have on some of my other points.

Earlier diagnoses. We all know how important early diagnosis is, and this law will help facilitate earlier diagnosis and intervention for many families.

Long-term decrease in the State's burden. More kids getting more treatment, and higher quality treatment, at earlier ages, should lead to higher-functioning adults, on average & in theory. Whether these adults are mainstreamed into the productive fabric of society or they still need help with daily living skills (and everywhere in between), a higher functioning population will require less state-provided care over the 60+ years of our kids' adult lives.

Increased Insurance Rates for all. How many families did we say would be covered by insurance mandated through the new law – 2,500 or more? (pulled completely out of thin air – I don't have any supporting documentation.) If each family receives $25,000 per year in benefits, that means the insurance companies are going to pay out $62,500,000 per year! (2,500 families * $25,000 each). This isn't money they were able to plan for by running profitability studies or devising new programs; it's money the government simply mandated they pay out. They are going to seek to recapture some of this lost money, and the best way they have to do that is to have everybody share the pain – higher rates all the way around.

This actually becomes an indirect tax, as the State reduces their financial exposure via DDD by passing the burden to the insurance companies, who then pass the hat to all their policy holders. In effect, everyone with health insurance in Arizona is going to subsidize this program a little bit. It's not really any different from simply increasing the sales tax by a sliver of a percentage point.

Supply & Demand of Therapists. (follow me on this one.)

More people having access to therapy will increase the demand for therapy, which could cause a shortage of therapists, leaving some families without services at all.

The shortage in therapists will allow the providers to raise their rates; some of the increased revenues will be shared with the therapists in the form of higher wages. This will attract more, and higher quality, therapists to Arizona. Some will move from other states, while others will seek out this major in school.

If the inflow of new therapists happens too quickly, it could lead to an oversupply of therapists. This could lead to a class system, where the high-end providers charge the most money and have the highest quality therapists (and serve the wealthy and the large-company-insured families), while the lower quality therapists work at providers who accept DDD payment and serve the less fortunate and less-insured families.

Eventually the insurance companies and DDD will come together to create a price list of allowable charges, which they hope will even the playing field. Even then, however, there wouldn't be a great incentive for the good therapists to leave the high profile clinics to go work in the lower quality clinics. In this scenario, it would take a very long time to self-correct.

This is a quick list off the top of my head; I'm sure there are other costs and benefits we haven't yet touched on. I'll update this list as I think of things worth sharing, and I' love to hear your thoughts as well - feel free to comment below...

Last week, in the first of 3 cases to go to trial, federal health officials concluded that childhood vaccines contributed to symptoms of autism in a 9-year old Georgia girl (as reported by the Atlanta Journal Constitution.)

The details from the court case are not yet completely available, but the result is. The U.S. Department of Health and Human Services has concluded that the family of Hannah Poling, of Athens, GA, is entitled to compensation from a federal vaccine injury fund. The amount of compensation is still being determined.

Obviously, this is going to add fuel to the vaccination debate fire. It's going to get even hotter when we look at the week's events in total. Let's take a look at how the week unfolded.

1. Senator, and Republican front-runner for the presidential nomination, John McCain was quoted as saying "there's strong evidence" that thimerosal is responsible for the increased number of diagnoses. This brings up a wave of federal spin following Senator McCain's comments.

2. The Center for Disease Control and Prevention, the American Academy of Pediatrics, the American Medical Association, the Food and Drug Administration, and the Immunization Safety Review Committee all stated that no scientific evidence points to a link between the two.

3. The associate director of the American Council on Science and Health expressed disappointment that McCain seemed to be poorly briefed on the issue. "I would hope that, as president, he would have advisers who would get it right. I attribute this to a misstep rather than policy."

4. The program director of the Arizona Partnership for Immunization says "...It doesn't surprise me that someone would not completely understand what the science is indicating." The group advises parents to discuss any vaccination concerns with their pediatricians (and we already know what the American Academy of Pediatrics says. – emphasis mine.)

5. The U.S. Department of Health and Human Services concluded that a family is entitled to compensation due to a vaccine's contribution to a girl's autism diagnoses.

Hmmmm. I wonder what Senator McCain really knew...

I'll stand by my article from last month – there are more questions than answers on this topic, and anyone who accepts the vaccination schedule as 100% safe across the board, dismissing any and all correlation between vaccines and autism, is probably earning a living from an organization who espouses that view.

We had some exciting news last week, as the Arizona Autism Insurance Bill (officially known as SB1263, and commonly called Steven's Law) passed through the Health & Appropriations Committee by unanimous vote. This was no due to the large support shown by our local parents, friends and families, who turned up en masse to the candlelight vigil and to the committee hearings at the capitol. My guess is that the large support for the bill helped the committee to realize the long-term benefit of getting more children more therapy, and at an earlier age.

The bill has yet to be passed into law, but the unanimous vote is a good sign.

Here are some additional facts, articles, and opinions (mine), in no particular order..

Highlights – beginning January 1, 2009, insurance companies will be required to cover Speech, OT, PT, ABA (behavioral therapy), Diagnosis, and Psychiatric/Psychological care.

AZCentral.com's coverage. Here's an article describing what went down last week.

State Senate. Here's a link to the bill's fact sheet from the State Senate's web site.

Loophole – Large Employers Only. This bill will mandate coverage for group plans for employers with more than 50 employees. That's a terrific start, but Arizona's economy is driven by small businesses – there will be a very large number of families who are unaffected by this bill. (mine included. As a self-employed Realtor, I don't currently have a group plan for more than 50 people.)

Restricted Coverage. It's great to see coverage for the basics (speech, ot, pt, aba), but some of Calvin's biggest gains have come from the 'non-traditional' providers: Neurologic Music Therapy Services of Arizona has been our rock – Calvin's most important hour each week since he was 2 years old; dieticians & allergists, biomedical, vitamin supplements, and homeopathic remedies will also not be covered.

Overall this is a gigantic win for both the ASD community and the State of Arizona. I do hope, however, that over time the coverage is expanded to include more families and more treatments. I also think we're going to see a change in the supply & demand equilibrium when this goes into effect next year, with some short term pain but long term benefits, but that's a topic for another post...

I expect this to be a worthwhile event. Similar bills have been proposed in other states, and have passed in some – so the legislatures out there are listening.  And the list of co-sponsors is extensive, which means the word will get out.  I'm crossing my fingers for a big turnout... 

Have you heard about the Autism Insurance Bill being proposed in the Arizona State Legislature? If not, then listen up – this has the potential to be an extremely important piece of legislation.. Maybe even life-changing for many families.

I can speak from experience on this one. When I left my job at a Fortune 500 company to go into business for myself, health insurance was one of the most challenging pieces to put into place. We wanted to include Calvin on our family insurance plan, and we were willing to pay for his premium. "Heck, we thought, why should the State be required to pay for his doctor's visits?"

Well, we eventually found one company who would insure Calvin on our plan, but with an exclusion rider so that any care which could conceivably be connected to autism would NOT be covered. We were out of options, so we accepted. However, when the dust settled and we actually had a policy in place, they had excluded Calvin entirely! So the State of Arizona has been providing his health insurance coverage ever since – not by choice, but by necessity.

This law will not only require insurance companies to provide coverage for "non-autism" treatments, it will also give some help for the very real, very necessary, and sometimes very expensive treatments and therapies we've come to rely on to improve the quality of Calvin's (and our family's) life.

Please visit http://www.azautisminsurance.org to learn more about it, or to find the contact information for your district's senator and representatives.