Autism bills would reform insurance laws

"Want to work for jumps, little lady?" asks Mikaela Egan, a teacher at Richmond's Faison School for Autism.

Margot Flowers, a 4-year-old from Chesterfield County, eagerly bobs her blond head in approval. She then breezes through a series of exercises, choosing the correct color rubber duck from several options before Egan switches things up on her.

"What state do you live in?" she asks. After brief deliberation, Margot offers, "Virginia!" Elated, she's rewarded with a lift above Egan's head, smiling ear-to-ear.

Soon, Margot's parents, who have paid about $70,000 for the treatment of two children with autism in the past four years, might too be rewarded for choosing Virginia.

For years, efforts at the General Assembly to mandate coverage for the diagnosis and treatment of childhood autism have fallen short. This year looks to be different — if Gov. Bob McDonnell signs it into law in the face of opposition by influential business groups.

House Bill 2467, co-sponsored by Dels. Thomas A. "Tag" Greason, R-Loudoun, and Timothy D. Hugo, R-Fairfax, would require coverage of autistic children ages 2 to 6, the so-called "sweet spot" for effective treatment.

On Monday the state Senate advanced its version of the legislation, Senate Bill 1062, sponsored by Sen. Janet D. Howell, D-Fairfax, to final passage today.

The legislation, which would cap annual costs at $35,000, passed the House on Wednesday, earning a rare round of applause from a gallery full of families who have been fighting for the change for more than a decade.

"In one way, shape or form, these bills go back to 2000," said John W. Maloney, a Henrico County autism advocate whose 15-year-old son struggles with the condition. "This legislation opens a door that has been closed forever."

The law would not apply to self-insured companies and would exempt small businesses with 50 employees or fewer, but it would cover state employees. A price guarantee would allow companies to opt out if the cost of coverage exceeds the premium by 1 percent.

While similar bills have died in committee in recent years, the legislation cleared the House with the support of Speaker of the House William J. Howell, R-Stafford.

Previous efforts would have covered all developmental disabilities, broader age ranges and failed to cap coverage. They also would have exempted that state's insurance plan, which Greason called "somewhat hypocritical."

"In the last three years, we've sharpened the focus and been very specific," Maloney said, adding that the law would be "the weakest autism mandate in the country."

Howell said the measure earned his blessing this year as a "much slimmer version that doesn't have the same fiscal impact that previous versions had."

But not everyone's satisfied. Opponents, including the National Federation of Independent Business, the Virginia Chamber of Commerce and tea-party groups, say the law would be another costly health-care mandate on Virginia businesses and taxpayers.

And one of the bill's opponents, Del. Jackson H. Miller, R-Manassas, has asked Attorney General Ken Cuccinelli to determine if federal law allows the legislature to cap insurance coverage at $35,000.

At Greason's request, the House Appropriations Committee has proposed spending $1 million to cover the cost to the state, which a study by the legislature's watchdog agency, the Joint Legislative Audit and Review Commission, estimated at between $590,000 and $820,000 annually.

Americans for Prosperity, a conservative group with 80,000 members in Virginia, began making automated calls Jan. 31 opposing the bill.

"We're not selectively targeting this bill because of what it covers, we're targeting it because it's a mandate," said AFP State Director Ben Marchi. "At a time when Virginia families are cutting from their own budgets, the last thing we need to do is saddle them with increased health-care costs."

Marchi expressed bitter disappointment in Howell for his support of the bill, saying he had proved that "what liberal Democrats can't accomplish on their own, he will happily help them with."

"Frankly, I think the Republican caucus needs to look for new leadership," Marchi said.

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Proponents argue that the cost to employers will be minimal and the benefits tremendous.

Autism Speaks, a national advocacy group, estimates that the cost to employers will be less than $1 a month for each family of autistic children based on similar legislation in South Carolina.

Kathy Matthews, executive director of education at The Faison School for Autism in Richmond, said the change would represent a "huge step forward for Virginia."

Nationally, autism is the fastest-growing developmental disability, affecting roughly one in 100 children, according to the Centers for Disease Control and Prevention. Children often begin to exhibit warning signs such as avoiding eye contact, trouble eating properly and trouble focusing around the age of 2.

"At the moment they get their diagnosis, they're already significantly behind developmentally," Matthews said. "It's so critical to get treatment early on so you don't lose any more time with those kids."

But quality treatment doesn't come cheap.

Matthews, who said students need between 30 to 40 hours of treatment a week, said her after-school behavioral programs cost about $30 an hour. Other more intensive therapy and parent training can range between $50 to $110 an hour.

While localities and school systems offer some assistance, most families have to pay significant amounts of money each year for applied behavioral analysis, the most effective way to treat autism.

Under the proposed legislation, that type of treatment cannot be denied by insurers if it is prescribed.

That would have been welcome relief to Tammy Kane of Louisa County, whose 5-year-old son, Michael, has been attending Faison for years.

She started sending Michael to Faison over the summers at a cost of about $10,000 a summer and saw such progress that they decided he needed to be there full time.

Now, he's improving rapidly, but at a cost of about $100,000 a year.

"We decided early on when we realized that there was really no financial help from anywhere that we'd do everything short of losing our house," said Kane. "And that's what we did. We cut down to the bare bones."

They're not alone.

In December, Virginia school divisions reported 11,705 students with autism, up from about 10,000 the year before. About, 1,830 of those students are between the ages of 2 to 6, but many other young autistic children are not accounted for in those numbers.

Greason estimates that the legislation would benefit between 200 to 300 families across Virginia in the first year alone and encourage more treatment providers to set up shop across the state.

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Nationwide, 23 states have enacted autism insurance laws similar to the one being considered in Virginia.

Autism legislation is being pursued in 25 other states, and only three — Oklahoma, Utah and Wyoming — have not pursued any form of insurance coverage.

In New York last year, then-Gov. David Paterson vetoed a bill that would have covered people of all ages with autism, which received unanimous support from the state's legislature. Paterson cited an estimated $70 million per year in additional costs to taxpayers, including higher health-care premiums, but autism advocates disputed that figure.

Howell said his support was due, in part, to the success and cost of similar but more expansive legislation in South Carolina three years ago.

Then-Gov. Mark Sanford vetoed the legislation, but the legislature overrode that decision.

"That was the governor that used to go hiking on the Appalachian Trail?" said Howell, alluding to Sanford's extramarital affair, which Sanford initially tried to veil by claiming he was hiking.

"I think we've got a better relationship with our governor," said Howell. "I think he'll be fine with it. He may make some amendments or tweaks, but I think we'll be OK."

Asked whether McDonnell might veto the legislation here, spokesman Tucker Martin would only say that should the legislation pass, "the governor will review it at that time."

Regardless, the bill passed the House by beyond a two-thirds majority, meaning the General Assembly could override a veto.

Maloney is cautiously optimistic.

"Our chief concern now is the governor," he said. "Any attempt to dilute the bill at this point would be a tremendous slap in the face of the families who have worked so hard."

whester@timesdispatch.com

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