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Autism bill put on hold

House panel wants time to study fiscal impact

by Jake Stump

Daily Mail Capitol Reporter

A bill that would have forced health insurance companies to provide coverage for autism has been downgraded to a study resolution, upsetting autism advocates and a state lawmaker who championed the measure.

Delegate Ralph Rodighiero, D-Logan, blames lobbyists and the insurance industry for basically killing the bill, and criticized some lawmakers for not aggressively supporting it. Opponents of the bill claimed the legislation would have hiked insurance premiums for all subscribers and called autism research and treatment inconclusive.

"The insurance lobbyists got a hold of it and were more concerned about protecting their big money profits than helping the kids of West Virginia," said Rodighiero, who has a 15-year-old son, Dominic, who is autistic. "A resolution is a way of getting out of what they should be doing for children with autism. It's a buyout."

Unless a person receives Medicare or another form of government-funded health care, families of autistic people are usually stuck with paying for medical costs out of their own pockets. That's why Rodighiero strongly pushed for the bill, which would have required insurance companies to provide coverage for the detection and treatment of autism.

At least 10 states, including Maryland, Kentucky and South Carolina, already have such laws on the books.

The bill made it to the House Finance Committee, where members hesitated to approve it because they needed more time to detect the fiscal impact and particulars of the measure.

Instead, the committee requested that a joint committee on government and finance study existing autism services in the state and determine what additional services and funds are needed. The committee's findings will be presented at next year's legislative session.

House Finance Committee Chairman Harry Keith White, D-Mingo, said his committee

received the bill too late in the session to give it proper consideration.

"We didn't have any fiscal note or fiscal impact on it," White said. "So we had to get fiscal notes from PEIA to see what it would cost them. For the first three years, it ranged up to $28 million.

"It was so much information in a short period of time. The best thing we could do was let all parties present their case during interims."

White added, "It's a big social issue. Only some of the private insurers are paying for it now. Even at that, you could max out on lifetime awards pretty easy."

Autism is a complex brain disorder that hinders a person's communication skills and ability to develop social relationships. Autistic people can also show signs of repetitive or obsessive-compulsive behaviors.

The cause and any potential cures remain unknown.

Several groups have cited that over the course of a lifetime, it costs $3 million to care for an autistic person. The advocacy group Autism Speaks reports it can cost families in upwards of $50,000 a year.

Delegate Rodighiero said the state also ends up hurting in the long-term because it has to pay for services for autistic people. By requiring private insurers to offer coverage and detecting autism early, that would save the state money, Rodighiero said.

"In the long term, the state is setting itself up to take care of these children for the rest of their lives," he said. "Not to mention the financial situation put on the families' end. Several families are going in debt because they're borrowing money they don't have to get services for their children. They're jeopardizing their homes and everything they work for. Again, the state of West Virginia is last in stepping up to help families and their kids."

Mark Polen, president of the Arnold Agency, which lobbies for Mountain State Blue Cross Blue Shield, explained the complexities of the bill and the projected costs of implementation.

"The estimates for the original bill were difficult to compile given the open-ended nature of the treatment that would have been available - particularly out of state and experimental treatment," Polen said.

Mountain State's actuary projected a minimum annual cost of $50,000 per patient under the proposed bill. But Polen said the actuary expected that figure could be much higher.

"Costs of this magnitude would be very difficult for the small group health insurance market to absorb generally, but especially if a small employer group experienced a case," he said.

Polen recommended that existing services in the state, such as the Autism Training Center at Marshall University, receive a dramatic boost in funding to help families struggling with autism.

"The diagnosis and treatment protocols associated with autism must become much clearer than they appear to be today before the health insurance system can become a true part of the solution these families need," Polen said.

Rodighiero said he wouldn't give up, and plans to push the measure again next year.

"We've got to get on this early intervention," he said.