Virginia Denies Insurance Coverage to Autistic Children
The losers are children with autism. The bill, SB464, was flawed, very flawed. But if you were one of the few it would have helped, it was valuable and a starting point for more coverage. Of course, this is the state where last week a Delegate named Bob Marshall (R) said that disabled children are God's punishment for having had an abortion HERE. Read and comment at WTKR.com.
RICHMOND, Va. - Legislation that would have required many Virginia employee health care plans to cover a treatment for autistic children died Tuesday under business and insurance industry claims that its costs would hurt business.
Sen. Janet Howell's bill was tabled Tuesday on an unrecorded voice vote by a House Commerce and Labor subcommittee.
The defeat ends a 2010 legislative push by families of children with the neurological disorder to secure coverage for a treatment called applied behavior analysis.
"They were lobbied hard by the insurance and business lobbies not to stand up for children and families," said Mark Llobell of Virginia Beach, grandfather of an autistic child and one of several tearful relatives who consoled one another after the vote.
ABA treatments cost $30,000 a year and up. Many middle-class families forced to pay the costs themselves confront financial ruin.
Virginia is among 35 states that do not compel insurers to cover the ABA treatments, which specialists say are the best hope autistic children have for living a normal life.
Howell, D-Fairfax County, presented the subcommittee members with a photo of her grandson, Bode, a child with autism.
"He's in a good place. He's in Arizona, not Virginia," she said, noting that Arizona mandates insurance coverage of the treatment. "Kids in Virginia shouldn't be treated any more shabbily than those in Arizona."
An actuary who studied likely costs of additional mandated coverage for ABA said the expenses would increase by only 0.2 percent.
Some legislators were troubled that the bill mandated coverage for private employee health plans but excluded state employees until 2015, a concession to a $4 billion shortfall looking for the 2011 and 2012 budgets.
Why were state employees ever excluded, asked Del. Sam Nixon, R-Chesterfield.
"Because we're bankrupt," Howell replied. "We don't have the money right now."
Robert N. Bradshaw Jr., a lobbyist for the Virginia Independent Insurance Agents, used that argument to benefit the opponents.
"Frankly, businesses are at the breaking point," Bradshaw said. "If the state can't afford it today, what makes you think small businesses can."
Del. Jeion Ward, D-Hampton, sought to amend the bill to force it to apply to all private insurers as well as state employees beginning in July 2012. Her motion failed, and the panel subsequently killed the bill.
Unreal that this Republican said disabled kids are God's punishment for having an abortion. That is insane. As a Christian Republican, this guy should have his fanny spanked, in public, for being such an idiot.
Posted by: countrygal | April 03, 2010 at 02:45 PM
AHIP has a high dollar govt contract to implement and manage the VSD -- vaccine safety datalink -- it's their in-house equivalent of VAERS. And researchers would love to get access to it but are routinely denied, citing patient confidentiality. It is a closed-loop system. THEY KNOW.
Insurance companies get discounts from drug manufacturers, which is partially how they set their formularies of which drugs are covered at what percentage. I'm sure that if they threatened to drop vaccine coverage, or publish or allow access to data suggesting that vaccines cause disease and disability, the pharma companies would retaliate by ending the prescription drug discounts.
It is easier for the insurance comapnies to ignore/deny a problem exists and put the burden on customers by denying treatments, forcing customers out with high premiums, etc.
Posted by: Garbo | February 25, 2010 at 01:16 PM
As a parent of a child with Autism in the state of VA and as an Educational Advocate for special needs children - The current midset of our legislators in VA is beyond crazy.
I would love to see a vote as to how many Delegates in the House have prescriptions for medications that are not necessary. Answer - probably MANY
How many of them are currently rehabing a family member after a stroke? Probably a few - well people that is all we were asking for. My son, lost all skills at 18 months, they call it Autism - I call it a Stroke but he is denied the quality rehab services that he needs but the Delegates family member who is receiving stoke rehab has the best services in the state - I am sure.
I have families here in the VA that are standing in lines at food banks to feed their kids because they have spent every dime they have to provide the therapies that the children have to have.
STOP INSURANCE DISCRIMINATION AND FREE THE CHILDREN.
Posted by: Amy Trail | February 25, 2010 at 05:49 AM
Your can whine and complain all day along about exexcutive salaries, etc., and that ain't gonna change any time soon, so get over that fact and move on.
My son with his 2 fragile x, autism kids must be lucky, then, to live in Montgomery County, MD., where he receives ABA therapy free and it is subsidized by the County Bd. of Ed. Both kids get speech, occupational and physical therapy on a regular basis through the Infants and Toddler Programs and of course all areas are supplemented with endless private therapies, at an amazing cost because insurance pays little here, as you know. At the beginning of this journey, we were told that people actually move to this area to get services. (I have to add that ABA therapy has caused my grandson to enjoy drastic improvement in his autistic behavior.)
I live in New Mexico. Everything is corrupt here and politicians are always involved in sketchy activities, and there is nothing here to compare to what my grandkids get in the State of Maryland. However, I must say that the culture here keeps matters such as autism close to the vest and there is little, if any,concerted effort by parents here to change things. Sad, on a number of levels.
Posted by: DSO | February 25, 2010 at 04:16 AM
Jenny is on to something if you can get insurance companies to realize that the over-vaccinated child is a cost, perhaps then they will use the statistics to correct the vaccine schedule.
I trully believe that if the insurance incustry comes to the conclusion that vaccines are causing extra visits and care, they will bring an end to this crazy schedule of vaccines. All you need is one to take the lead and the rest will follow.
Maybe in this instance the health insurance industry could become and ally.
Is there any reason that Insurance would want to side with pharma? I wonder?
Posted by: Nora | February 25, 2010 at 12:06 AM
JS, funny you should mention Rheumatoid Arthritis, which is now linked with--drum roll, please--vaccine reaction (see reports at VAERs, espcially regarding Gardasil) and gluten/casein intolerance. Sound familiar, anyone???
Posted by: Taximom5 | February 25, 2010 at 12:00 AM
Okay - so, wow! Let's say I'm crunching numbers at an insurance company. I see that the numbers of autism related medical stuff goes way up after vaccinations. From my "standpoint" vaccinations become a risk indicator for regressive autism, i.e. regressive autism in an off-the-books pre existing condition. If I go public, it's another pre-existing condition public relations nightmare. If I keep quiet publicly, but tell the government and the pharmaceutical companies what I know, I have a really strong negotiating point on both fronts. Hmmm, which way should I go?
So, yeah, it's a lot to overcome from an autism insurance advocacy point. I wonder if, then, it would be easier to start by vying for non-regressive autism coverage and take it from there?
Posted by: Jenny | February 24, 2010 at 11:43 PM
Jenny I think they know these things, after all the executives making millions a year do so because they know how to wheel and deal (in their favor) with human lives. Perhaps that's why our kids cant get coverage.
Posted by: bensmyson | February 24, 2010 at 09:21 PM
Since insurance companies in general, and not just Virginia's, are up for discussion, I have a question I've been curious about this week. I'd enjoy hearing some opinions on this:
I know that everyone is screaming for a true vax/unvax research study. And I'm sure that a very specific one with all the proper controls and all that is what is needed. However, in the meantime, why can't a general comparison be done using information from insurance companies. I'm sure their coding system could easily allow for a patient comparison of vaccinated vs unvaccinated youngsters in regards to something as general as, for instance, do vaccinated kids have more doctors visits than unvaccinated kids. Just because some parents choose not to vaccinate doesn't mean they don't go to doctors. They could easily do age breakdowns, gender breakdowns, # of visits in between vaccinations, so whether there are patterns of increasing doctor visits after each vaccination, or even before and after numbers when vaccines are added to the schedule, ie Hep B, or the rotovirus, or pneum., or when monovalent shots became combined. Am I crazy? I don't think that there is a law prohibiting this kind of generalized information when it is done for the benefit of the public health.
Posted by: Jenny | February 24, 2010 at 07:36 PM
We shouldn't be surprised this didn't pass in VA. Autism Speaks and their traveling mouthpiece once again show that anything Autism Speaks is involved in proves useless for our kids. I really wish these so called A. S. warriors would disappear. A lot more would actually be accomplished!
Posted by: Not surprised | February 24, 2010 at 07:14 PM
I'm just going to close my eyes and make it all go away.
Boy, isn't it easy to kill a bill when it doesn't affect you personally?
I found out 2 months ago that the bill passed in Florida only covers HMO's. Guess what, to get my son's 'other stuff' covered, I had to go with a high deductible to get some of his things covered. Better than dealing with an HMO that constantly denies coverage.
I've got more important things to do than bicker with the damn insurance company all day. My son and I are going to go play on the swings...
Posted by: Kevin | February 24, 2010 at 06:51 PM
The problem is that autism is now being diagnosed in 1% of children born in America. The societal costs are going to be astronomical down the line as these kids age out of the school systems and into lifetime disability. The state and federal governments should be coordinating and using every resource at their disposal, including coverage mandates for ABA, meaningful research into causation and therefore prevention, and research/mandates for other effective biomedical treatments that can lessen and sometimes reverse symptoms. This is not time for "a penny saved is a penny earned." It's time for "a stitch in time saves nine." If people are whining about the costs of ABA today, they really can't see the forest for the trees. The only effective cost shifting is going to happen when the powers that be admit that autism is an iatrogenic problem and the liability is shifted where it belongs -- the pharmaceutical companies and the federal agencies who were supposed to regulate them but didn't. If AHIP is worried about having to pay for autism treatments, maybe they should stop covering vaccines.
Posted by: Garbo | February 24, 2010 at 05:00 PM
Your arguments are garbage. Of course it is "autism" that breaks the camel's back, right? Not any of the other diseases that are covered, right? Who decides that? Why not something like rheumatoid arthritis, which is not fatal? Many of the RA drugs cost on the order of $16,000 per patient per year and are given FOR LIFE. RA is vastly on the rise too by the way.
If we are truly at a breaking point, why is there not a reordering or priorities, such that things like Viagra, IVF and breast reconstruction surgery get thrown off the list? All these "we're broke" arguments are pure bs--insurance companies are only broke when they want to be. As for the insurance industry execs deserving their salaries, sounds like the propoganda floating around capital hill re the banking chiefs--google the work by Matt Taibbi or spend about 5 minutes on The Huffington Post to read all about that.
Posted by: JS | February 24, 2010 at 03:43 PM
Jim, I don't really see myself defending insurance companies, more like pointing out that these mandates aren't free. Insurance companies aren't going to absorb the costs associated with this, or any other mandate (with profit margins in the 5% range, they can't). They will pass the costs on to their customers. Those additional costs will cause some people at the margins to lose their coverage, some of those people may even have kids with autism.
Posted by: Robert Smith | February 24, 2010 at 03:11 PM
Seriously, Robert, I don't get your defense of the Insurance industry. If you spent $20K on biomedical, what do you think was the cause of your son's condition?
Maybe there's no one in a smoke-filled room plotting to screw kids with autism, but have you read the transcripts of the Simpsonwood meeting?
It's all about money and the vaccine/pharm/insurance industry not taking responsibility for their mistakes. Wake up, man, the insurance industry IS screwing YOU and US too!
If the biomedical treatments are helping your son, then the insuance guys have no right to say his condition ISN'T TREATABLE!
Why do you defend this?
Posted by: Jimsomnia | February 24, 2010 at 02:26 PM
"Frankly, businesses are at the breaking point," Bradshaw said. "If the state can't afford it today, what makes you think small businesses can."
This is so sad. What makes these idiots think that the families can afford this?
Also, CyberTiger said "Virginia is intensely democratic..." which is not the case. Virginia, historically, has been a very conservative state and still is, except most of Northern VA.
VA resident, sadly.
Posted by: ObjectiveAutismDad | February 24, 2010 at 01:11 PM
Robert, anyone who doesn't believe that the insurance industry is corrupt, or at least an organized racket, is either on its payroll or has never been a victim of it.
Which one are you?
Witness former CIGNA exec Wendell Potter on Bill Moyers Journal explaining exactly how the insurance profits on wall street while we pay more for less coverage:
Posted by: Jimsomnia | February 24, 2010 at 12:59 PM
I went off when I heard about that guy's comment! I may have issues sir, but my mom never had an abortion and no child is a punishment! What a butthole! Who votes these kind of people in!?!
Here in Missouri the Autism Insurance Bill has gone to be debated once more on the Senate floor. Many families have testified, but the number of lobiests there also carry alot of clout.
I do not know what to expect. I hope for the best and have my groups advocate for the bill to go thorugh. The state can no longer aford to pay for ALL the services for those with autism!
WE ARE BROKE!!! And as more budget cuts are made, the longer the wiating lists become and the less people are able to get services from us. This bill MUST GO THROUGH!! So that needed services can be paid for!
Those with autism need help! The state is in no condition to continue to flip the bill for EVERYONE! Insurance covers everything else, why shouldn't it cover autism services?
Seems to me they would gain more customers through such a means!I do wonder if the President's Health bill goes through how that would affect the bill though.
Posted by: Darian (nickname) | February 24, 2010 at 12:47 PM
"Ben" - I'm not sure it's fair to compare the compensation of the CEO of an insurance company with the President without looking at total compensation. Yes the Blue Cross CEO makes more in salary, the but President lives in the White House, has a pretty sizable discretionary budget for food, entertainment, etc., has unlimited use of a 747 for himself and comparable transportation for his family, etc. He will also have the opportunity to makes millions giving speeches, serving on boards, etc. after he leaves office. Also, nobody forces anybody to take the job. If a candidate feels the salary isn't appropriate to the level of responsibility, he can either choose not the seek the job, or can ask his employers for a raise after he gets it.
That said, I have no idea why the market values people capable of running multi-billion dollar companies, movie stars, or elite athletes in certain sports more highly than it does elite politicians. It just does.
With respect to insurance companies offering coverage for autism, I really don't think the comparison with cancer or heart disease is a fair one. Insurance companies attempt to price risk. Cancer and heart disease rates are fairly stable, the mechanism for getting them and the treatments are well understood. Can the same be said for autism? Twenty years ago the rate of autism was 1 in 10000, now it is approaching 1 in 100 with no sign of abating. We have no idea what is causing it. How do you price that risk? Also, ABA is one treatment for autism, but it isn't the only one (I personally spent nearly $20k last year on bio-medical treatments for my son and that doesn't include the loss of my wife's income when she largely quit her job to manage our son's therapy). Should we also be getting insurance to cover that? How do they price that risk? There's a reason insurance companies don't want to fool with this, and its not because they want to screw kids with autism.
Posted by: Robert Smith | February 24, 2010 at 12:43 PM
Virginia is second only to Texas in the US death penalty stakes,
"In Texas, a death penalty case costs an average of $2.3 million, about three times the cost of imprisoning someone in a single cell at the highest security level for 40 years. (Dallas Morning News, March 8, 1992)."
Virginia is intensely democratic and Virginians have priorities. Go figure!
PS. Cybertiger comes from the UK where the democratic will is weaker but where the people still sponsor futile wars in Afghanistan and Iraq rather than help investigate the causes of autism and its logical treatment.
Posted by: Cybertiger | February 24, 2010 at 11:22 AM
Robert in a fair market economy there would be no mandatory coverage, all insurance companies could ala carte particular coverages for everyone. No heart problems in your family, opt out of heart coverage etc. But it is not that way in the insurance marketplace. I'm certainly not likely to get breast cancer and neither is my son, why have that stuck in there on required coverage when autism is intentionally excluded. You cant have it both ways.
And how pray tell is a CEO of a non-profit worth 4 million a year? You telling me that the Governor of the State or the President of the USA isn't worth that kind of money then? Whether it is taxpayer money or not I find it hard to swallow the reasoning that this dick at BCBS is worth $2,000 an hour when the $200/month we pay for my son's health insurance doesnt cover autism. Remember this policy increase went up over 100% over 4 years offering nothing. $24 a year (1% increase to cover autism) will not break the bank, not when you consider the alternative.
Ya think Aflac might have a supplemental policy for newborns to cover autism someday?
The CEO of Allstate makes 2.92 million. http://www.forbes.com/lists/2009/12/best-boss-09_CEO-Compensation-Insurance_9Rank.html
Of course the head of Aetna makes 38.12 million http://www.forbes.com/lists/2009/12/best-boss-09_CEO-Compensation-Health-Care-Equipment-Services_9Rank.html
Posted by: bensmyson | February 24, 2010 at 11:09 AM
Amber, as far as I can make out from the article you cited, the 5 largest for profit health insurance companies made $12.2B in profits on $232B in sales. In other words, their profit margin is about 5.25%. That doesn't seem like a terribly high profit margin, far below what I would expect from a "corrupt" organization.
Bensmyson, the number of people who have the skill set to successfully run a multi-billion dollar company is extremely limited. As such, the market sets their compensation pretty high. If you are among that extremely rare set of people who, in addition to having the required skill set, are willing to work for significantly below-market wages, I would suggest you give Blue Cross-Blue Shield NC a call.
Regarding the study you cite, even if we accept that the cost of the mandate is only 1%, it is still going to price some people at the margins out of the health insurance market. Something else you fail to consider, is that autism coverage would be one additional mandate on top of dozens of current and future mandates. All those 1%s add up pretty rapidly and serve to price even more people at the margins out of the market.
Again, the mandate is not eliminating costs, it is only shifting them to other people. I think a more honest way of handling would be to have the states fund autism therapy directly and raise taxes to fund it rather than forcing private entities to provide products that they don't feel in their interest to do.
Posted by: Robert Smith | February 24, 2010 at 09:47 AM
I live in Virginia and not surprised by this. My son who is now 11 would not have been covered by this but I still supported it for families with younger children. We stopped doing ABA 5 years ago because of the costs and we are still paying the bills that went well into 6 figures. We figured out long ago that we are on our own. Interesting that my insurance will pay for DMPS but not ABA. The only thing good about Virginia is that they don't bother me about vaccine waivers.
Posted by: Maggie | February 24, 2010 at 09:26 AM
Actually the costs according to an October 2007 Autism Speaks report, http://docs.google.com/viewer?a=v&q=cache:p1mY-ARrnxcJ:dhhs.nv.gov/autism/TaskForce/2008/ATF_Report_08/Appendix%2520E.pdf+cost+to+include+autism+insurance&hl=en&gl=us&pid=bl&srcid=ADGEESjJwAkvnc8DVdFUx13CXzsTUYpj8bnrmmtJL26eDsb6O_qd8WEGFUfCX3iLtwhe-s-LIQ0mcnWX2BUd18w41e05SV35NdjP9FTKV2O1g3yI7kyt58A5HVXRNxG8GgqUHDaIKdot&sig=AHIEtbR4_pfL-REG-00ugQ_tx0k3g8en-g
Earlier this year (2007), The Council for Affordable Health Insurance, a research and advocacy association of insurance carriers, released its annual report on state health insurance mandates, Health Insurance Mandates in the States 2007. The report defined a mandate as “a requirement that an insurance company or health plan cover (or offer coverage for) common – but sometimes not so common – health care providers, benefits and patient populations.” Using this definition, the report identified legislative mandates for autism benefits in ten states: Colorado, Delaware, Georgia, Iowa, Indiana (which, as we have noted, provides comprehensive benefits), Kentucky, Maryland, New Jersey, New York, and Tennessee. The report assessed the incremental cost of state mandated benefits for autism in these ten states as less than one percent.
Posted by: bensmyson | February 24, 2010 at 08:56 AM
North Carolina doesnt require insurance companies to cover anything related to autism. We have been able to squeeze about $1,200 out of Blue Cross Blue Shield for some therapy but that's after a $500 deductible and of course a monthly payment of over $220.
If I remember correctly one group showed where including autism into the coverage increased all premiums about 30 cents per month per person covered. Two years ago Ben's insurance was $100/month, in two years it has more than doubled.
Blue Cross in NC is a not for profit, $186 million last year in profit, $209 million in 2007. The top six executives at Blue Cross each made more than $1 million last year, topped by Chief Executive Bob Greczyn at close to $4 million ($2,000 an hour). Greczyn's annual income included a $3 million bonus and was a 23 percent increase over 2007. Other top executives also saw sizable bumps in their 2008 incomes. Chief Operating Officer James Wilson, for example, got a 32 percent raise, while Chief Financial Officer Daniel Glaser's compensation rose by 21 percent and Chief Sales and Marketing Officer John Roos' income went up 20 percent. Remember now this is pay bumps during the worst economic climate in 80 years.
In addition to its annual profit, Blue Cross has a $1.3 billion reserve account.
Posted by: bensmyson | February 24, 2010 at 08:46 AM
Sadly, the health insurance industry is corrupt. Record breaking profits, but they can't afford autism.
Posted by: Amber | February 24, 2010 at 08:44 AM
This is the second time that the autism insurance mandate has failed in Virginia. It failed last year as well. While this is very discouraging, parents are not giving up.
Posted by: Carolyn M | February 24, 2010 at 08:43 AM
Oklahoma is just the same, you should have seen the foul deeds associated with Nick's Law. http://nickslawok.blogspot.com/
We have fought so hard .... and still nothing...
Posted by: casey | February 24, 2010 at 08:27 AM
My dad always counseled, "Insure against a catastrophe not an inconvenience." If your child needs ABA, you're dealing with a catastrophe.
Posted by: Holly M. | February 24, 2010 at 07:56 AM
Barring a major change in circumstances, I am going to refuse any further vaccinations for my children until the government and/or the insurance companies step up to the plate and pay for treatments needed for the injuries they cause (and no, I don't consider the vaccine compensation fund a sufficient remedy - takes too long and seems deaf to the reports of parents).
At my house it has boiled down to a simple formula: No liability + no meaningful coverage for injury treatments = no further vax.
That is my opinion based on what I believe is best for my chilren. Other parents have to do what they believe is best.
God help our society.
Posted by: Parent | February 24, 2010 at 07:41 AM
Sadly, the industry is right, the proposal would hurt business, and it would hurt consumers too. Mandates cost money and the companies, many of which are non-profit, can't absorb the costs. They will have to raise rates to cover them, which could force some at the margins to drop their coverage. That's not to say that Va. shouldn't impose the mandate, only to point out that all they'd really be doing is shifting costs from one group of people to another group.
Full disclosure: The public school system pays for my son's ABA, which I fully understand impacts local property tax rates.
Posted by: Robert Smith | February 24, 2010 at 07:28 AM