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Friday, October 7, 2011

Different Positions on the California Mandate

Patrick Johnston, president and CEO of the California Association of Health Plans, writes at Capitol Weekly in opposition to the California mandate bill:

SB 946 would increase pressure on the State’s General Fund; increase health premiums by hundreds of millions of dollars; exempt public health insurance programs and the millions of children they cover; and, by shifting the responsibility of educational services onto health plans, would set a costly new precedent.

Our current budget situation is proof that taking benefits away from the public is much harder than giving them new ones. Yet this bill mandates providing non-medical services for autism in July of 2012, which would end if the benefit isn’t part of the “essential health benefits” that will be included in policies sold to individuals, families or small businesses under the new federal health care law.

Under federal law, the cost of any additional benefits required by state law above and beyond “essential health benefits” must be borne by the states. Once these benefits are terminated, the pressure to restore those benefits would be great and THE STATE would have to absorb the cost for this mandate.

Another massive flaw in SB 946 is the exemption for public health plans from covering the same services for autism that private plans are required to cover. This carve-out means that California will require benefits for children of means while millions of low-income children will not have them. If carving out Medi-Cal, CALPERS and Healthy Families is too expensive for the State to cover, how is that cost any less dramatic for a private sector that is also facing budget struggles?

The California Association of Health Plans recently released a report projecting the cost of treating autism in California. Our estimates indicate that covering educational, non-medical services nears $850 million a year.

Today, Capitol Weekly carries a response from Peter Bell, executive vice president for programs and services at Autism Speaks.

Mr. Johnston’s assertion was accompanied by the same inflated cost analysis health insurance lobbyists have floated without success in Sacramento and 27 other state capitols that have required health care plans to stop discriminating against families dealing with children with autism and cover ABA treatment. Rather than estimates, we have real-life experience over several years in states that have enacted autism insurance reform showing that the impact on premiums is consistently well under 1 percent, or less than the cost of a cup of Starbucks per person per month.

ABA provides a level of early intervention for children diagnosed with autism that starts before they enter school and that has been scientifically proven to improve their functioning and help them achieve independence in the future. In the process, the need down the road for taxpayer-funded special education and social services declines. An independent analysis by the California Health Benefits Review Program estimated the initial savings for California taxpayers at almost $140 million, money that could help offset education and other critical services that are being cut.

The nation's largest autism science and advocacy organization, Autism Speaks, worked with Governor Brown’s administration and Senate President Pro Tem Darrell Steinberg to help craft SB 946, which awaits Gov. Brown’s signature. SB 946 provides a much-needed solution for families and California taxpayers, while shielding insurers from unreasonable financial exposure.