October 30, 2014

Americans for Prosperity gets it wrong on the autism bill

As a new parent, you quickly start to view a lot of everyday things in a different way.  Every time my son gets a cold, or heads off to daycare (my wife and I call it “school” to assuage our consciences) I feel a little pang of worry – it’s natural to want to protect your kids and take care of them.  So far, we’ve been lucky, and my son is a healthy, happy and vibrant young boy.  But not everyone is that lucky.  One of my closest friends from college has an autistic child and he and his wife work very hard and make sacrifices I can’t even imagine in order to care for their kids.  Autism is a disorder that is frequently misunderstood and is rarely covered by health insurance, leaving parents with the stark choice of going broke paying for special schools and programs designed to help autistic kids or taking the chance with public systems that are simply ill equipped to deal with those special needs students.  The parents of children with autism have been working these issues hard with the General Assembly, and their hard work paid off this session with a bill introduced in both the House and Senate that would require health insurance companies to cover autism.

Loudoun Delegate Tag Greason and Fairfax Delegate Tim Hugo patroned HB 2467,  which has garnered the support of a number of senior members in the House of Delegates, including Speaker Bill Howell.  And while this bill has bipartisan support, it has also drawn the fire of Americans for Prosperity, one of the leading conservative economic public policy organizations.  I am good friends with their national Executive Vice President and General Counsel.  Normally, I agree with their positions, but on this bill, they’ve got it wrong.

Ben Marchi, the Virginia State Director of AFP, has sent out at least one blast email criticizing the bill, and a recorded robo-call of his has gone out to AFP’s 80,000 members in Virginia, according to the Washington Post. The bill, in their eyes, is yet another government expansion and bad for small businesses  and taxpayers.  I don’t buy it and neither should you.

Marchi’s criticism is shallow and cynically political.  He tries to tie the autism bill with Obamacare, arguing that the bill is “telling private companies what services they must offer. Sound familiar? Remember our fight against Obamacare?”  Yes, I do remember the fight against Obamacare, and the issue there was completely different than the issue here.  We fought against the federal government requiring individuals to buy health insurance – an act that two courts have found unconstitutional.  Those courts found the mandate unconstitutional because Congress doesn’t have the authority to mandate individuals buy health insurance.

This bill isn’t a mandate on individuals. It is a mandate on insurance providers – companies whose existence is only made possible by the Commonwealth.  There is nothing in the Virginia Constitution that forbids the General Assembly from mandating coverage for insurance provides who seek to do business in the state.  The Commonwealth’s General Assembly can do a lot of things that the Federal Congress cannot do – and requiring coverage types is one of those things.  The Commonwealth, under VA Code § 38.2-3519, already requires minimum levels that insurance carriers must provide if they want to do business in the Commonwealth.  The health insurance business is already one of the most heavily regulated of any industry – and it should be – in the state.  I don’t know how adding autism to the list of covered illnesses is somehow so beyond the pale that AFP would try to equate this bill with Obamacare.  They’re not even in the same ballpark.  So when Marichi says “[t]here is little difference in Speaker Howell authoring a bill that gives state government the authority to dictate to private companies what services they must offer and the monstrosity of ObamaCare,” he is – at best – not being intellectually honest.  There’s a huge difference, and AFP can’t be so obtuse as to not recognize it.

Marchi adds a throwaway line that I found personally distasteful – “Autism is a very personal and emotional thing for families to deal with – but not every tragic situation deserves a new government mandate.”  Okay, Ben – which tragic situation does deserve a new government mandate?  All these parents want is for their child’s illness to be treated like any other illness.  A child with autism is no less tragic than a child with diabetes, or a child with cerebral palsy, both of which are diseases that are generally covered by health insurance.  Why should autistic kids be treated any differently than other special needs kids?  There’s no good reason, and trying to turn this argument into some kind of nanny-state bash is ignorant.

Marichi goes on to say “Unfortunately, some politicians in Richmond have tried to highjack this issue for political gain, while at the same time placing unfair mandates on small businesses and taxpayers.”  This isn’t fair, and Ben should know it.  The families of autistic kids have been fighting long and hard to get Richmond to pay any attention to their problems – grassroots lobbying and the amount of hard work that groups like the Virginia Autism Project – and they’ve finally been successful.  I don’t consider that to be a “highjack for political gain” – I consider that to be a victory for the democratic process, where regular people were able to persuade their legislator to support a bill that they want to see enacted.

AFP complains about some of the specific provisions of the bill, which they argue run afoul of federal mental health care parity laws.  If that’s the case, then I strongly urge the Speaker and the General Assembly to lift those caps and treat autism like any other illness in kids.  If the caps are the problem, lift the caps.  That would make this a better bill and if you’re going to have your erstwhile friends attack you for doing the right thing, might as well go all out.

If there’s a better way to convince these insurance companies to cover autism like any other disease, I’m all ears.  If AFP has a better plan, let’s hear it.

As I said, Americans for Prosperity has done a lot of good work over the last two election cycles, and their efforts to stop Obamacare deserve a lot of credit. But they’re just plain wrong here, and I hope that their membership takes a good hard look at this legislation before making a knee-jerk decision to oppose it.  There are too many families in Virginia impacted by autism and unable to get the care they need for their kids – this is one of those situations where government needs to step in.  There’s nothing unconstitutional about it.

Ben Marchi himself just became a new father – it’s unfortunate that he and those on the staff of the Virginia AFP can’t find the empathy to recognize that this issue goes beyond politics and has a real effect on Virginia families.  There is no reason why autism should be treated differently than any other medical or mental illness. That’s all these parents want. And I think it’s not too much to ask. Delegates Greason and Hugo and Speaker Howell deserve praise, not criticism, for leading the charge on this issue.

Comments

  1. pgreer says:

    It is funny how health insurance companies will covera crap like bariatric surgery, but not autism.

  2. Cucci Mane says:

    The nonsense coming from AFP regarding the autism bill is one of the many reasons why I used to be a life-long Democrat before becoming a Republican. When right-wing, Republican groups talk incessantly in knee-jerk fashion about keeping your own money without ever taking a proactive stance on alleviating suffering in the world, it gives off the impression that they are greedy and just don’t care about anyone else. We have billionaires and people who live in abject poverty living in this nation. Clearly, wealth is not “trickling down” the way it should and we need to address this issue. I stop listening when a Republican explains in simplistic terms that poor people “just need to work harder.”

  3. Parents faced with long term pervasive needs that need extreme care often must place their children into the foster program or risk going bankrupt. (And going bankrupt may mean there is no extra money after that parent dies to help with care beyond what the state offers.) This scenario is in NO ONE’s best interests, regardless of party.

  4. Loudoun Patriot says:

    Tag Greason, Bob Marshall and Jill Vogel have done a lot to move this legislation forward. I commend them for their efforts and fully support it! Tim P, you know I luv you guys, but this was a bad move for AFP.

  5. Let's Be Free says:

    The solution is not to come up with another set of government mandates.

    Every child is a precious individual.

    The best thing that can be done for autistic kids (or any other label applied) is to overturn the SOL and No Child Left Behind testing regime and the teach to the test and lock-step performance tyranny and mindset those regimes create. Eliminating the top down big-government, so-called compassionate conservative dictates would relieve most of the destructive pressure that government and modern society places on parents of the children who have the biggest challenges.

    Johnny and Jane don’t have to keep up with everyone else. I’ve seen plenty of special need Johnny and Janes develop into happy, healthy productive adults when love guided them along their own personal path rather than programs, policies and performance dictates.

  6. What Cucci mane has described above is EXACTLY what was done to George Bush by his own folks. He had enough “selective” issue misinformation by dems….without getting slapped by the far right.
    Sure, we all want to keep most of our money…but it is also our duty to protect those who cannot protect themselves.
    I do not, and never will advocate for those that WILL NOT help themselves….so our far-right friends can put a sock in it , right away.

    Bush dedicated Billions to addressing the AIDs problem in Africa. Going further, he ended Malaria outbreaks there that cost and additional Million deaths annually.
    He championed Medicare issues that reduced the fraud seen in that program, and attempted to fix Social Security back in 2007.(where is that today?? Oh, yeah….around 20 years closer to being broke that it was then)
    And at every turn, the far-right was taking equal potshots at the man….sharing theat duty with the far-left.

  7. LBF, autism is not a learning disorder. It’s a mental, medical illness. It needs to be treated like an illness, and it should be covered by health insurance.

    The best thing for autistic children is to make it possible for their families to get them the care they need – the same kind of care they could get if their kid had diabetes, cerebral palsy or schizophrenia. That’s all they want.

  8. Quite a few of the autistic students that I know personally from my son’s school score very high on the SOL tests. I know of at least two who regularly score perfects in math.

    This doesn’t mean that they can communicate with their peers, or write a legible paragraph, or stand in line orderly for a drink of water.

  9. Let's Be Free says:

    Well, I couldn’t write a legible paragraph probably until I was in 7th or 8th grade, am unlikely to stand in line orderly for a drink of water to this day, and still am frequently befuddled by my peers.

    No known medication relieves autism’s core symptoms of social and communication impairments. Basically, the medical therapy that is out there today is drugging the kid into passivity (mostly he’s) with little to no long term understanding of the impact of life-long drug use.

  10. LBF, no known medication can cure a stroke, remove cancer permanently from someone, or cure diabetes. That doesn’t mean insurance shouldn’t cover it.

  11. Most autism therapies involve things that look more like rehabilitation: working with speech therapists, occupational therapists, personal development counselors, etc. These are medically recognized therapies that provide long term advantages, especially when begun early and sustained. If a person suffered a stroke, we don’t think twice about paying for these services. Why is autism any different?

    I know of no autistic students who are drugged into passivity. Many take no medication whatsoever.

  12. Let's Be Free says:

    I am sorry for actually having some real experience and beliefs in this era of experts, where every expert and their lobbyists/professinal association says the sun will shine and birds will sing, if only more of my services are bought.

    The speech therapists (even I in the dark ages recall getting speech therapy in grade school) and OT’s I’ve known have overwhelmingly in number worked for public school systems. Kids should get what they need in the schools and for the most part they can.

    If parents want to pay for more out of their own pockets, or by buying some sort of prepaid package plan (which is what health insurance has become, calling it insurance any more is a misnomer) they should feel free to pay. In my experience, the best treatment for kids in difficult straits like this is a ton of time with and attention from their parents. That’s not the sort of think that can be regulated or contracted out.

  13. LBF — I’m sorry that you’re real experiences and beliefs have left you with such a cynical view.

  14. Squiddy says:

    LBF, I can’t help but think you’re confusing autism with ADHD …

    Anyone, I’m sure this isn’t “perfect” – but I’m happy to see something move forward, and not waiting for that “perfect” legislation – not covering autism under medical insurance just seems like bad-faith.

    I’ve long supported AFP – but that over-the-top email they sent will certainly give me pause about doing so in the future.

  15. G.Stone says:

    With all due respect to those of you supporting this bill you are missing the bigger picture here. Mandates such as this coupled with layers of regulations are killing small business in America. This bill however well intentioned is just one more cost that will add to the already excessive burden. It is the totality of these individual burdens that when bundled together become too much to bare. When these burdens are tallied, it is often jobs that are sacrificed. We did not get the current state of affairs over night.

    I don’t have a problem with the Obama analogy or comparison. Republicans and Conservatives have been taking the Obama administration to task for the mother of all mandates and then turn around and support this legislation which is a mandate whether you want to call it one or not. It is a government regulation that adds COSTS ! Call it whatever you want it will get added to the Cost of Goods Sold on every balance sheet from every company forced to participate.

  16. G.Stone, these mandates don’t affect small business – they don’t affect companies with fewer than 50 employees.

    States can mandate things. The federal government can’t. That’s why I oppose the mandates. The two situations are not analogous in my book. You never get to ask the question of whether the mandates at the federal level are a good idea because they’re unconstitutional to begin with.

    If you want to argue mandates are a bad idea, go for it, but the analogies to Obamacare are specious.

  17. G.Stone says:

    Brian
    I was pretty broad for a reason. It is a cost to the company no matter what the size. I submit a company with 100 employees IS a small business. I have owned a few small companies and base my opposition to this on the fact that the aggregate total of all of these good ideas ends up being a cost and compliance drain. Companies with fewer than 50 employees are just the really small of the small. Hanging your hat on a specific number of employees in order to justify yet another mandate does not cut it. The problem is many who advocate for these new regulations see them in a vacuum and not as another cost stacked upon many others that when first presented had just as many advocates claiming they too were worth the sacrifice and acceptance. They then march on after the signing ceremony leaving only the owners and shareholders to deal with the real world effects. That being a cumulative crushing burden on operations, expansion, hiring, capitol and profits.

  18. Brian Schoeneman says:

    Which is more important? The cost to a company, or a child getting the care he needs to be able to function on his own and be a contributing citizen?

    The cost is worth it.

  19. Loudoun Lady says:

    What happens when insurance companies decide that providing VA businesses with health care policies is costing too much because of this mandate? Or the state mandate starts attracting families with children with autism to VA, raising rates for everyone? These are at least plausible scenarios and pretty much what G. Stone is talking about – the unintended consequences of the layering of mandates and regulations to the point where certain companies won’t do business here – or the ones that do have to jack up their rates on everyone they cover.

    I know families with children that have autism – and my heart goes out to them. I don’t have the answer to their needs, but I also don’t have an answer for a sick child or adult that maxes out on their limits on a healthcare policy due to a catastrophic accident or long-term illness.

    I don’t think it is as simple as saying the cost is worth the outcome.

  20. Brian nailed this one. It is State vs. the Federal Government. State is okay. Feds are simply unconstitutional.

  21. Loudoun Lady says:

    I am not arguing if the state can legislate on this matter, it is an argument of whether it is good legislation.

  22. G.Stone says:

    “The cost is worth it.”

    What happens when this cost added to all the other costs ( many of which were enacted by those who thought their cost was worth it )keep a business from being started , force a business out of the market or relocate to another local. Jobs go bye bye. When jobs go bye bye so does the insurance tied to those jobs. So then you have to ask yourself again, Is the
    Cost(s) worth it ?

    What is that old saying ? The road to hell is paved with good intentions.Or maybe the road to burdensome regulation is paved with good intentions ?

  23. LL, the cost of this program is simply going to be passed on to the rest of us through higher premiums, as every other mandate has done. The estimates are that your premium will go up 40 cents. Virginia is #6 on the list for the largest number of health insurance mandates and we remain the top state in the union in which to do business. This mandate won’t affect that rating.

    All these families want is for their child’s illness to be treated the same way as other illnesses. The insurance companies are cynically trying to say that autism isn’t a legitimate illness in order to get out of coverage. That’s why it’s necessary for the state to step in. Otherwise, you know I wouldn’t be arguing in favor of another mandate.

    There are few times when mandates are acceptable, in my opinion, and a breakdown in the market is one of them.

    G.Stone, this mandate isn’t going to stop a business from being started, especially considering – as I’ve already noted – it doesn’t apply to companies with fewer than 50 employees. Most of them don’t offer health insurance anyway and they shouldn’t be required to.

    There’s no slippery slope here. If there were, it would have happened before this mandate came through – like when the state mandated acupuncture therapy be covered. If that didn’t kill off small business, this won’t either.

  24. Loudoun Lady says:

    Well Brian (said in my best Reagan imitation), we all know estimates for costs – particularly from a government entity are always on target. Further, I find it troubling that we are number 6 for the number of mandates, is this a race to stay there?

    At some point, perhaps now, these mandates have an adverse effect on insurance companies. You don’t know whether this specific mandate will or won’t be “the one” that is too much, goes to far, or otherwise keeps insurance carriers from providing coverage in VA, or raises premiums more than the estimates. You make the estimates sound as certain as “the sun will rise tomorrow” – it’s not.

    It is mindset of “just one more” that I have a problem with.

  25. My mindset isn’t really “just one more.” It’s more, if there are going to be any kinds of mandates, this is one that should be there.

    Yes, these are estimates. Even if they are wrong, the underlying policy – ensuring that autistic kids can get the treatment they need without bankrupting their families while allowing them to be treated like kids with any other chronic illness – is the right policy.

    Even if all the worst case scenarios come true, I still think that policy choice trumps them.

  26. Loudoun Lady says:

    “is the right policy.”

    Your opinion Brian, mine is different. Knowing a couple families with Autistic kids, and having had some very in depth conversations on therapy and treatment – privately and within the LCPS system – I am sure this will be a welcome mandate. It still doesn’t convince me it is right.

    Further, this is a topic wrought with emotion and political liability if it is NOT passed. Need I remind everyone of how Tom Rust was beat over the head with this very issue when he has been behind this type of legislation for years? The question “why do you hate the children?” has been played by Stevens Miller already.

    I don’t hate autistic children, but I also don’t think layering state regulations and aiming for 5th place in overall healthcare mandates is a good thing.

  27. What do you think is the right answer then, LL?

  28. Loudoun Lady says:

    I already admitted I don’t have the answer, but that doesn’t mean I can endorse something that feels right but is – in principle – wrong.

  29. G.Stone says:

    Brian

    I have tried and failed to get through. You keep bringing up the numbers of employees and based on some of your assumptions you have never owned, operated or financed a business small , medium or large. I have made the point a number of times it is the aggregate of all of these regulations that strangle business. They operate a margins that do not allow for this constant barrage of costs brought on through mandates and regulation. Having operated a small business from 1989 until just last year I speak from experience. Look at the massive number of small business failures in tha last 3 years. they were operating right on the edge and all it took was an economic downturn and they are gone. Further, small companies are far more dynamic in their structure , make up and operation than your assumptions or those of lawmakers in Richmond or washington. This is one of the problems, to many operational assumptions by those who have little or no experience.

  30. G. Stone, you’d be wrong. I ran my own small business for almost two years. I know what it’s like to operate on a shoe string.

    I understand your point about the aggregate. My point is not about the aggregate. It’s about this specific situation.

    Your point is valid, as is LL’s point on the general principle. But again, we’re not talking about principles or potentials or aggregates. We’re talking about a specific issue that is affecting families right now. I have yet to hear any alternatives that solve this problem without requiring a mandate. I get the feeling that if they existed, we’d all be talking about them.

    We all have principles and one of mine is limited government. Another of mine is helping people who can’t help themselves in a way that doesn’t require a government handout. That’s what this does – government mandates autism is covered by insurance. Kids can get the treatment they need to grow up and become contributing members of society. If they don’t, chances are they’ll end up on some kind of government assistance – either when their parents are gone or their parents end up bankrupting themselves to cover their care. In the end, the cost is too high for those families – especially considering the only arguments you guys can come up against this are aggregates and principles.

    There’s a time when public policy preferences have to give way to real life. This is one of those times.

  31. Ray Nelson says:

    As the parent of a child with autism and an advocate who has emailed, written, called and visited the GA about this issue, I can safely say this is the lowest cost autism insurance mandate in the country. South Carolina passed a law several years ago and estimated costs to the state employee health care plan at nearly $9 million. After having the law in place for several years the true costs reported are below $900,000.

    The mandate issue is another case of equating federal powers with commonwealth powers. The fed doesn’t have the right to tell us to buy insurance. However, the commonwealth has the right to mandate coverage in the insurance industry. It does this to protect the buying public. If you pay for insurance, you should get what you are promised. If insurance companies purport to cover medical conditions, they should be required to cover them no matter what the name of the condition.

    As a former insurance agent, I know how difficult the regulatory agencies can be. Agents and companies are both licensed and rates are vetted and approved by the commonwealth prior to their release. However, every insurance company deals with them on a regular basis, and this mandate is one of many. I’m curious as to why AFP isn’t trying to get all the mandates repealed, including the ones that force coverage of mammograms or prostate screenings?

    The reason is that those are medical conditions and, as such, should be covered by a health insurance policy. Autism is a medical condition, not an educational one. It is diagnosed by a neurologist, psychiatrist or developmental pediatrician. Our schools do not and should not employ those personnel. Therapy for people on the spectrum includes speech therapy, occupational therapy and behavior therapies like ABA. However, the school is only legally responsible for addressing how those therapies affect the education of our kids. That means the important stuff, the habilitative therapies and pragmatic speech work, often are overlooked.

    The real queston of cost is long term. A study released by Dr. Michael Ganz of Harvard estimated lifetime societal costs for a person with autism at $3.2 million. Multiply that by an incidence rate of 1 per 110 children and it adds up quickly. The cost of not doing this will bankrupt our country faster than any insurance mandate.

    However, if you treat these kids early with good therapy the outcomes are more positive. Many folks on the spectrum grow up and hold jobs, found companies and design software. They contribute to society and the economy. By investing in these kids, we are investing in our own future.

    Isn’t that what being American is all about?

  32. Loudoun Lady says:

    Therein lies the problem Brian, government at all levels trying to mandate specific problems for specific families. Given the complexity of the insurance industry, to include necessary real reform – such as portability across state lines (that might take a bite out of being 6th in the Country in insurance mandates) I can’t come up with an insurance solution. Further, just because those in opposition can’t come up with a solution to a specific problem doesn’t mean the one solution on the table should be adopted.

    Mr Nelson, Thank you for you contribution here. Coverage or not, there is plenty people can do to support families with children with autism – and I look at our friends that are families like yours and count them as a blessing in our lives.

  33. Nancy says:

    It is so nice to hear such compassion and understanding from someone who doesn’t have a child with autism. I hope this compassion grows and flourishes! Thank you!

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