Clock ticking for autism mandate

Bill passed by Pa. House but stalled in Senate

Intelligencer Journal

Published: Jun 24, 2008
00:47 EST

By DAVE PIDGEON, Staff

The words spill out of Tim Haun's mouth so quickly about his favorite movie, "Monty Python and the Holy Grail," that they're hard to distinguish — a sign of the zealousness the 14-year-old harbors for a memorable scene.

Tousled brown hair, lanky arms waving emphatically, dressed in layered red and black shirts like a typical teenager, the bespectacled Tim can barely stay in his chair at the kitchen table.

"I like the part where, where they, where they go, where they throw all the animals out," Tim said. "That's hilarious, and I thought it really was particularly hilarious when he goes, when they say, when they say, 'French?! What are you doing in England?!' "

Tim's excitement about the 1970s-era British comedy tempers at least for a moment the struggle his family goes through to provide him with adequate care.

Tim has a form of autism, a chronic brain disorder that interferes with his ability to communicate and understand others. And the family's insurance denies coverage for much of the extensive behavioral therapy he needs just to try to function normally in school and at home.

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The Haun family's predicament lies at the center of a legislative struggle in Harrisburg about whether private insurance should be required to cover autism treatments, as it is in 13 other states.

Speaker of the House Dennis M. O'Brien, a Philadelphia-area Republican whose 21-year-old nephew is autistic, sponsored a bill to mandate private insurance coverage of autism services. The legislation received unanimous support in the state House last year but has languished in a Senate committee for about 11 months.

Currently, major providers in Pennsylvania deny coverage for critical treatments like speech therapy and applied behavioral analysis. They say such treatments lack measurable achievements over time.

Insurers say a state mandate would increase insurance costs for every customer, even those without autistic children, by as much as 6 percent and cause budget problems for businesses that employ 50 or fewer people.

Plus, insurers point to the state Department of Public Welfare, which provides treatments for autism through several programs.

"Pennsylvania has a uniquely good and qualified comprehensive program open to all children regardless of economic status or health coverage," said Sam Marshall, executive director of the Insurance Federation of Pennsylvania. Marshall said more attention should be paid to shoring up the state's autism programs rather than passing costs on to the average Pennsylvania insurance customer.

"We want to strike a fair balance to make sure kids with autism are getting care and treatment that improves their lives and (that) health insurance remains available and affordable as possible," he said.

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However, a recent report commissioned by the Pennsylvania Health Care Cost Containment Council, obtained by the Intelligencer Journal but not yet released to the public, says the state's autism programs do not "provide complete coverage." The report, largely critical of the insurance industry for failing to provide adequate information for review, says the state's program is hampered by frequent delays, large staff turnover, the small number of providers who accept the state's reimbursement and a need to frequently recertify providers.

The report also concludes that the average monthly impact on insurance customers should an autism insurance mandate become law would be only $1 per month, far less than the 6 percent increase projected by the insurance industry.

"Insurance companies are all for finding money for autism as long as the government pays for it," O'Brien said during an interview in his Harrisburg office. "Well, you know what? I think the insurance companies have to be held accountable.

"It's discriminatory of the first order," he said, calling it "a violation of the civil rights" of families with autistic children.

The report also says "lack of (the mandate) clearly leads to delays in diagnosis," a critical factor in treating autism, O'Brien said, because patients diagnosed after age 5 have a harder time responding to therapy.

Pressure is on O'Brien to get the legislation passed. He ascended to House Speaker in 2007 with the help of the slim Democratic majority in the state House, and conventional wisdom in Harrisburg says that when the current legislative session ends this year, either the Democrats, with an increased majority, will elevate one of their own to the speaker's chair or a new Republican majority will oust someone many see as a turncoat.

O'Brien could very well return to his former status as a rank-and-file lawmaker, giving him far less leverage to bring about a mandate.

"If it's not done now, there's little chance it will get done," O'Brien said. "This is the right thing to do."

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The bill puts a ceiling of $36,000 on insurance coverage, with the state's Medical Assistance program covering any expenses above the cap. The bill also would require the state to devise a more structured way to make sure providers are qualified experts.

Despite passing by a 194-0 vote in the House in July, the bill has sat for nearly a year in the Senate Banking & Insurance Committee, which is chaired by a former insurance broker, state Sen. Don White, whose campaign has received thousands of dollars in donations from insurance lobbyists.

While White was not available for comment, his spokesman, Joe Pittman, said last week that White's ties to the insurance industry have nothing to do with the length of time the bill has sat in committee.

Pittman said a dozen proposed health care mandates are before the Legislature and that White has pushed for the Health Care Cost Containment Council to review House Bill 1150 before the committee makes a decision.

"We are very conscious of the fact we need to be aware of the financial impact any health insurance mandate will have," Pittman said. "We're interested in trying to make sure whatever we do is in the best interest for children with autism while keeping the cost of health care down."

Pittman said Monday his office still hasn't seen the council's report.

If House Bill 1150 isn't passed by the time the Legislature and the governor finish writing the state budget — the deadline is June 30 — it will be nearly impossible for it to become law because the Senate has announced it won't convene for a lame-duck session after the November election.

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Meanwhile, the Hauns anxiously await word on the bill. While they have insurance provided by the national United Church of Christ — Tim's father, the Rev. Jim Haun, is a pastor at Zion UCC in Strasburg Township — their policy doesn't cover autism therapy. Neither do other insurance providers available to them in the state.

The only way the Hauns were able to get financial assistance for Tim's behavioral therapy was to have his primary diagnosis changed from autism to another condition he has: attention deficit hyperactivity disorder.

Despite Tim's problems, Kay Haun holds out hope the 14-year-old can grow up to be a productive adult — something behavior therapy can go a long way to helping him achieve.

"My hope for Tim is I want him to find some emotional stability so he can go out and get a job," she said.

Intelligencer Journal staff writer Stephanie Weaver contributed to this article.

E-mail: dpidgeon@lnpnews.com