Speaker Dennis O'Brien, shown in this file photo, is the prime sponsor of a bill mandating insurance c...(more)

 

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The state Senate and House approved the legislation in the last two days, with the Senate voting 49-1 Wednesday night.

Gov. Ed Rendell has indicated he will sign it.

That the bill again has the backing of its most prominent supporter — Speaker of the House Dennis O'Brien, the bill's author and uncle to a 21-year-old autistic man — just days after he slammed drastic changes made by a Senate committee is testament to its rollercoaster ride.

"This will confirm Pennsylvania's status as the national leader when it comes to helping families deal with autism by ending discrimination in insurance coverage," O'Brien said in a prepared statement.

The bill has been batted between the House and Senate like a tennis ball for a year, but Senate Republican caucus spokesman Erik Arneson said the conclusion is close.

"Our caucus is pleased to pass what Autism Speaks (a national organization) says is the strongest bill in the nation," he said Wednesday.

Comment from Sen. Don White, the Republican chairman of the Senate Banking & Insurance Committee, where alterations that watered down the bill took place, was not available Wednesday night, but his spokesman, Joe Pittman, said White was "eager to concur" with the new version.

The provisions over autism coverage, though, sparked the most heated debate.

O'Brien introduced the bill in 2007. It would have mandated insurance coverage of all autism treatments up to $36,000. The bill had 82 co-sponsors and was unanimously approved by the state House.

White's committee had the bill for about a year, half of which the Pennsylvania Health Care Cost Containment Council used to study the financial impact of such a mandate on all private insurance customers. The council reported last week the mandate would cost every insurance payer about $1 per month and save the state about $90 million over four years.

The insurance industry, though, argued a mandate would raise the cost of premiums more drastically and argued the better route was for the state to flow more tax money into state programs that helped families afford vital treatments.

The council's report said state programs experienced frequent delays, large staff turnover and missed opportunities to diagnose a child before the crucial age of 5, after which treatment is much more difficult over the course of a lifetime.

Supporters of the mandate, though, said private insurance should be a family's first option and state-administered coverage second, not the other way around as it is today. Insurance companies in Pennsylvania deny some or all autism treatments, particularly those that deal with behavior and social skills, the most obvious symptoms of autism.

Another long-standing argument between the insurance industry and supporters of a mandate both here and in other states involves whether some rehabilitative treatments for autism are medically necessary or meant to help educate a child, services insurance companies wouldn't normally cover.

White's committee last week approved rewritten language that stripped the bill's teeth, allowing insurance companies to determine what is "medically necessary" and what treatments should be denied coverage. The committee also added the cancer and insurance company merger provisions, and the entire Senate passed the bill 49-1 on Sunday.

Pittman said Senate members viewed language in the original version as too broad, unnecessarily burdening insurance companies with covering a wide range of treatments that may not otherwise qualify for coverage.

"Insurers have a definition of what's 'medically necessary' in their plans and policies, and frankly it's best left to them to determine," he said.

O'Brien and other autism advocacy groups immediately derided the Senate version, and the bill's future appeared uncertain. Among the troubles they listed: private insurance could use different definitions of what should be covered compared to state programs, and because many families would use both, this would lead to inconsistencies in coverage for children and financial hardship for parents.

Bill Patton, a spokesman for O'Brien, said the speaker and other legislative leaders hammered out a compromise Tuesday.

From this compromise, the House inserted language that specifically defined what insurance companies must cover, including Applied Behavioral Analysis, long cited as an important tool in treating autism that helps prevent regression.

The House passed the new version Tuesday night 203-0.

E-mail: dpidgeon@lnpnews.com