It's time for Medical Insurance Companies in Oregon to cover Autism Treatment

Autism Health Insurance Reform: Update from Senate Hearing on SB555 2/28/11

Thank you again to everyone who came down to the February 28, 2011 Oregon Senate Hearing on Autism Health Insurance Reform, SB555.  The hearing was definitely interesting in many ways.

You can find a link to an audio recording of the hearing and copies of the exhibits on the Senate Health Care, Human Services and Rural Health Policy Committee web-page at:

The hearing primarily featured invited testimony from the Insurance Industry.  Three insurance industry representatives came to testify in person: Dr. Steve Marks of PacificSource; John Powell, apparently of Regence; and the medical director from Providence.  Kaiser also submitted written testimony, and had met with Chair Monnes Anderson in advance.

Insurance Industry Testimony:

  • PacificSource announced its’ SUPPORT AND ENDORSEMENT FOR SB555!  They freely acknowledged that they had lost a major court case (McHenry v. PacificSource) over this issue, and said that they were ready to do their part.  They did say that that had some ideas for improvement in several areas, but made it clear that they were supporting the bill.  This wasn’t a complete surprise:  PacificSource is now at a competitive disadvantage, in that they are now much more vulnerable to additional litigation than their competitors.

(Side note:  over the last few months, I’ve heard many people – especially in the insurance industry — dismiss the significance of the McHenry v. PacificSource case as a one-off case applying to just one child on one policy for one insurance company; today’s endorsement by PacificSource makes it clear that they fully understand the significance of what the McHenry’s have accomplished).

  • John Powell, a lobbyist for Regence, raised a number of concerns about the cost of the bill, but rambled in his testimony and didn’t provide any hard data.  Many of the “facts” that he presented weren’t entirely accurate, either.  For instance, he said that Blue Cross of Minnesota was “voluntarily” providing autism coverage; actually, they “voluntarily” paid an $8.2 million penalty and signed a consent decree to provide unlimited autism coverage after the state Attorney General sued them for illegally denying mental health coverage in 2001.
  • Providence was also poorly prepared for the meeting.  They announced their opposition to the mandate, and promised to provide actuarial data to show how expensive it would be at some point in the future, but didn’t have it available yet.  They also suggested that the state of Oregon create a new task force or autism commission to investigate issues around insurance coverage.  They suggested that this was an important issue, that should be examined thoroughly, for a long time – i.e., after this legislative session is finished.

This last request – about creating an autism commission – caught the attention of our sponsor, Sen. Edwards, who was monitoring the hearing by video from another room.  In the best scene of the day, he ran down to the hearing room to testify and pointed out that, actually, we’ve ALREADY HAD AN OFFICIAL STATE AUTISM COMMISSION FOR THE LAST TWO YEARS and that PROVIDENCE AND ALL OTHER MAJOR INSURERS WERE REPEATEDLY INVITED TO PARTICIPATE TO TALK ABOUT INSURANCE ISSUES AND REPEATEDLY REFUSED.

  • Sen. Monnes Anderson summarized Kaiser’s written testimony; they argued that we should wait until we know what the Affordable Care Act (national health reform) will provide for autism coverage – i.e., wait until the 2013 legislative session.  They also argued that increasing costs will make more employers switch from state regulated insurance to unregulated self-funded plans [fact of the day:  currently, only 8.7% of Oregonians receive their insurance from an unregulated self-funded plan, vs. the 39.4% who are in regulated plans; the remainder are either uninsured (17.3%), or on Medicare (12.7%) or Medicaid (16.1%)]

Our Testimony:

Several members of the autism community were also allowed to testify at the end of the hearing – despite the fact that we’d been told in advance that testimony would be by invitation only.

For my testimony, I presented an Actuarial Cost Estimate from Autism Speaks, and my own cost-benefit analysis.  After the insurance industry representatives rambled and complained about cost without providing any specifics, delivering a detailed written analysis of the projected costs that was clearly supported by references kept the initiative on our side.

Debate within the Committee:

The debate within the five Senators on the committee was also very informative.

  • Sen. Shields and Sen. Bates are clearly supporting us, and made a number of comments that were helpful.
  • Sen. Monnes Anderson, the Chair, wants to have the bill sponsors meet with the insurance industry to see what we can do to “improve” the bill.
  • Sen. Kruse is uncertain about the boundary between medical and educational interventions, and wants to make sure that we’re not asking insurance companies to do what the public schools should be doing through special education.
  • Sen. Morse didn’t ask many questions, but did listen attentively.  Off-line, he has indicated that he hasn’t made up his mind, but is receptive to our concerns.

Next Steps:

We have a tight deadline:  the committee must finish its’ work and at least schedule a vote by April 2, 2011, or our bill is dead for this session.

I believe that we will have some discussions with representatives of the insurance industry – including Kaiser, PacificSource, and Providence – to talk about ways of addressing their concerns.  I will work with Sen. Edwards on planning and strategy for those meetings.  Presumably, we will have another hearing in a few weeks, hopefully leading to a vote to move forward to the Ways and Means committee to manage the budget issue.

I will be certain to keep you informed about progress.

Things you can do in the interim:

  • If you are in PEBB or OEBB – insurance plans for state employees and educators – we need your help to ensure that the PEBB and OEBB boards understand how important these benefits are.  If you are represented by a union, please contact your union representative and ask for their support, and please keep me informed.  Similarly, if you know anyone with a dependent with autism who works for PEBB or OEBB, please get them involved.



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