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

Autism Health Insurance Reform: Action Alert – Stop HB2342A – Waives ALL Health Insurance Consumer Rights

Contents:

  • Stop HB2342A – Waives ALL Health Insurance Consumer Rights
  • Update on our Legislation for 2017
  • Sample message in opposition to HB2342A

ACTION: Stop HB2342A – Waives ALL Health Insurance Consumer Rights

The Oregon legislature has just introduced a bill granting the Director of the Department of Consumer and Business Services (DCBS) – who oversees the Insurance Division –emergency powers to override any and all Oregon laws governing health insurance, in order to protect the insurance industry from the risks of President Trump’s proposed American Health Care Act (AHCA). Rules issued under this extraordinary act can be issued on an emergency basis without prior notice or public comment for up to 6 months.

This could include limiting or eliminating coverage of treatment for autism or any other expensive condition.

We’re all concerned about what final form the “American Health Care Act” will take, and how it will impact health consumers. There is certainly risk that the AHCA could destabilize the insurance market, making insurers less willing to sell insurance plans through the Cover Oregon exchange. Indeed, President Trump has even threatened to withhold cost-sharing payments to subsidize insurance for the purpose of destabilizing President Obama’s health reform and pressuring Democrats to surrender their opposition.

That’s the risk that HB2342A was designed to address – it was designed to protect insurance companies from the financial fallout of the AHCA.

The bigger risk for ordinary people – the one that dominates the headlines, and congressional town hall meetings – is that the AHCA will eliminate coverage of Essential Health Benefits or pre-existing conditions. Talk show host Jimmy Kimmel recently brought attention to this issue by describing his new baby’s heart condition – and pointing out that without coverage of Essential Health Benefits and pre-existing conditions under current law, a family with a child like his would likely face death and bankruptcy.

Until last week, I had assumed that Oregon would be an island of stability and that our state laws mandating coverage of treatment for autism, developmental disabilities, and mental health conditions would protect us from the worst effects of any changes to national legislation.

Unfortunately, Oregon’s HB2342A essentially grants the Director of DCBS unlimited authority to protect insurers from financial difficulty by waiving any and all laws requiring coverage or protecting consumers. In a very real sense, HB2342A represents a pre-emptive surrender to President Trump’s threat to destabilize insurance markets by withholding promised subsidy payments.

It’s no secret that the easiest way to cut costs for insurers is to eliminate or restrict coverage of expensive health care services – the very services that our neediest patients require to survive and thrive. This could include imposition of strict age and visit limits on treatment for autism, elimination of mental health parity benefits, and even pregnancy and childbirth expenses.

Since HB2342A supersedes ANY Oregon law governing health insurance – not just the insurance code – it could even waive Oregon’s civil rights code, and permit discriminatory insurance practices that eliminate coverage for individuals with disabilities or gender dysphoria.

Lest anyone think that this threat is imaginary, DCBS has a long history of working closely with insurers to protect profitability at the expense of coverage for patients. To give one example, when Oregon’s Mental Health Parity law was enacted in 2005, it required coverage of medically necessary care for all mental health conditions. Against the unanimous advice of mental health professional and advocacy organizations, DCBS restricted the definition of “mental health” to exclude conditions such as developmental disabilities and gender dysphoria, to reduce costs for insurers. It did so despite a written warning from one civil rights attorney that the only basis for doing so appeared to be that people with these conditions were “unpopular.” This error was finally corrected in 2012 (gender dysphoria) and 2015 (developmental disabilities), with an explicit acknowledgement that these exclusions violated Oregon’s civil rights act and were inconsistent with the Mental Health Parity statute. There are many other examples.

HB2342A specifically permits “temporary” rules under ORS 183.335(5), which can be issued without prior public notice, comment or hearing for up to 6 months.  We can be certain that the Insurance Industry will be working closely with DCBS on any such rules, but that health consumers and providers will have no such guarantees.  Indeed, this bill was developed in consultation with the Insurance Industry – but not health care advocates.  I’m a member of the DCBS Health Care Advocates group – we were never consulted or even informed.

HB2342A is simply unnecessary – if there’s truly an emergency that requires a tradeoff between insurer profitability, insurance premium rates, and coverage of Essential Health Benefits, the Governor should call a Special Session of the legislature to make those decisions in a public and transparent manner.

If DCBS is to be granted this extraordinary authority, it should come with limits to ensure that consumers are protected, with an amendment, such as:

  • “Notwithstanding the rule-making authority granted in subsection (1), the Department of Consumer and Business Services may not adopt any rule that is not in compliance with the provisions of Chapter 743A [Health Insurance Mandates] or Chapter 659A [Civil Rights]; that reduces coverage of Essential Health Benefits as defined in ORS 731.097; or that permit health insurers to exclude consumers with pre-existing conditions.”

Call to Action: HB2342A has already been narrowly approved by the House Rules Committee, and is scheduled for a House Floor vote on Tuesday, May 16th. Please contact your State Representative and State Senator TODAY to ask them to oppose HB2342A. I’ve included a sample message that you can use at the end of this e-mail.

You can track the progress of HB2342A here. The final text of HB2342A hasn’t been published, but you can read the amendment that was adopted here.

Update on our Legislation for 2017

Earlier this year, I wrote about the four bills that we’ve introduced in the Oregon legislature this year. Two are moving forward, and two aren’t. Here’s a quick summary:

HB2839 Organ Transplants for People with Disabilities:

Prohibits discrimination against potential organ transplant recipient on basis of mental or physical disability.

HB2839 was unanimously approved by the House, and is scheduled for a hearing and possible work session (vote) in the Senate Health Care committee on Thursday, May 18. It has been extensively revised in a very cooperative process with the organ transplant centers, and now uses more modern language based on work by policy analysts at the Autistic Self-Advocacy Network. There will be one more amendment to clarify the application of the law to patients at OHSU, which – as a government institution – would ordinarily be exempt from the sort of expedited judicial review that HB2839 permits.

I greatly appreciate the help of OHSU and Providence in developing a consensus bill.

HB2931 Behavior Analysis Interventionists with College Degrees:

Clarifies educational requirements for registration of behavior analysis interventionists.

HB2931 was unanimously approved by the House, and by the Senate Health Care committee. We expect approval by the full Senate.

SB917 CCO External Review:

Implements Federal regulations (42 CFR 438.402) on External Review of medical necessity determinations by CCO.

Although this bill had strong support from health consumer advocates, and no formal opposition, it was blocked by concerns from the Department of Consumer and Business Services that it could increase their administrative costs, and fears that Oregon’s Independent Review Organizations (IROs) – who conduct the External Reviews – may lack capacity. We are working with Oregon’s IROs who have assured us that there are no capacity constraints, and we are very confident that the administrative costs for DCBS will prove to be very manageable. We expect to bring this bill back next year.

HB2858 Insurance Consumer Complaints and Enforcement Process:

Establishes transparent and efficient procedures to adjudicate consumer requests for restitution or enforcement of the insurance code, based on the BOLI Civil Rights Division process for adjudicating civil rights complaints.

Although this bill had strong leadership support, it was fiercely opposed by the Insurance Industry, even though it represented a compromise from past efforts to eliminate the industry’s exemption from the Unlawful Trade Practices Act by requiring consumers to work through DCBS before attempting private litigation. This will come back again and again – as long as it takes – until consumers have a meaningful way to hold insurers accountable for violations of the law.

————–

Sincerely,

 

Paul Terdal

Sample message in opposition to HB2342A

Here’s a short, simple e-mail message that you can use to get started. Revise the middle paragraph to describe how this affects you, your family, or your patients, and update the greeting and address.

To:

Your own State Representative and State Senator.

You can find their contact information here: https://www.oregonlegislature.gov/FindYourLegislator/leg-districts.html

CC:

House Speaker Tina Kotek: Rep.TinaKotek@state.or.us

Senate President Peter Courtney: sen.petercourtney@oregonlegislature.gov

Subject:

Please Oppose HB2342A – Waives ALL Health Insurance Consumer Rights

Body:

Dear Representative [insert name] and Senator [insert name],

I am a constituent in your district.

Please oppose HB2342A, which would give the Department of Consumer and Business Services extraordinary authority to waive any and all Oregon laws protecting health insurance consumers, in order to protect insurance industry profits from the “American Health Care Act.”

This is exactly the wrong response to the chaos in Washington DC over health care.

Whatever Congress and the President do, we need to ensure that Oregonians can continue to get coverage for Essential Health Benefits and pre-existing conditions – we shouldn’t abandon our state’s values and commitments to those with disabilities or expensive medical conditions at the first sign of trouble from our national leaders.

[*** If you can, please insert a brief personal story here. For instance, if you, your family, or your patients have pre-existing conditions or health needs like autism that could be at risk, please write about that and about how that coverage could be at risk if DCBS and the Insurance Industry decide that you are too expensive to continue covering ***]

HB2342A is simply unnecessary – if there’s truly an emergency that requires a tradeoff between insurer profitability, insurance premium rates, and coverage of Essential Health Benefits, the Governor should call a Special Session of the legislature to make those decisions in a public and transparent manner.

If DCBS is to be granted this extraordinary authority, it should come with limits to ensure that consumers are protected, with an amendment, such as:

  • “Notwithstanding the rule-making authority granted in subsection (1), the Department of Consumer and Business Services may not adopt any rule that is not in compliance with the provisions of Chapter 743A [Health Insurance Mandates] or Chapter 659A [Civil Rights]; that reduces coverage of Essential Health Benefits as defined in ORS 731.097; or that permit health insurers to exclude consumers with pre-existing conditions.”

Sincerely,

 

Your Name
123 SW Main
Hometown, OR 97201
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