BusinessReport.com

Republicans are pro-business by and large, which usually translates into “no new mandates” when somebody tries to pass a law forcing insurance companies to cover another type of medical treatment.

Why? Because the more insurers have to pay for, the higher premiums go, which is bad news for business owners already burdened by high premiums. So it seems odd that a Republican would author a bill containing just such a mandate.

Nevertheless, District 70 Rep. Franklin Foil—a Republican—has authored House Bill 958, which would require insurance companies in Louisiana to cover something called Applied Behavior Analysis—a type of autism therapy proven effective at helping children with severe autism adjust to school and normal life.

Backers of the bill—and similar legislation in other states—say it will lift a huge financial burden from the shoulders of parents of children with autism. Therapy is very expensive, with families frequently being driven into filing for bankruptcy.

In the other corner are business and insurance groups, which are traditionally anti-mandate because of the specter of higher insurance premiums, already a source of bedevilment for business owners and employees. The upshot of higher premiums, argue critics of mandates, is fewer people with insurance, which leads to still higher premiums.

That’s what the Arizona Chamber of Commerce and Industry warned, right before an autism therapy bill sailed through that state’s Legislature, says Ann Seiden, spokeswoman for the chamber. The bill, as with other mandates, was well-intentioned, she says.

“We just think there’s a better way to go about reducing the number of uninsured and to meet certain coverage needs,” Seiden says.

Gil Dupré, CEO of the Louisiana Association of Health Plans, a trade association for health insurers, says H.B. 958 is one of nine insurance mandate bills filed this session—the most in one session. He says it’s a sign that lawmakers need more educating in the effect mandates have on premiums. LAHP hasn’t had a chance to study the bill closely; philosophically the group opposes mandates.

“This particular bill is a very difficult one to address, because obviously everybody wants to take care of children, and obviously everyone wants to take care of children who have medical problems,” Dupré says.

Foil, who has a sister with Down’s Syndrome and an 8-year-old with autism, says he campaigned on a platform of supporting parents of children with special needs.

“It’s something I was very passionate about,” he says. “This just seems to be a concrete way I can help parents who have children with these issues to make a difference, and it’s a first step.”

Foil, who also campaigned as pro-business, says he’s trying to ease the burden on business by exempting employers with 50 or fewer employees.

“I want to get the legislation passed, and I’m willing to work with business and insurance groups,” he says.

As for complaints that the mandate will drive up premiums, Foil says “it being too expensive is somewhat of a relative term” compared to the financial and social cost of not treating severe autism early—or at all.

Toni Peters, a Denham Springs mother whose 9-year-old son, Ricky, has autism, persuaded Foil to write the bill. She also works for Families Helping Families of Greater Baton Rouge, a resource center for families grappling with disabilities.

Her story is likely familiar to any parent of a child with severe autism. As a toddler, Ricky couldn’t speak, would scream uncontrollably, bang his head against the wall, try to jump from moving cars and run into the street without looking. Peters credits ABA therapy with giving Ricky back his speech.

“He will talk you into the ground now,” she says. “He can carry a full conversation now.”

He also learned to be still and focus. Ricky is doing well in school and has friends. But the therapy was so expensive Peters had to sell her house to pay for it. The financial and emotional stress caused she and her husband to divorce—also common between parents of children with autism.

Estimates of the incidence of autism range from 1 in 150 births to 1 in 500. Only a portion of those are severe enough to require intensive therapy, though diagnoses of autism in the United States are growing at an alarming rate.

“The cost on society is going to be tremendous,” she says. “Everybody is going to have to pay the expenses of these children, whether it’s a little bit now or a whole lot later.”

Shelley Reynolds, a former Business Report employee now working with states through a national group, Autism Speaks, to get the legislation passed everywhere, helped Foil craft H.B. 958. Making it law, she says, would not only help families but would create a market for highly trained therapists that Louisiana doesn’t have now. Without ABA coverage, taxpayers will simply pick up more of the tab, says Reynolds, whose son Liam was diagnosed with severe autism 10 years ago but has benefited greatly from ABA therapy.

“Something’s got to be done,” Reynolds says. “It’s a national health emergency.”

Jim Bouder, a Pennsylvania father whose 12-year-old has autism, is the chief operating officer of a school for children with autism. He’s been aiding Autism Speaks through his actuarial acumen—detailing the most likely impact on premiums in various states, a service he renders for free.

Bouder says critics of the legislation regularly inflate the projected rise in premiums—even beyond mathematical possibility—without offering any data to back it up. In Pennsylvania, insurers and business groups warned of 4% to 8% rate hikes.

By Bouder’s calculations, the actual bump would be no more than half of 1%—or $1.60 more per policyholder per month. “The insurers up here have had six months to attack my approach, and they haven’t been able to refute it,” he says.

Bouder is still checking some of his inputs for Louisiana, but says he’s come up with a mid-range impact on premiums of less than half of 1%, or about $1.59 a month for individual policies and $4.40 a month for family polices. The absolute worst-case figure is 1.17%, he says.

The Louisiana Association of Health Plans isn’t projecting any figure yet. Neither is the Louisiana Association of Business and Industry, a group also historically opposed to insurance mandates. LABI is still studying H.B. 958 before taking a stance.

Bouder will have plenty of numbers with him, however, when he’s in Baton Rouge on April 30 to present his findings to the House insurance committee in support of the bill.

“I’m happy to donate my time,” he says. “This is something I believe very strongly in, and I think I’m on to something that will be very helpful. I don’t see state borders as being a reason why I shouldn’t help our kids.”