Missouri governor backs insurance plan for autistic children

COLUMBIA, Mo. -- Missouri Gov. Jay Nixon wants to require insurance companies to pay for as much as $55,000 worth of behavioral treatment services annually for autistic children.

Nixon said Thursday that coverage of the costly behavioral treatments should be an essential element of legislation that both the Democratic governor and Republican legislative leaders have pledged to make a priority next year.

He will speak about the legislation during a stop at 12:45 p.m. today at Dempster Hall on the Southeast Missouri State University campus in Cape Girardeau.

Nixon's proposal is similar to a bill passed earlier this year by the Senate that never came to a vote in the House. Insurance industry lobbyists had warned that mandating coverage of childhood autism would cause premiums to rise for other policyholders.

At issue is what's known as "applied behavioral analysis," which some parents say produces dramatic improvements in their autistic children but which can cost upward of $50,000 a year. Such services are not currently covered by Missouri insurers.

Fourteen states have laws mandating insurance coverage of "medically necessary, evidence-based autism therapies" such behavioral analysis services, according to the advocacy group Autism Speaks.

At Nixon's side as he announced his plan Thursday were Myles and Lora Hinkel and their 6-year-old son, Blake, who provided an example of the challenges of raising autistic children by attempting to rip a seal off the lectern during Nixon's news conference. Unable to speak until age 3, Blake now can talk in several-word sentences and read short words as a result of behavioral treatment services, Myles Hinkel said.

A local social services agency has helped the Hinkels pay for Blake's treatment. But that aid runs out next year, the father said, and the family is hoping for a state insurance mandate.

State insurance department director John Huff said the proposals backed by Nixon and the Senate would be affordable for consumers.

"Fundamentally, major life changing events -- like a diagnosis of autism -- is what insurance is all about," Huff said.

Nationally, about 1 in 150 children are diagnosed with an autism spectrum disorder, and Nixon said more than 30,000 people could have autism in Missouri.

An actuarial analysis conducted for Autism Speaks of a previous Missouri legislative proposal, which included a $72,000 annual benefit cap for autistic people younger than 21, estimated that an insurance mandate would result in a less than 1 percent increase in the cost of health insurance premiums. For an average group health insurance premium of $3,573 a person, that would equal a $27.10 increase, the study said.

Warnings on premiums

But the industry group America's Health Insurance Plans has warned of premium increases of greater than 3 percent, which it estimates would make health insurance unaffordable for thousands of people.

Calvin Call, executive director of the Missouri Insurance Coalition, said the industry has had no conversations with Nixon about an autism insurance requirement and still has concerns about its costs.

Nixon said he's not interested in compromising on four key elements. He said the bill must cover both the diagnosis and treatment of childhood autism, provide between $35,000 and $55,000 annually of behavioral services, cannot cap the number of treatment visits and must bar insurers from terminating coverage solely because of an autism diagnosis.

"This is not about trying to find a bill that every insurance lobbyist in Jefferson City can sign off on," Nixon said. "This is about doing something that is right, correct, proven and needs to get done."

Since the legislature adjourned in May, Nixon has repeatedly criticized both the insurance industry and Republican House leaders for not voting on the Senate's autism legislation.

But House Speaker Ron Richard, R-Joplin, said Nixon has not talked to him about the details he wants included in an autism bill. Richard has created an interim committee to craft autism insurance legislation and pledged it will be one of the first bills debated when lawmakers return in January.

"Our goal is still an affordable, transparent, workable solution," Richard said.