State Sen. Tommie Williams and three other General Assembly members Tuesday urged their colleagues to pass legislation this year that would require private health insurance companies in Georgia to cover treatment for autism.
“It’s time to fix this problem,” said Williams, a Republican from Lyons. His niece’s daughter, Ava Bullard, is the inspiration for the proposed legislation, called Ava’s Law. The issue has been raised at the Legislature for the past five years, Williams said.
“We should pass this bill,” he said.
Williams was joined by Rep. Scot Turner (R-Holly Springs), whose son suffers from autism; Sen. John Albers ( R-Roswell); and Rep. Ben Harbin (R-Evans) at a news conference that was part of Autism Day at the Georgia Capitol. Albers and Harbin are lead sponsors of the Ava’s Law bills in their chambers.
“If the bill gets to the floor of the House and Senate, it will pass,” Harbin said.
To bolster their case, the legislators noted that Gov. Nathan Deal supported first-time funding for coverage of autism in the State Employee Health Plan. The proposal allocates $2.4 million for treatment.
Still, neither Ava’s Law nor the governor’s proposal would mandate payment for treatment under Medicaid and PeachCare for Kids, the plans covering children of the state’s poorest families.
Ava’s Law also would not apply to large companies that self-insure employees’ coverage. But Shelley Hendrix, director of grassroots development at Autism Speaks, noted that many employers such as the Southern Company, Home Depot, Sun Trust, IBM, Time Warner and the Southern Baptist Convention already provide “meaningful coverage” for those with autism.
The CDC says about 1 in 88 children has been identified with an autism spectrum disorder, and that the number among boys is 1 in 54. The disorder is characterized by difficulties with social interaction, verbal and nonverbal communication and repetitive behaviors.
Although expensive, autism treatment has been effective, researchers say. Autism Speaks, a national autism science and advocacy organization, says nearly half of autistic children who receive early intervention with applied behavioral therapy will recover “typical function” and another 40 percent will make “significant improvement.”
Hendrix said the annual cost of the treatment ranges from $50,000 to $75,000 per patient. The estimated average cost for private health insurance plans, she added, would be $0.32 per member per month.
In a recent guest editorial in the AJC, Albers said that during the next 10 years, autism treatment is expected to cost $200 million to $400 million, but that early diagnosis and intervention can reduce the cost of lifelong care by two-thirds.
With appropriate treatment and clinical intervention, Georgia is projected to save more than $1 million per child, Albers said.
Georgia is one of 16 states that does not mandate coverage for autism.
Of the 34 states that do mandate private health insurance coverage for autism, only Vermont also provides funding for treatment of children under Medicaid, according to Autism Speaks.
Ava’s Law, which was filed during the 2013 General Assembly session, was presented for review last November to the Governor’s Special Commission on Mandated Health Insurance Benefits. The commission recommended that the Legislature not require private health insurers to cover autism treatment.
Rep. Richard Smith (R-Columbus), who chairs the commission and the House Insurance Committee, cited the cost of the proposed new coverage at the November commission hearing, Morris News reported.
“That is an issue, especially when you consider the uproar that we’ve been listening to concerning people whose premiums have doubled and tripled,” Smith said.
He also pointed out that large employers that self-insure would not have to follow the coverage mandate if it were approved.
The Georgia bill would require coverage of evidence-based treatments for autism such as applied behavior analysis.
Turner said he was fortunate that his private employer’s health insurance covered autism treatment when his son was diagnosed at age 3. “We were able to give Sam a fighting chance to become a productive citizen.”
Ava’s mother, Anna Bullard, also participated in Tuesday’s news conference and made a plea for adoption of the legislation. She said Ava, now 9 years old, is functioning normally because of the applied behavioral therapy, which she started at age 3.
“We are so blessed Ava got the treatment she deserved,” Bullard said. “But for everyone [like Ava] there are thousands of children who cannot speak. I will not give up. If it’s not this year, we will be back.”