Crist, Marino cheer autism insurance law
May 21, 2008
Miami Herald--May. 21, 2008
BY MARC CAPUTO
For the first time, large insurance plans in Florida must offer up to $200,000 to diagnose and treat autistic children, under a law Gov. Charlie Crist signed Tuesday morning.
Flanked by grateful parents and advocates who included former Miami Dolphins quarterback Dan Marino, Crist hailed the legislation as ”a great bold step in the right direction.” At least seven other states have similar autism-coverage mandates.
”This will bring relief to children struggling with autism,” Crist said. “Autism does not just affect the individual who has it. Autism affects the entire family and their friends.”
But the legislation is just that — a step in addressing the treatable developmental disability that is diagnosed in about one in 150 children. Estimated number of autistic kids in Florida: about 30,000.
SOME NOT COVERED
Not all of them, however, will enjoy the benefits of the legislation. It only applies to Florida-regulated insurance plans for large employers with more than 50 workers. And that accounts for slightly more than half of all the insured in Florida, according to state Sen. Steve Geller, the Cooper City Democratic leader after whom the legislation is named.
House lawmakers earlier this month sought a more expansive insurance package covering far more children with more developmental disabilities, such as Down Syndrome, but the Senate rejected the measure because legislators were unsure of its scope, cost and effectiveness.
Autism is a tricky disorder to diagnose. It can manifest itself in severe forms, in which kids have extreme trouble speaking or behaving. Or kids can have milder forms, known as Asperger’s syndrome, that can go undiagnosed.
The neurological disorder often appears in a child before the age of 3 and impairs social interaction, verbal and nonverbal communication and imaginative abilities, and restricts a broad array of activities and interests. No one’s sure what causes it, or why diagnoses of the disorder are on the rise.
But unlike most other developmental disabilities, autism is often treatable if caught and treated early through rigorous — and costly — speech, physical and occupational therapies.
Under the legislation, anyone in high school or who is 18 or younger who was diagnosed with autism by the age of 8 must receive a maximum of $36,000 in coverage for speech, physical and occupational therapies. The mandate also requires insurers to pay for the diagnosis of autism, which can cost up to $3,000. Lifetime benefit: $200,000.
Marino said he could afford to have his son, Michael, treated at an early age and now he’s normal and happily attending college. But many families can’t afford the therapy, and advocates say that can cost society more as autistic children flunk classes and struggle to find and keep work when they get older.
For more than a decade, Marino and Geller have pushed the state to do more. And although Florida legislators have cut hundreds of millions in state spending for developmentally disabled programs, Crist, Marino and the advocates dwelled on the positives of the legislation Tuesday.
”This is a great thrill for me today to be a part of history,” the Hall of Fame quarterback said.
By mandating the coverage, insurers say they’ll likely have to raise rates for everyone, starting sometime next year. The amount isn’t clear, as insurers have yet to negotiate with state regulators over which therapies to offer and when.
The advocacy group Autism Speaks estimates that the mandate could raise monthly rates by up to $1.56 for individuals and $4.20 for family plans.
CONFLICT
The concept of mandating coverage conflicts with Crist’s ”Cover Florida” health plan that he expects to sign into law Wednesday.
That plan seeks to reduce government mandates in order to lower the cost of insurance and thereby provide opportunities for coverage for the estimated 3.8 million uninsured Floridians.
Crist, though, said he wasn’t troubled by forcing the mandate on the insurance companies — and thereby the policyholders — because “it was the right thing to do.”
”Many companies are doing very, very well,” Crist said, “and there’s a time for them to give back, too. And this would be that time as it relates to this very important issue.”