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Alabama lawmakers and lobbyists clash over care for children with autism

A bill to require insurance coverage for therapy for children with autism faces an uncertain future after the House Insurance committee chair, Rep. Kerry Rich, R-Albertville, this week called for compromise.

Rep. Jim Patterson, R-Meridianville, introducing his bill to provide insurance coverage for children with autism.

But the problem is the two sides couldn't be farther apart. And Rich made no promises that he will bring the bill up for a vote.

HB284, sponsored by Rep. Jim Patterson, R-Meridianville, calls for health insurance coverage for applied behavioral analysis, a type of behavioral therapy that is a primary treatment for children with autism. Nick Saban and his wife Terry sent a letter Monday to the Alabama Legislature, urging its members to support HB 284, the Autism Insurance Reform Bill. "Forty-five US states have laws requiring health insurance coverage for autism therapies," they wrote in the letter. "We are asking you to assist these families to get the help they need for their children and loved ones." But business interests oppose the bill, saying the cost of providing coverage would drive insurance premiums up to the point that some businesses could not afford coverage. Opponents of HB284 during a public hearing on Wednesday argued the mandated coverage amounts to a tax, similar to the federal Affordable Care Act. A competing version of the bill, SB57, calls for coverage of the therapy only for children from birth through nine years old and places the administration of the program under the Department of Mental Health. That version would also pulls $3 million from the state's education budget to provide no more than $40,000 of services per child in a given year. Opponents of SB57 argued the financial burden doesn't belong in the education trust fund, nor should it be administered under a government agency.

Board-certified behavior analyst Ashlie Walker testifies at a public hearing on HB284, Mar. 8, 2017

According to Autism Speaks, 45 states cover behavioral therapy for people with autism. It is the primary therapy for children with autism and is as essential to treating autism as insulin is to treating people with diabetes. Ashlie Walker, a board-certified behavior analyst, employs 24 certified behavioral analysts who work in Alabama, and calls the battle against HB284 "a war on kids with special needs." Walker told lawmakers, "Fifty years of research have demonstrated the effectiveness of applied behavioral analysis." Denying people with autism coverage for behavioral therapy is the same as denying people with cancer access to care, Walker said. At a public hearing in the House Insurance committee on Wednesday, parents of children with autism lined up to share their stories of financial ruin in trying to afford therapies for their children. Parents and experts spoke of the life-changing benefit behavioral therapy has for children with autism and the fears they have if they can't afford to pay for that therapy. Many parents were held outside, as the committee room quickly reached capacity. Michael Wasmer with Autism Speaks said the cost to provide coverage was around 50 cents per member of the involved insurance pool. But Blue Cross and Blue Shield of Alabama lobbyist Robin Stone spoke in total costs of millions of dollars. Wasmer said Stone's projections were faulty because they were based on the assumption of maximum usage of behavioral therapy, because not all children with autism need behavioral therapy, and those that do would not require maximum usage. Even children with autism who need maximum therapy only need that level of usage for three to five years, Wasmer said. Once a child with autism starts school, if a determination is made that behavioral therapy is necessary, schools shoulder the cost. Ultimately, that means taxpayers are paying for needed therapy that supporters of HB284 believe should be covered by insurance.

Business Council of Alabama President Bill Canary testifies at public hearing on HB284, Mar. 8, 2017.

Business Council of Alabama President Billy Canary, testified against the bill, and said he had worked on the Governor's Working Group on Children with Autism last year that crafted SB57 in hopes of avoiding "pitting one group against the other." Canary said it is not fiscally responsible for behavioral therapy to be covered without limits. Canary acknowledged the emotions involved, saying "these children do need help," and said the governor's working group kept Psalm 127:3 at the forefront of their discussions: Children are a gift from God. Patterson said the families of children need help now. "We don't need to let another year to go by without doing something to help these children," Patterson said. After the meeting, Patterson and Canary had a heated exchange. Canary asked why Patterson filed the bill without approaching him, and Patterson pointed out that it's usually the lobbyists who approach lawmakers, not the other way around. Canary accused Patterson of having his own agenda to force a healthcare tax on people, to which Patterson replied, "Don't call it a tax. I resent that." Canary said, "It is a tax. That's the truth." Patterson said, "I'm willing to work with you, but don't insult me by calling it a tax. That's just a way to play politics. Billy, you're better than that." The men agreed to meet. "We've got to do something," Patterson said, adding he is hearing from parents in his district "crying and begging for help, and I'm going to represent the people in my district because that's what I'm down here for." Walker agrees that help is needed now, saying behavioral therapy when provided early makes a difference in whether a child with autism becomes independent or spends their life dependent on loved ones and government assistance. Referring to the struggle to get insurance coverage for children with autism, Walker said, "We're in the most desperate place I can imagine." Dr. Bama Hager of the Autism Society of Alabama, attended the hearing and said afterwards, ""Alabama families living with autism would like the opportunity to see our lawmakers that represent us have a vote on HB284. We'd like to see it come out of the committee favorably for a vote on the floor so that we can see which of our legislators are representing us in the way that we have asked them to represent us for eight years."

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