There are only a few weeks left before the 2017 Legislative session ends with even less days that the Senate will be in session. What will the Senate do with HB284 (Autism Insurance bill)? I still believe that the game plan for the Senate is to kill us with kindness, give us the lip service of support, and blame the demise of our bill on running out of “time”. There are some honorable and good men and women in the Senate that have and do share information with our stakeholder group about some of the more “unsavory” intentions and rumors of delay and the death of Autism Insurance Equality. Whether we get a fair floor vote comes down to three Senators: Del Marsh, Trip Pittman and Jabo Waggoner. To get that floor vote, the bill must be voted out of committee by Pittman, fast-tracked and placed high on the calendar items by Waggoner while the leader of the Senate, Marsh, could ensure it’s fast-tracked like McCutcheon did in the House but hasn’t and all before May 18th. It could all happen Wednesday if they really wanted it to: a committee vote, signature from Pittman sending it to the Rules committee with Jabo immediately placing it on the Senate floor calendar at the top of the list. But will they?
I’m not ready to start a “thank you” tour like some in our stakeholder group are tempted to do nor have I thought it wise to secure “yes” votes prematurely when the fate of our children rests with these three Senators. What will Pittman do Wednesday? Will Marsh actually help? And I do not think the Almighty himself knows what Jabo is going to do and he’s always been impossible to read prior to the moment he makes a decision. So, our focus must be with those three Senators with nobody breaking ranks, being petty or giving up. We may not have an opportunity like this for years so strap on that armor and pick up that sword and fight with me for another two weeks. We are in the right and our request for insurance equality is just and God is watching.
I am a Republican with strong populist and libertarian roots. Most of us working on the Autism Insurance bill (HB284), affected by Autism and fighting for families in Alabama are Republicans or vote Republican yet have effectively and harmoniously been totally inclusive in working with those who identify as “liberal”, Democrats and Independents to do something for all Alabama families, for our Education system and for our taxpayers. But, the lies and misinformation campaigns from some in my own Party and those in “lobby world” are so pervasive that I don’t know how anything gets done or comes out of this legislative process “clean”. This experience of fighting for HB284 makes me want to take a figurative flame-thrower to Montgomery or, in the least, some Magic Erasers.
Those who oppose HB284 are using highly politicized Obamacare images and language. Blue Cross and Billy Canary have even stooped to their new low of creating a website to spread lies and misinformation (which they have recently taken down). On that new site, they quote outrageous monetary figures that they do not explain nor do they cite sources or fact. I guess they were hoping to catch enough gullibles in their nets that may be stupid enough to believe it simply because it’s on the internet, has Marsh’s name in the URL, has an image of the Capitol, says the word “conservative” and rails against mandates (which are things all Republicans and conservatives are blindly supposed to hate without using reason to deconstruct that ridiculous notion). Their figures are lies and not even possible under our HB284 because of the “kill switch” that we put in our bill if it causes your monthly premium to rise above 1% due to adding ABA therapy. If our bill is the cause for the 1% rise then it goes away and the mandate suspended. What kind of people would build a “kill switch” into their own legislation? Responsible citizens that are now being demonized by Bill Canary, Blue Cross and some in my own Party.
It is disgusting that they’ve taken their virulence a step further by inferring that we are using our kids as a political tool because, after all, who would vote against children? In the various blogs and media coverage and their new website against HB284, our opposition (whether it be Blue Cross, Business Council or some Republicans) have cited no alternative solutions to “help” alleviate the growing financial pressure currently being absorbed by our public schools, the crushing financial costs to families, the impacts on marriages, the strain on our social service programs. Those fighting against us have failed to acknowledge that the State of Alabama, prior to Obamacare and with Republican support, have passed and added insurance mandates all over Title 27 of the Code of Alabama. The Alabama Legislature has been periodically forced to make the Blue Cross insurance monopoly cover Postpartum Care Coverage, Breast Cancer Screening, Genetic Testing for Cancer, Mental Illness Coverage, Prostrate Cancer Early Detection, Colorectal Cancer Examinations, Domestic Abuse Insurance Protection, Chiropractic Coverage, and Alcoholism Treatment. And I’m the wrong one for wanting medically necessary autism treatments covered as a consumer and that I pay for? If “mandates” are so reprehensible and wrong then why haven’t the Republicans in Montgomery, who have a supermajority, repealed all of the insurance mandates contained in our Code of Alabama? Because, Blue Cross doesn’t want to cover anything without being forced to. What kind of evil corporation has to be forced to cover Breast Cancer screening? Blue Cross Blue Shield of Alabama, that’s who. So, am I really shocked they would be fighting my daughter’s autism therapy needs? No.
You may remember that at the beginning of this Legislative session, Billy Canary and BCBS did come up with and pushed an alternative Autism bill (SB57 and HB404), which I call “Billarycare”. In that bill, the taxpayers alone would continue to foot the bill for the medically necessary treatment for Autism by diverting $3 million out of the Education Trust Fund over to Alabama Mental Health to manage and distribute for the provision of ABA therapy for Autism. Luckily, we fought that socialist insanity and our Legislators could see that “Billarycare” strapped all costs on the tax payers (our taxes are already paying for this stuff… draining school budgets and other social welfare programs). The ideas and solutions that came from Blue Cross Blue Shield and the Business Council of Alabama was the pure essence of socialized medicine yet they are trying to demonize us using the same moniker. I say enough and It’s time for tax and budget relief and we can get that through HB284.
We all know that there are no free lunches and somebody has to pay for anything and everything in this world. So, at the recommendation of Speaker Mac McCutcheon to find a viable middle ground for HB284, I sat down with Representative Jack Williams (R-Birmingham area), Ashlie Walker (Milestones Behavior) and Michael Braun (Autism Speaks Lobbyist/Father of ASD child) where we devised reasonable solutions to protect the taxpayer, the insurance premium payer and the business community yet we also found a way to save tax money over time and get our Autistic children and adults the treatment they desperately require. These points became the amendments to HB284 that were voted on in committee and passed the State House by a vote of 100 to 0. HB284 more than satisfies and responds to every fear being touted and spread by the Billary crowd and the Blue Cross monopoly.
We have monetary caps and a “kill switch” built into our HB284 to protect against run away costs.
Medicaid coverage is included because it was ordered to cover medically necessary ABA therapy for Autism in 2014 and they’ve been out of compliance for almost 3 years. They are ripe for a lawsuit which could potentially cost the state millions of dollars to settle, with most going to the attorney who files it. The attorneys would win the minute they file it because the Order came out of the 11th Circuit Court of Appeals (which has jurisdiction over Alabama) and Federal Medicaid Agency. Alabama Medicaid covers over 50% of the children in Alabama. Representative Anthony Daniels (D-Huntsville) had the foresight to include Medicaid coverage for ABA therapy in HB284, in part, to protect state interests against a lawsuit that could cost the state millions of dollars in damages.
In our negotiations with Representative Jack Williams (R-Birmingham area), we built in monetary caps scaled by age. We must remember that not every child diagnosed with Autism will require medically necessary ABA therapy but we do know that those who do may need it more frequently during the “early intervention” years of 0 to 9 years old. The goal and purpose is to provide the child with the social, communication and gross/fine motor skills to integrate into their communities, their school classrooms and not require a ton of public resources in the form of special education, additional staffing supports, or small classroom environments. We also want to reduce the need for Medicaid Waivers, Disability payments, supported employment, involvement of Department of Rehabilitative Services, or residential treatment facilities. The public (i.e., taxpayers) pays for all of those things currently because insurance will not and has not covered it this medically necessary therapy.
The monetary caps look like this: 0 to 9 years old would have a yearly cap of $40,000 a year of benefits for ABA therapy. 10-13 years old would be $30,000, 14-19 $20,0000 and over 19 years old would drop to $10,000 a year. This is a more than reasonable safeguard.
This bill does not impact large employer self-funded plans nor would it affect individual or small group policies created after 2010 under the Affordable Care Act (ACA or Obamacare).
Finally, this bill also contains a “kill switch”. I believe far more legislation should follow the example of the Autism Insurance bill and include a trigger that destroys the “law” if, under predefined perimeters, it proves damaging or ineffective. We would hope that this becomes a smarter way to govern and one that is uniquely Alabama. The “kill switch” is a simple one. If monthly premiums rise above 1% due to having to cover ABA therapy then the businesses and state employee insurance would “opt out” and there would be no requirement to cover ABA therapy. The ultimate safeguard and one that our stakeholder group has been agreeable to insert.
We are confident that the premiums will not go over 1% because of the comparable monetary figures coming from Missouri, Louisiana and South Carolina who have mandated this coverage, as well. In those states, insurance premiums were impacted between fifty cents ($.50) and one dollar ($1) a month per policy holder. We do not see why Alabama would be any different, based on similar states like the ones listed above. Of course, we will not know until we jump into the water and this is why the “kill switch” exists. It will protect against those scary and exaggerated projections being put out by Blue Cross Blue Shield and Billary’s team.
As an aside and making a larger observation of state politics, I believe that, as a Republican, if the Party of Lincoln, Teddy Roosevelt and Ronald Reagan doesn’t have the fortitude to send men and women to Montgomery that can withstand the temptations, lies or threats of BCBS, the Business Council of Alabama or any other “power player” that we haven’t identified yet then we have no right to lead. If we can’t be the highest examples and hold everyone, regardless of status, to the laws we create then we shouldn’t be in the majority. If we can’t be inclusive and fight for all Alabamians and be mindful of their needs then we have no place in Montgomery. If we can’t think outside boxes and chart a new and smarter way to govern then someone else should. If we do not destroy this old and rotting tiered system of who this state works out for and who it doesn’t then we are no better than the old Democrats who constructed it back in 1901.
In my favorite book, ‘Atlas Shrugged’, it was the socialistic businesses that preyed on and joined government to bend laws and regulations to their benefit alone. They did not want to compete so they did what those kinds of businesses do and that was to manipulate and own government to maintain or achieve some advantage. Taggart Railroad and Rearden Steel wanted government to stay out of their way and wished to innovate, improve and compete. It was the Bertram Scudders, the Claude Slagenhops, the Orren Boyles and the Wesley Mooches that were the real “looters” of the people while Galt, Taggart, d’Anconia, and Danneskjold that wanted to set the people free. Are we not all victims of this kind of secret and back room manipulation of those who think they are smarter than we are and somehow entitled to tinker and force outcomes in government and business that have rippling and negative consequences for everyone they view as below them? The politicians and businesses that have been usurping our Republic in this way need to be purged.
I’m tired and the people are tired of taking a back seat to the “we haves the influence” and the “we haves the power” interests that lay up in Montgomery, Tuscaloosa or Auburn and subvert our votes almost immediately after we cast them. If the Republican Party wants to lead then we must start demanding it from our own elected leadership and also start running candidates that will live up to our core principles through actions of actual leadership, transparency, honesty, and morality.
We demand that the Senate free HB284 and fast track it for a floor vote. This bill is in the hands of our Senators and will they do the right thing for Alabama and be able to look past the pressures and lies of the lobby powers that believe they have paid for the head “place at the table”. This is the people’s government and Blue Cross has a corporate charter by the approval and good will of the people of Alabama and those charters have historically been conditional on the behavior and actions of the corporation. So, why does it feel, sometimes, that it is the people that live conditionally in some Blue Cross or BCA world that is conditional on our compliance and unquestioned obedience to what they want?
Those of us that believe in free market competition and principles find the behavior of Blue Cross Blue Shield (BCBS) and the Business Council of Alabama (BCA) unacceptable and wrong. BCBS has a 90% market share in Alabama and has been maintaining it, not by doing a great job or high satisfaction of their customers, but by the brute force of their money, lobbying efforts to stifle and kill competition and their ability to wage misinformation campaigns. This behavior isn’t capitalism and it definitely isn’t “free market” because we have no real choice or competition in this state when it comes to health insurance. It is a textbook monopoly. In fact, Blue Cross is currently involved in the largest Anti-trust suit in the country. Antitrust means “relating to legislation preventing or controlling trusts or other monopolies, with the intention of promoting competition in business.” The Plaintiffs are, in part, small business owners alleging paying inflated premiums in markets where Blue Cross dominates. Which makes one wonder why the Business Council of Alabama is in bed with Blue Cross?
So, to have my fellow Republicans defending and protecting BCBS over the people only solidifies perceptions of oppression and “Fat Cat” politics because what choice do we have? I don’t have a choice in insurance, if it is through BCBS, to cover my daughter’s medically necessary treatments. Isn’t the very definition and requirement of competition a race of comparative equals? Who can compete against a 90% market share in a political environment perceptively created and maintained by force and/or manipulation? And all while under Republican leadership. I’m not saying the Democrats didn’t do the same when they were in the majority but voters will only remember who was there when the people reject this collusion and behavior. That time is now and Teddy Roosevelt’s big stick is being dusted off and waiting for the people to start swinging. He was the Republican that busted up the monopolies and that, my friends, is pro-business. Trees and shrubs need pruning and weeds pulled to maintain beauty and health. This is true in the business world, as well.
By targeting our bill as “liberal” or “Obamacare” and claim we are shamelessly using our kids for political gain then you denigrate Republicans that sponsored and fought for this bill and turn off fellow Republicans and make Independents and moderate Democrats look for alternative candidates that are not lap dogs for big lobby interests like BCA and BCBS. There’s a time for politics and this isn’t that time. Let’s do the right thing, get HB284 out of committee, on the calendar and pass HB284.
Senate delays are equal to a “No” vote and we will remember when it’s time for us to vote. We just want a fair shot for a Senate floor vote.
James R. Gallini
Attorney, Father of a beautiful autistic daughter, and Shelby County Republican