ALERT: CALL TO ACTION
We need you now and on March 7th.
I’ve been asked to provide my input on the Autism Insurance Mandate bill (HB 284). This bill would require some insurance policies to provide therapeutic treatments for Autism, like ABA therapy. Autism Speaks held an informative webinar session last week and provided detailed slides, HB 284 Q&A. I will be referencing a few of those slides in my explanation.
There are positives contained in the Autism Insurance Mandate (HB284) like no age caps or monetary caps. It would expand coverage for State employees, including teachers to include ABA therapy. But, I did find one huge problem that I’d like to explain.
Starting at page 21 of the slides, if you do not have a “grandfathered” individual or small group plan (pre-Obamacare) then this bill would not cover treatments, like ABA therapy. Why was this provision put into the bill when it hasn’t been in prior versions over the years? I don’t know and the explanations provided were unclear so I have been researching this point in order to understand.
In short, Obamacare requires health insurance to cover specific items in policies and each state defines, what’s called, their “Essential Health Benefits” plan. Currently, Alabama does not include ABA therapy in our “Essential Health Benefit” plan but they could and have made edits and additions over the past few years. So, if our “Essential Health Benefit” plan can be changed then why put language into a bill excluding Obamacare policies (which impacts a lot of individual and small group policies [less than 50 employees])? Wouldn’t it be better to remove that exclusion and mobilize the ASD community to reach out to our elected officials and focus attention on changing that “Essential Health Benefit” plan? It doesn’t make sense to keep that provision in the bill and hope that Congress, who appears to be waffling on taking any substantive corrective action, repeals Obamacare. We can get that “Essential Health Benefit” plan changed for Alabama and not wait around for the Feds to do something.
We need to show our gratitude to Representative Jim Patterson of Madison County for sponsoring HB 284 yet request that the “non-grandfathered insurance plan” exclusion language be removed once it is out of committee. We shouldn’t shy away from a fight by keeping that exclusion in there but swing back at Blue Cross harder than they are trying to hit us. At some point, I’d hope that our elected officials take an assessment of Blue Cross’s surpluses and compare it to the people’s budgetary situation. Has it been a net positive for the people of Alabama by licking the boots of Blue Cross?
So, how do we take action as the people?
You need to remember the name, Jim Ridling. He’s the guy that can change the “Essential Health Benefits” plan in Alabama because he is the Commissioner of Insurance. Mr. Ridling was appointed to this position by Governor Bentley and he needs to know what we think and he needs to hear our voices. Blue Cross Blue Shield doesn’t pay Mr. Ridling’s salary, we do. Governor Bentley believed Mr. Ridling was doing such a great job (insert sarcasm) for the people that he gave him an 80% raise last May. For perspective, our teachers got a 4% raise (which, of course, was immediately eaten up by insurance premium increases).
On Autism Legislative Day, March 7th, 2017, we need to go directly to Commissioner Jim Ridling (firstname.lastname@example.org) in the Department of Insurance and inform him that the people want the ‘essential health benefit’ plan changed to include medically-necessary treatments, like ABA therapy. It is that simple and it is the right and decent thing to do. Let’s ask Jim to choose whom he serves…the people or Blue Cross. By changing the state plan it would nullify that exclusion in HB 284.
If Ridling is unwilling to do his job for Autism impacted families in Alabama then we have a huge opportunity in 2018 to elect a Governor of the people and for the people who will appoint our next Commissioner of Insurance or use executive action to mandate coverage. Which candidate would be for us? The one that isn’t financed by Blue Cross or other big lobby groups.
An equally high priority on March 7th, is to visit Medicaid and provide my input to Commissioner Stephanie Azar (@StephanieAzar1 for Twitter) and (email@example.com). We have a Medicaid Agency that was “mandated” to cover Autism-specific treatments, including ABA therapy, back in 2014 but our State Medicaid Agency refuses to do it. They have an enormous budget and they are continually one of our crisis agencies; swallowing more and more of our general fund. It comes down to funding “priorities” and, for Medicaid, our ASD kids and adults are simply NOT a funding priority. This agency covers roughly 50% of the children in Alabama. Does Medicaid need legislation to start covering ASD kids? No. Do they need more funding to start covering autism-specific treatment? No. It’s as simple as making our kids a funding priority and having Medicaid start adding Behavior Analysts to their provider lists. If they don’t then I’m committed to filing suit in order to convince them to do their job and honor the mandate. In this situation, it’s not about “more money” as much as it’s about funding priorities. They pay for vasectomies and so I think they can find it in their hearts to cover individuals with medically-necessary treatments, like ABA therapy. We don’t need legislation for this to happen but we do need your voice in Montgomery on March 7th.
On a daily basis, I see how the public schools in Alabama are currently shouldering the financial burden of providing these therapeutic and medically-necessary treatments to our Autistic students through their special education programs. We, as taxpayers, are already paying for ABA and Autism-specific treatments through this cost-shifting but that’s the dirty secret that Blue Cross and some elected officials either don’t want you to know or are ignorant of. The taxpayers are already absorbing the costs of Autism through the requirements for more staff supports in school, service providers for the ABA therapy, residential treatment facilities, day programs, supported employment, Medicaid waiver program, public assistance and insurance when they come of age. The cost-shifting to our education apparatus is unsustainable and is why Blue Cross Blue Shield, private insurance and Medicaid must step up and carry their respective weight.
In politics, I do not believe in the philosophy of ‘business as usual’ and do not believe in the people honoring fake rules of political decorum that don’t apply to lobbyists in Montgomery that are working against the people’s interests. If they goose our elected officials that work for us then I believe they leave us no choice but to gander. The political winds have changed and Montgomery must be cognizant of the coming storm that will sweep those loyal to big lobby back where they came from.
Over the years I have seen a growing and disparate treatment of the majority in this state by the few that have the right zip codes, have the right jobs, work in the right professions, have the right friends and sit in positions of decision making power. This isn’t who we are as a people and what this country is about, has been about or should be about. I find it intolerable and so I fight for those who don’t have a voice and whose state doesn’t work for them. Too many of my fellow citizens and their children are suffering. They are suffering in our small towns, rural counties, big cities and in our suburbs. If there is something we can do to stop it then we have an obligation to do so.
Sometimes we must stand firm and say ‘you move’ because we’ve been moving since 2012 on Autism Insurance Reform and moving for politicians, for bureaucrats, and for lobbyists. It hasn’t gotten us anywhere and, as a result, my daughter is now 13 and all of my clients and friends’ children are getting older and run over by a system that doesn’t understand them, is discriminating against them and have few ideas on how to help them yet groan and mumble when they become another strain on our public assistance programs because nobody did their jobs when our kids were younger. Shame!
I’m proud to be a loud voice fighting for decent and right action and honored to count so many of you as my friends fighting next to me. These battles have rarely been about my daughter but have been about all of our children and their well-being. Standing against the status quo and demanding answers does not make you popular in the so-called “circles of power” yet always remember that we are many and they are few. So, to end this outrage of discrimination we need your calls, tweets and emails to your elected representatives, Ridling and Azar but specifically your presence and your activism starting today, in Montgomery on March 7th, and until this battle is won. Can we rely on you?
We rise together. As one.