Hundreds of pieces of legislation are sitting on Governor Jerry Brown’s desk awaiting his proverbial “thumbs up” or “thumbs down.” Gov. Brown has already warned that many of these bills will be vetoed, saying that there will be “plenty of veto blues.”
One bill that regretfully deserves a veto is Senate Bill 946 (Steinberg). It would impose a costly new mandate for private health insurance to pay for educational non-medical services for children with autism, while exempting the public health programs — Medi-Cal and Healthy Families — from the requirement to cover the same therapy.
The bill was jammed through the legislature at the last possible moment without sufficient time for debate or evaluation of the potential consequences of passage. While on the surface it may seem like a well-intentioned bill, it is riddled with flaws and in the end will do more harm than good.
There is no question that parents of children with autism face tremendous challenges. That’s why California health plans already support a wide range of medical services to help their members and their families, including diagnosis, medication and psychiatric and psychological counseling.
But SB 946 would increase pressure on the State’s General Fund; increase health premiums by hundreds of millions of dollars; exempt public health insurance programs and the millions of children they cover; and, by shifting the responsibility of educational services onto health plans, would set a costly new precedent.
Our current budget situation is proof that taking benefits away from the public is much harder than giving them new ones. Yet this bill mandates providing non-medical services for autism in July of 2012, which would end if the benefit isn’t part of the “essential health benefits” that will be included in policies sold to individuals, families or small businesses under the new federal health care law.
Under federal law, the cost of any additional benefits required by state law above and beyond “essential health benefits” must be borne by the states. Once these benefits are terminated, the pressure to restore those benefits would be great and THE STATE would have to absorb the cost for this mandate.
Another massive flaw in SB 946 is the exemption for public health plans from covering the same services for autism that private plans are required to cover. This carve-out means that California will require benefits for children of means while millions of low-income children will not have them. If carving out Medi-Cal, CALPERS and Healthy Families is too expensive for the State to cover, how is that cost any less dramatic for a private sector that is also facing budget struggles?
The California Association of Health Plans recently released a report projecting the cost of treating autism in California. Our estimates indicate that covering educational, non-medical services nears $850 million a year.
These non-medical time-intensive life skill services traditionally are provided by schools or regional centers. Health plans would have to quickly establish networks in this non-medical arena through contracting. Since there are no California licenses, certification or minimum qualifications as yet — there are no guarantees of quality. This raises regulatory and contracting costs, as well as serious questions about consumer protections.
This mandated shift in financial responsibility for covering educational non-medical services would also set an alarming precedent that could compel coverage for countless other non-medical services—causing an explosion in health insurance costs.
We need to come together in a public dialogue to help families and individuals facing the challenges of autism. But passing a premature, incomplete, expensive bill that excludes the poor makes no sense.
SB 946 deserves the “veto blues.”