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Rosalia Martinez-Brandon, a Simpsonville mother of an autistic child, explains the difficulties in getting insurance coverage and autism treatment for children in South Carolina.
Tim Smith

COLUMBIA – South Carolina taxpayers could have to fund insurance coverage for autistic children under a legislative proposal.

The proposal that would put autistic children not covered by a 2007 bill in a high-risk insurance pool was advanced by a state Senate panel. 

Both the House and the Senate have passed in different sessions another bill that would address the same issue by mandating coverage for those children left out of Ryan’s Law in 2007. A House-passed version of that bill sits before the same panel that took up the new bill Wednesday.

Instead of taking the House bill up, however, the panel took up the new bill that in effect asks taxpayers to pay for coverage for families who already have private insurance.

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Ryan’s Law mandates that the state health plan and large group policies cover treatment of autistic children, including applied behavior analysis therapy, which parents say holds the most promise for autistic children.

The insurance coverage is vital for autistic children, parents say, because applied behavior analysis therapy can make a dramatic difference for the children.

Parents of autistic children, including some from Greenville, attended Wednesday’s hearing.

Derrick Howle of Greenville, who said he convinced his employer, BMW, to provide coverage that benefits his autistic son, was puzzled why the Senate didn’t just take up the House-passed bill, especially since four years ago the Senate passed the same bill though it failed to become law.

“That bill is extremely important for those families who have insurance through small businesses and individual markets,” he said. “I’m lucky in the sense I work for a company that cares.”

Sen. Sean Bennett, a Dorchester County Republican and chairman of the banking and insurance subcommittee that held Wednesday’s hearing, said he was not picking sides, but he said advancing the new bill to the full committee would give those in support and those opposed to the bill a chance to work out a compromise. The committee meets next week.

“It doesn’t get past me that we’ve got to find a solution that’s going to work for everybody involved to get these kids the care and the therapy that they need,” he said.

The issue involves two separate problems. The first is that families, even those with coverage, are having a tough time getting treatment for autistic children because the state’s Medicaid provider rates are low compared to other states. Some therapy providers have quit or moved to other states such as North Carolina, which pay much higher rates.

More: SC autistic children wait for therapy due to low Medicaid rates, advocates say

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The other issue is requiring coverage for children left out of Ryan’s Law, those in small group plans or individual plans.

Lorri Unumb, an autism-awareness advocate whose son is the subject of Ryan’s Law, said she believes the bill advanced Wednesday could mean higher insurance costs for families of autistic children.

“I object to any new program that requires families who are already paying for insurance to pay again for this separate coverage,” she said.

Unumb said 10 years ago the autism community agreed to exclude those in individual plans and small-group plans because the cost of claims was unknown.

“We now know what the premium impact is,” she said, referring to 2015 numbers, the latest available. “It’s under 50 cents per member per month.”

Because the costs seemed minimal, she said autism-awareness advocates four years ago returned to lawmakers to ask the two groups initially excluded by Ryan’s Law to be included.

The resulting bill passed the Senate, she said, but failed to win a hearing in the House and died there.

In 2017, however, the House passed a similar bill that now sits in Bennett’s panel.

“It’s crazy,” she said. “You’ve got a concept that has already passed the full Senate and already passed the full House, just not in the same session.”

She said the first alternative proposal by those who don’t back the House-passed bill would have created a new program at the state Department of Disabilities and Special Needs. Another autism program there expired last December, sending children in that program to the state’s Medicaid agency.

She said the autism community only wanted to get benefits for people who already have insurance and did not want to set up yet another program.

The bill filed last week would place those not covered in Ryan’s Law in an existing high-risk insurance pool, create a trust fund and ask the Legislature to put money in it to pay premium costs.

She said that move seems unusual because the families involved are already paying for insurance.

Supporters of the new bill say that under the federal Affordable Care Act, if a state passes a new healthcare mandate, it has to pick up the cost of that mandate. So if lawmakers passed the House bill, they argued, the state would have to pay the cost.

But Unumb said in the four years of the ACA’s existence no state has been forced to pay for any mandate the state enacted. The state, in fact, decides in effect if it should send itself a bill, she said, and no state has.

She said 46 states have passed mandates for insurance coverage of autism therapy, and the majority include small group plans and individual plans in that mandate.

“Even though we were by far the leader in requiring this coverage, we’ve now fallen behind, because we now only require for state employees and large group plans, whereas those states require it for all of their privately insured individuals,” she said.

Kenny Bingham, a former House lawmaker, appeared Wednesday representing the South Carolina Alliance of Health Plans, a unified board for managed care in the state. He said he believes the new bill addresses the “totality of concerns” over coverage of autism in the state. He said it provides a “safety net” for families who do not have coverage today.

“It gives them hope; it gives them an opportunity,” he said. “We believe it’s the right thing to do for the state.”

Burnie Maybank, a former two-time director of the state Department of Revenue who handled insurance issues for former Gov. Carroll Campbell, said he was asked by Unumb, who recently became a DDSN commissioner, to appear before the panel.

He said he doesn’t have a problem with the panel advancing the new bill as long as it also advances the House-passed bill.

He said among the concerns about the new bill is that insurance companies would not write coverage for small plans if a high-risk pool exists and that they might shift existing policies into the pool.

“What basically this would do is the taxpayers would pay for this coverage, and I don’t think there is any precedent for that, other than the state health plan,” he said.

More: SC autistic children wait for therapy due to low Medicaid rates, advocates say

More: Advocates ask federal government to intervene in treatment of SC autistic children

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