Considering Utah SB 57

Utah’s SB 57 is an Autism Insurance mandate that would make insurance companies cover behavioral therapy, occupational therapy, and speech therapy for children with autism. I worked on the bill 2 years ago and I’ve worked with children with autism. I just want to spend some time sorting through it.

Let’s start by talking about all the arguments against the bill.

Argument 1:”I don’t believe in insurance mandates”

Fine if you are a political pundit, but I personally think that ideologies should be checked at the door if you are a legislator. When elected, you have a responsibility to consider each situation individually and do what is best for the city/state/country.

That being said, voters reward ideology and they punish independent thinking. Mitt Romney was framed as a “flip flopper” for changing his mind based on the current situation. People get elected by saying things like “I don’t believe in insurance mandates,” and they get reelected by sticking to that ideology.

Argument 2: “Insurance companies should cover it without a mandate”

Great, but they won’t. Just like they didn’t cover diabetes, heart disease, or cancer without a mandate. Insurance companies are in the money business and the less they cover the more they make. I would love to live in a world where they’d cover an epidemic of autism’s proportions on their own, but I don’t so…. mandate please!

Argument 3: “We can’t give a handout to every group that asks for one”

First of all, this is not a handout. Families pay insurance premiums, they just want their particular medical condition covered. They aren’t asking the government to pay them anything.

Second of all, I like the fact that you don’t give money to every group petitioning for funding. If an underwater basket weaving college wants public funding, please don’t just hand it over. However, autism affects 1 in 47 children in Utah. We have the highest rate of autism in the country. Read: epidemic. This is not a fringe group. That is one child in every grade in every school in every district in Utah. And they don’t need a handout. They need their medical needs covered by insurance.

Argument 4: “We don’t have the money

Yes you do. Because you’re paying plenty in social services for people with autism. And for every child that receives treatment, they can save up to 1 million dollars per child over their lifetime.  The bill is predicted to cost 3 million dollars. The pilot program showed the bill will not cost as much as expected, so it won’t even cost 3 million. Assuming, it does somehow cost that much, you could cover 30% of the children with autism for the same cost as not treating 3-4 children. That sounds fiscally conservative to me!

Argument 5: “Small business will be forced to close because of the mandate.”

Except they won’t. 34 states that have passed the law and a Utah pilot program prove that it will not shut down small businesses. The estimated increase is $0.33  per member per month. 33 cents. A business isn’t going to close based on 33 cents.

Now, let’s go through what has happened at the capitol.

HB 88

HB 88 was a bill that extended the aforementioned pilot program. It would cover 10% of children with autism (in addition to the approximate 30% SB 57 would cover), but is a social program. It’s basically a medicaid expansion for children up to the age of seven. This bill is not bad and will help a lot of people, but how come Utah’s Republican legislature is more ready to spend more money, covering less kids by extending social programs?

SB 57 1st Substitute 

This bill should ultimately pass later this week. It’s an amended version of the original bill and instead of covering kids up to 18, it will cover kids up to 9 for roughly 12 hours of therapy a week (the recommended amount is closer to 30 hours a week). The bill kicks in in January 2016. This is what we call a compromise. 

Buzz and Woody (Toy Story) Meme meme

Passing an insurance mandate in Utah is a HUGE accomplishment. Should it really be so hard though considering how much financial, social, and common sense it makes?

The Down Side

I am currently living with an almost seven-year-old boy with autism. Once he turns seven he ages out of HB 88 and in 2016 he will almost be nine and age out of SB 57. Nothing the legislature did is helping this little boy. 

Last week, when the amendments were announced, it was a day of mourning in this home. Sure, the bill is of great historical significance, but that doesn’t help him or any other child with autism right now over the age of five. It totally and completely blows. No one is at fault except out of touch legislators and insurance companies. It’s just something that really really sucks.

What I’ve learned 

Ideology doesn’t win.

Facts and logic don’t win.

Politics moves slowly.

The people who are fighting for something are not usually the people who benefit.

But sometimes, somehow, things get done anyway.

Congratulations to everyone who helped, and will help, SB 57 become law.


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