In its meeting at the Coverdell Legislative Office Building in downtown Atlanta, the commission Monday voted 8-3 not to proceed with a recommendation on House Bill 73, which would require coverage of medical foods for certain metabolic disorders and some gastrointestinal conditions costing up to $7,000, and HB 74, which would mandate coverage of hearing aids costing up to $6,000. It voted 7-4 to not recommend Senate Bill 191 and HB 309, which together would require autism treatments costing up to $50,000. Those bills are also called Ava’s Law, named after Ava Bullard, the daughter of Anna Bullard of Lyons, who spearheaded the effort to get the autism legislation passed.
HB 73 and 74 were introduced into the House in January and received two readings but were not voted on. SB 191 and HB 309 each were introduced into their respective legislative bodies in February and got at least one reading but were not voted on.
Monday’s vote is not binding, but District 134 State Rep. Richard Smith, R-Columbus, the commission’s chairman who also serves as chairman of the House Insurance Committee, said the committee likely would not approve the bills as they currently are written until the commission first recommends them. If the bills are rewritten, they could be introduced in the 2014 General Assembly, which starts in January.
“There were various reasons [why the commission voted no] depending on who you talk to,” Smith said. “My thoughts on it, and why I voted the way I did on the autism bill, it was very restrictive on who would be required to cover autism. By that I mean self-insured companies like your large companies and small businesses, the state of Georgia cannot mandate they do anything.”
Smith also said the cost to the state for all three mandates could be at least $20 million, money the government would have to pull from other programs in its budget.
District 54 State Rep. Edward Lindsey, R-Atlanta, who represents part of Buckhead, co-sponsored HB 73 and 74.
“I was disappointed with the result, but this is just the first inning in a long game,” he said. “The advocates and I understand we have to work hard to be able to show the necessity of these bills in tough economic times. However, both of these bills are critical to the long-term health of Georgia’s children.”
District 56 State Sen. John Albers, R-Roswell, who represents part of Sandy Springs, co-sponsored SB 191. In an email he said the autism bill would “provide a huge savings to Georgia, [an] estimated $1 million per child,” and was also disappointed by the vote.
“I am optimistic and believe helping children, family and being fiscally responsible is a no brainer,” he said. “I will bring it before committee to be passed in January. Thirty-four other states have passed this legislation. It is the right thing to do and we don't want to be last. I will stand with Georgia families and be a good steward of the taxpayers.”
Judith Usirtti, director of state governmental affairs for Autism Speaks, a New York-based national nonprofit advocacy group for autism patients and their families, which has a Georgia chapter, said the doctors on the commission voted yes and those supporting the bills will file their own report with the governor, in addition to the one the commission as a whole sent.
“Now we work our way through the legislative process with a negative report attached to our efforts,” Usirtti said. “Richard Smith did not mention this in the meeting, but we have discussed this with him: What needs to be changed is we’ve offered solutions to him for things he’s concerned about. No. 1, he’s concerned about health insurance premiums skyrocketing. We’ve included language in the bill to have an opt-out provision. If the required coverage caused health insurance premiums to go up more than 1 percent, then they could opt out.
“We’ve been monitored the issue in 34 other states. We see it as a 32-cent impact per member per month, which is under one half of 1 percent. Another thing they’ve mentioned is self-funded plans and they’re not subject to state law, so a lot of people will not be helped by Ava’s Law. Self-funded plans decide every year on what they will include in coverage.”
Sara Kogon, co-founder of Let Georgia Hear, a Sandy Springs-based advocacy group, said nearly 3,000 people have signed an online petition pushing for the hearing aid bill to be approved.
“We didn’t really know [why the bill was not recommended] but it’s a terrible climate for health insurance,” she said. “Nobody knows what’s coming in with the Affordable Care Act and mandates have not been favored by Republican legislators.
When asked what needs to be done to get the bill approved, Kogon said, “I’m really not sure. Every time we’ve come up with suggestions, we hear opposition to those. We’re not really sure right now. We haven’t had those discussions yet.”
Christine Cox, president of the Decatur-based Georgia Medical Foods Coalition, said 122 people needing medical foods would enroll in the state exchange through the Affordable Care Act at an annual cost of $857,000 with a per member per month cost of 11 cents.
“We think the cost to the state of a bill like this is minimal compared to the later costs the state will have to incur,” she said. “If people do not receive their medical foods there is a high cost in terms of lost benefit to society/lost productivity, increased medical costs as people get sick and have to be hospitalized. People will actually go on Medicaid and those costs will rise. Every dollar you spend on this bill is $7 saved. It’s a short-sighted bill. At least 38 other states have laws to mandate medical food coverage either through insurance companies or the states themselves.”
Cox said the group will possibly rewrite the bill between now and the 2014 session.
“We’re on a brainstorming patch,” she said. “But we’re not going away and are not giving up. It’s far too important.”
Lindsey said he also will continue to press on.
“I’m real proud of the folks who stepped up to advocate for it,” he said. ‘Even if we don’t get the mandates, by getting the word out, we are putting pressure on the insurance carriers to provide this coverage. We will work directly with insurance carriers to get these laws passed, because of lot of children depend on [them] for their success.”