TIME FOR AUTISM INSURANCE? - No

BY KEITH D. CHEATHAM
Published: January 4, 2009

When legislators return to Richmond this month, they will face a pressing question -- do we want more expensive health insurance coverage for fewer people, or do we want more affordable health insurance coverage for most people?

It's a fair question, and the answer will depend on how legislators respond to a recent recommendation of the state's Special Advisory Commission on Mandated Health Insurance Benefits to add another health insurance mandate to the growing list of ones we already have.

The advisory commission mandate recommended this time around is for coverage of educational services for "autism spectrum disorder," a complex developmental disability encompassing a group of disorders that cause problems with social interaction, communication, and behaviors.

Unfortunately, the advisory commission's recommendation, if accepted, won't make health insurance more affordable for many, and that's especially true for fully insured small-business owners and their employees. Larger, self-insured employers, such as the Commonwealth of Virginia, on the other hand, will escape the new mandate because they are exempt from the state requirements and don't have to provide the coverage unless the legislature specifically adds it. So far, efforts to add the benefit at least to the state's health plan have failed -- largely due to the added costs during these difficult budgetary times.

The advisory commission's November vote was also interesting in that it came just two days before

The Times-Dispatch reported what we already know: Small-business owners are struggling to provide quality health insurance to their employees, and more employees are being asked to pick up more of the costs.

The newspaper also published, on Dec. 18, another article outlining a family's recent legal battle with the Hanover County school system to provide appropriate services for their son, who suffers from this disorder. A review of articles across the state reveals this is not an isolated incident and that families are frustrated that their children are not receiving these services from the school systems. However, mandating that smallbusiness owners cover educational services through their health insurance policies does not fix this problem.

The proposed mandate could add as much as $4.88 per month for standard coverage, according to a Joint Legislative Audit and Review Commission (JLARC) report. That may not sound like a lot, but when applied across the employer group, it amounts to a significant cost increase for employers. Taken alone, this one mandate might not break the bank, but as I testified before the vote, it is the cumulative cost of all the state mandates that must be considered, and they are substantial. Virginia now ranks third in the number of mandated benefits and providers.

The recommendation of the advisory commission is set on a collision course with another legislative commission -- the state's Small Business Commission -- that voted recently to recommend that the 2009 General Assembly refrain from piling on more mandates. The Small Business Commission went a step further and also agreed to take a few bricks off the backs of smallbusiness owners by recommending the approval of more affordable policies that remove some of the mandates for small-business owners who haven't been able to afford health insurance coverage for their employees for some time.

The Council for Affordable Health Insurance periodically reports on trends in state-mandated benefits -- and what it has to say is noteworthy. Without going into great detail, here's what the council had to say:

That thinking can be documented. One recent national report shows that only 63 percent of all firms offered health benefits in 2008. That's down from 66 percent in 1999. For small firms with three to nine workers, only 49 percent offered health benefits in 2008 -- down from 56 percent in 1999. Adding more mandates won't reverse this trend.

So the question that awaits state policymakers when they return this month is still the same -- do we want more expensive insurance coverage for fewer people, or do we want more affordable coverage for most people?
Keith D. Cheatham is the vice president of government affairs for the Virginia Chamber of Commerce. His office is located in Richmond and he can be contacted at