Parents Fear Health Law Could Derail Autism Coverage
Washiington, DC, United States (KaiserHealth) – Autism treatment advocates have won one legislative battle after another since 2007, most recently in California, which sent a bill to the governor this month mandating that insurers cover the disorder. Now more than half the states have such requirements, but that success could be in jeopardy as federal officials set new national standards for health coverage.
Insurers and employers argue that the laws increase health costs because treatment is often expensive and lasts years. But the advocates have prevailed by using federal data showing a growing number of children with the disorder, compelling stories about middle-class families struggling to afford treatment and testimony from celebrity parents of children with autism, including former pro football stars Dan Marino and Doug Flutie.
However, a provision in the 2010 health overhaul law gives the federal government authority to define “benefits” that will be offered on the health insurance exchanges, or marketplaces, to individuals and small businesses starting in 2014. If states mandate a benefit, but it isn’t on the federal list, the states would be responsible for the cost of the coverage.
As a result, autism benefits and dozens of other state-required benefits, covering services and conditions such as infertility, acupuncture and chiropractic care, could be at risk. By the end of September, the Institute of Medicine is scheduled to recommend criteria the Department of Health and Human Services should use in determining the essential benefits package. HHS is expected to announce its decision by the end of the year.
“We do think states will be under enormous pressure to repeal benefits” not deemed essential, said Stephen Finan, senior director of policy for the American Cancer Society’s Cancer Action Network. The society is concerned that the benefits package will not include all the cancer screenings that it has recommended.
“It will be a new day,” said Amanda Austin, a lobbyist for the National Federation of Independent Business, which typically fights new insurance mandates because the costs will lead to higher premiums.
HHS faces a difficult balancing act: The more comprehensive the benefits package, the more it would cost insurers and their customers. Taxpayers would pay more, too, because the law provides government subsidies to help millions of people afford coverage.
Tens Of Thousands Of Dollars In Services
Most of the state laws covering autism require insurers to pay for behavioral analysis as well as physical and occupational therapy. These services can cost tens of thousands of dollars a year, although many states put dollar limits on coverage.
Autism encompasses many disorders ranging from mild to severe that can affect a child’s behavior and ability to communicate. Applied behavioral analysis typically involves one-on-one counseling to teach children how to behave or act in different situations. Although parents and many clinicians consider it the most effective therapy for children with autism, the results are mixed in peer-reviewed research.
Insurers typically oppose state benefit mandates, saying they reduce their ability to control costs. In addition, they argue that autism is a development disorder that is best addressed by the educational system, not the medical system.
Parents worry the essential-benefits provision could reopen the debate over covering treatment for autism and spark another showdown with insurers.
“Fear runs through my mind,” said Ann Rounseville of Newton, Mass., whose son Luke, 4, has been able to get speech, occupational and behavioral therapy because of the insurance benefit that started this year.
“Without this coverage he would not be getting any of the extra therapy he needs,” said Rounseville, estimating the Massachusetts law has saved her family more than $10,000 since May.
Stuart Spielman, a lobbyist for Autism Speaks, the New York-based group that has led the push for coverage laws, said he’s confident HHS will include autism because the federal law lists behavioral health treatment in its broad outline of what should be considered essential. The law also spells out the need for emergency services, hospitalization, maternity care, prescription drugs and prevention.
It’s unclear how HHS will decide what to deem an essential benefit. The agency could declare a broad list of categories of treatments and services essential and leave the specifics to the states.
At the state level, autism treatment advocates have argued that the problem is too big – and too expensive for families – not to be covered by insurers. They also say providing treatment to young children can save money in the long run by reducing the later need for institutionalized care.
The state mandate laws typically only affect about half of people with health coverage because they do not apply to self-insured employers, typically large companies.
1 In 110 Children Affected
According to the federal Centers for Disease Control and Prevention, 1 in 110 American children have been diagnosed with Autism Spectrum Disorder, including 1 in 70 boys. A Harvard University study in 2006 found that on average the annual care for a person with autism runs about $29,000 for medical costs and $38,000 for non-medical costs such as special education, camps and child care.
“The mandates have been a way for states to be doing something on a major issue without money coming out of the state treasury,” said Jack Pitney, professor of American politics at Claremont McKenna College in California. “It’s a cost borne by insurance companies who are not an object of a great deal of public affection.”
Insurers argue that the cost of autism coverage gets passed on to all their customers through higher premiums. The Council for Affordable Health Insurance, an insurer-backed group, estimates that autism mandates boost premiums from 1 percent to 3 percent.
Highmark, Pennsylvania’s largest private health insurer, says the autism mandate enacted in the state in 2009 increased premiums from 0.6 to 1 percent. Overall, the cost of employer-paid insurance for family coverage last year was $13,770, according to a Kaiser Family Foundation study. (Kaiser Health News is an editorially independent part of the foundation.)
Autism advocates point to lower estimates. They say data from the agency overseeing health benefits for South Carolina state employees shows that autism coverage added just 44 cents per member per month.
Richard Cauchi, program director of the health program of the National Conference of State Legislatures, said HHS has not yet said how it will determine the cost to states of keeping certain mandates. States may be required to pay the insurer or the enrollee.
Cauchi was surprised 16 states approved a variety of new mandates in 2011 given the uncertainty about future costs. Four of the states imposed autism benefits: Arkansas, Rhode Island, Virginia and West Virginia.
Until 2007, only Indiana required insurers to cover autism treatment. Today, 26 states do, not including California, where Gov. Jerry Brown (D) has not yet said if he will sign the bill, and New York, where a bill awaits the signature of Gov. Andrew Cuomo (D).
Autism advocates and other patient groups continue to press for more benefits laws. By 2014, Cauchi said, “There could certainly be a number of mismatches between what’s considered essential and what states have on their books.”
Wilson Cristancho of Miami hopes the autism treatment Florida requires remains part of his insurance. Before the law took effect in 2009, he said he piled up nearly $30,000 in debt for his son’s medical bills. The intensive therapy now paid for by his insurer has helped his son, Marc Anthony, 9, communicate and improve his hand-eye coordination.
“The mandate has had a huge impact on me and my family,” Cristancho said. “We don’t want to see it go away.”
– Provided by Kaiser Health News.
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Central banks lend dollars to European banks
Wroclaw, Poland (AHN) – Several central banks are loaning dollars to European banks that use the euro currency to prevent a return to a situation similar to 2008.
Participating in the three-month loan offers are the European Central Bank, the U.S. Federal Reserve, Bank of England, Bank of Japan and Switzerland’s Central Bank.
News of the coordinated step caused global markets to go up. The Standard & Poor’s 500 index in the U.S. closed up by 1.7 percent, while the German stock market closed up by 3.2 percent.
The announcement of the dollar loan was made at the European finance ministers meeting being held at Poland, which was attended by U.S. Treasury Secretary Timothy Geithner.
The loans will be done through swap lines and will carry a fixed interest rate. The Fed offered to lend dollars to help Europe contain the debt contagion. The deal would hold no real risk for the American central bank since it deals directly with the ECB and other European central banks.
With the loan, Europeans would not need to borrow from one another using overnight cash rates or seven-day dollar loan rates from the ECB.
While there was an agreement for the dollar loan, European finance ministers are not expected to agree to a collateral deal to pave the way for Greece’s next $151 billion (€109 billion), according to Finnish Finance Minister Jutta Urpilainen.
Finland insists on a collateral from Greece, such as shares in nationalized Greek banks or real estate. Germany added that in addressing the debt contagion crisis, the 17-nation eurozone must be guided by Europe’s existing treaties.
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Girls Gone Wild founder wins gambling debt case against Vegas casino
Las Vegas, NV, United States (AHN) – Nevada’s Clark County District Court on Wednesday threw out the case of Las Vegas billionaire Steve Wynn against Girls Gone Wild founder Joe Francis as it ruled that Francis did not intend not pay $2.5 million in gambling debts to Wynn.
District Court Judge Linda Marie Bell found that prosecutors had insufficient evidence to the theft charges against Francis. Francis had denied owing the amount to Wynn Resort after gambling there in 2007.
“I have maintained my innocence in this matter from the start,” Francis said in a press statement. “I think it was disgusting that Steve Wynn attempted to manipulate banking records to try to make this a criminal case.
Francis vowed to get back at Wynn.
“Believe me; I will do everything legally possible to make sure justice is served in this matter and that I am compensated for the damage that these false charges have caused to my reputation,” he said in the statement.
Francis’ world-renowned attorney, David R. Houston, said the Wynn Group used heavy-handed tactics to collect money from his client, “but failed utterly and completely.”
The case arose when Francis took out a marker or personal check to pay the casino. He check bounced prompting Wynn to file theft charges.
Prosecutors, however, said Francis’s bank account may have been frozen in connection with a federal tax case indicating there was no intent to default on the marker.
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Solar panel manufacturer Solyndra files for bankruptcy
Wilmington, DE, United States (AHN) – American solar panel maker Solyndra has filed for bankruptcy. It is the third solar firm since August to seek court protection from creditors.
Solyndra filed a Chapter 11 petition with a U.S. Bankruptcy Court in Wilmington, DE, after it amassed debts of $1 billion. However, it still has assets of about the same amount.
The California-based company shuttered on Aug. 31 and laid off its 1,100 workers. It suffered from losses due to competition from larger, foreign manufacturers that flooded the American market with solar panels, causing prices to drop.
On Labor Day, U.S. Rep. Pete Stark appealed to Solyndra to compensate the 1,100 dismissed employees. Stark, in a letter to Solyndra Chief Executive Officer Brian Harrison, said the summary dismissal of the workers without warning was reckless, irresponsible and heartless. The legislator hinted the layoffs could be illegal.
Solyndra, which did not give the mandatory 90-day warning for layoffs, said the law provides exemption from compliance with that requirement for companies that continue to attempt to line up financing to the day they closed.
The sudden dismissal prompted a former research engineer of the solar-panel maker to file a lawsuit on Friday against Solyndra.
Solyndra borrowed $535 million from the Energy Department loan guarantee program. The loan was criticized by Republican lawmakers, leading to an investigation this year by a subcommittee of the U.S. House Energy and Commerce Committee of the loan guarantee.
Solyndra retained 113 workers to help the debtors with restructuring efforts. With the reduction of its workforce, Solyndra’s payroll will be drastically reduced to $650,000 bi-weekly from $3.5 million.
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The Debt ( *** )
United States (Celebrity News Service) – 114 minutes
In theaters September 2, 2011
Rating: R, Thriller
The Debt earns our gratitude.
It’s a remake of a 2007 Israeli thriller about a legendary hunt for a notorious Nazi war criminal that examines that ever-elusive boundary between legend and truth.
The espionage drama begins in 1997 as shocking news reaches retired Mossad (the Israeli CIA) secret agents Rachel (Helen Mirren) and Stefan (Tom Wilkinson) about former colleague David (Ciaran Hinds), whom they worked with on a previous mission several decades ago.
The journalist daughter of facially scarred Rachel is in Tel Aviv to promote a book she has just written about her mother’s Nazi-hunting exploits, over 20 years after World War II, when she and her two colleagues hunted down, abducted, and apparently killed infamous Nazi doctor Dieter Vogel (Jesper Christensen), known as the Butcher of Birkenau for the horrific genetic experiments he performed, and who was then living and practicing obstetrics in East Berlin.
But improbable as it seems, Rachel finds out now, 30 years later, that Vogel may still be alive in the Ukraine, where a mental hospital patient is claiming to be him.
So we flash back to 1966 to see younger versions of Rachel (Jessica Chastain), Stefan (Marton Csokas), and David (Sam Worthington) perform their demanding mission, built around Rachel’s visits to gynecologist Vogel’s office, ostensibly to treat her infertility.
With a scheme as impassioned, complicated, and tense as the one the trio of spies has cooked up, things do go awry — and, people being people, a romantic triangle develops among them, which doesn’t exactly help them stay focused on the task — so that their mission will have to become part of history with several of its secrets remaining just that.
Director John Madden (Shakespeare in Love, Proof, Captain Corelli’s Mandolin) keeps his thriller urgent and breathless most of the way, in a manner that recalls the Bourne trilogy and Steven Spielberg’s Munich. But although he really takes to the thriller genre, Madden makes the romantic entanglements much more than an afterthought; that is, he seems to know just when to slow things down and just when to speed them up.
The two-time-period screenplay by Matthew Vaughn, Jane Goldman, and Peter Straughan must satisfy our desire for justice as well as our curiosity about the interpersonal dynamics involved. And as the past and the present catch up with each other, the film does just that, ratcheting the suspense up to an excruciating level several times.
If the third act doesn’t quite exceed or even fulfill our expectations — and, sad to say, it doesn’t — we can blame it on the superior nature of the first two acts.
The ensemble cast is mostly fine, and we would expect no less from the likes of stalwarts Mirren and Wilkinson. The exception is wooden Worthington, who rarely makes a big-screen impression at all despite his level of charisma-free stardom (Avatar, Terminator Salvation, Clash of the Titans) and here once again brings little if anything to the table. The result is that we really don’t buy that his David is the young version of Hinds’ mature version.
But the splendid if not astonishing chameleon Jessica Chastain takes a third 2011 step (after The Tree of Life and The Help) toward what appears to be a rapid rise to superstardom.
As a powerfully gripping and fascinating thriller, The Debt is paid in full.
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