Brian Lyman

Montgomery Advertiser

An Alabama Senate committee Wednesday approved a bill that would require insurance coverage for autism, but only after a lengthy debate in which the chairman repeatedly attempted to amend the bill in what supporters said was an attempt to delay or prevent its passage.

Most of the amendments offered by Senate Finance and Taxation Committee chairman Trip Pittman, R-Montrose, were defeated, but Pittman did manage to amend the bill, sponsored Rep. Jim Patterson, R-Meridianville. to limit coverage to large businesses and cap therapies to age 16. Pittman framed his strategy largely in terms of trying to protect public money and expenses, and noted that the state's largest insurer, Blue Cross Blue Shield of Alabama, had made an offer to cover autism therapries in exchange for an age cap and limiting the age requirement.

"One of the great ironies of this is we want to mandate an insurance company to do something they will do on their own," he said. "But it’s the same company. "I think the trust issue a little misguided."

To supporters, though, Pittman's goal seemed to be an attempt to send the legislation back to the Alabama House of Representatives and allow it to die in a conference committee. Sen. Cam Ward, R-Alabaster, whose daughter is on the autism spectrum, at one point referred to lobbyists and saluted "all the people in the hallway"who he claimed -- over Pittman's denials -- drafted the amendments.

"I’ve been here long enough to know that (running out the clock) is a strategy, and I see it in play," said Sen. Bill Holtzclaw, R-Madison.

Those suspicions rose still further Wednesday after the bill passed committee 14 to 2. Pittman, one of the no votes, refused to transfer the bill out of committee, saying he wanted the amendments that were defeated on the bill, particularly one that would exempt the mandate from the state's public insurers, like teachers and state workers' insurance, and Medicaid -- which is required by the federal government to provide autism therapies.

"The bill still needs work," he said. "This blows our budget wide open. It’s going to cost the taxpayers tens of millions of dollars."

Supporters of the bill strongly disagreed with that assessment. Patterson said businesses in other states can pay as little at $10 per employee per year to provide the coverage.

"They knew when it came to (Pittman's) committee, with his feelings on mandates and government, you’d get these kinds of amendments," he said. "This bill should have been in the Health committee."

Senators who support the bill had a hard time hiding their anger over Pittman's strategy Wednesday.

"We won 14 to 2," Ward said Wednesday. "And now he's trying to politically blackmail us into votes he lost on. I’m not going to do that."

Sen. Dick Brewbaker, R-Pike Road, warned that Pittman was putting the session in peril.

"I still expect the bill to be reported out tomorrow," he said Wednesday evening. "But if it’s not, I think we’re about finished. I think there are enough senators at that point who will believe all the previous undertakings given never meant seriously."

Pittman said it was a risk he was willing to take.

"I would rather sine die (end the session) than to allow bill to pass in current form," he said. "The state would be saving tens of millions of dollars."

Coverage

Alabama is one of a handful of states that does not mandate coverage for autism therapies, which can cost up $120 an hour, and many families pay for the therapies out of pocket. Local school systems also shoulder a greater burden of the costs.

Patterson’s legislation initially would have required insurers to cover up to $40,000 a year for autism therapies for children up to age 9; $30,000 for those aged 10 to 13; $20,000 for those aged 14 to 18 and $10,000 for those 19 and older. Insurers would have been allowed to suspend the plans if they demonstrate offering the coverage will raise premiums one percent.

The Alabama House of Representatives voted 100 to 0 last month for the bill. But the legislation has stalled in the Senate, and supporters have had to threaten filibusters to push bill forward.

Autism advocates organized in support of the legislation. Supporters, wearing red T-shirts with saying "Autism matters" on the front and the names of individual children on the back, flooded the small Senate committee room Wednesday. but both the Business Council of Alabama and Blue Cross Blue Shield of Alabama, the state’s dominant insurer, pushed back against it, arguing it would raise costs for businesses.

BCBS floated a proposal Tuesday to cover the therapies starting in January, though only for those 16 and younger, if the mandate was dropped. Robin Stone, a lobbyist for BCBS, said the insurer planned to offer something similar to what was in Patterson's bill, whether or not the bill passed.

"What we believe is employers should make this choice," he said after the vote. "What the Legislature is doing is replacing this choice of 1100 businesses in this state with a legislative order. That’s our position."

Pittman offered several amendments he said would save the state money, including one to exclude Medicaid, the Public Education Employees Health Insurance Program (PEEHIP) and the State Employees Health Insurance Program (SEHIP) from the mandate. The state cannot exclude the coverage in Medicaid, and Democrats and Republicans on the panel did not want to.

"We can’t leave those children behind because they’re on Medicaid," said Sen. Linda Coleman-Madison, D-Birmingham.

Others were concerned about families with autistic children. When Pittman mentioned the stress businesses face in providing insurance, Sen. Billy Beasley, D-Clayton, asked Pittman to "think of the stresses the families of children with autism go through each day."

Ward openly accused Pittman Wednesday of allowing insurance lobbyists to write the amendments, including one that would limit maintenance therapies, a move Ward in committee called "the cruelest amendment." Pittman denied that Wednesday, saying "I'm my own man."

Supporters of the bill have repeatedly suggested backroom deals were killing the bill. Senate President Pro Tem Del Marsh, R-Anniston, denied that Tuesday night.

“There’s been conversations about what are the implications if this passes, what’s going to happen,” Marsh said. “All that kind of talk is going on. But there’s no deals cut. I can’t tell you, standing here right now, how that thing is going to end up at the end of the day.”

There are five days left in the current legislative session. If the bill passes the Senate, it must go back to the House for concurrence or a conference committee.

"If it doesn’t get a second reading tomorrow in the regular order of business, more than half the Senate is going to be extremely uncooperative," Brewbaker said.