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Moms plead health causes, but Georgia lawmakers don't have the money

Monday, March 18, 2013 7:53 AM
Last updated 7:46 PM
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ATLANTA -- Chocolate-covered doughnuts, heart-shaped Sweetarts and attractive young moms seeking hearing aids for their children greeted legislators last week as a panel designed to resist pressure for such insurance mandates like they support held its organizational meeting that afternoon.

JIM BLAYLOCK/FILE
Melissa Solares plays a card game with her son, Arturo, 5. Auturo has autism and spoke only a few words before he was 4. Ava’s Law, which state Rep. Ben Harbin, R-Evans, advocates, would mandate insurance companies pay for expensive, intensive services for children diagnosed with autism.

Bracketed in the space of a few hours was the clash of two social forces squeezing lawmakers. On one hand is the desire to hold the line on health-insurance premiums. On the other is a desire by ordinary people for help coping with rotten luck.

The mothers with the treats are concerned about families with even fewer financial means.

“It’s basically a group of seven or eight parents that started meeting in our school cafeteria,” said Kelly Jenkins, co-founder of LetGeorgiaHear.org.

That led to a petition drive, conversations with politicians and their assault on legislators with a sweet tooth.

For years, Republicans who control Georgia government have argued that health insurance is too costly because of laws that require insurance companies to include specific coverage for 41 items like chiropractors and mental illness. To do something about it, they created a panel to review proposed mandates before legislators can vote on them. The 19-member mandates panel, made up of legislators, doctors, the insurance commissioner and members of the public, can’t veto anything, but its recommendations could carry some weight in the General Assembly.

Three proposed mandates will come before the commission this year, one called Ava’s Law that would require coverage of Autism a second one, House Bill 74, which would require coverage of children’s hearing aids and a third, HB 73, which would include prescribed weight-reduction diets for the obese.

Sen. Tommie Williams, R-Lyons, sponsored Ava’s Law, named for his 9-year-old niece who is now a veteran witness before legislative committees after four years of pushing the proposal.

“I don’t know why insurance companies won’t see that this isn’t some untested treatment. This is something that works, and it saves money in the long run if they get the treatment early,” said Williams, the former president pro tempore, the highest-ranking Senate position.

Rep. Ed Lindsey, R-Atlanta, the sponsor of the hearing-aid and diet bills, is also a heavyweight Republican as the party’s House whip -- a leadership post third in line behind the speaker. Lindsey doesn’t feel he’s straying from Republican orthodoxy in pushing mandates that constituents asked for.

“I’ve long been an advocate for the principle that my job is not to come down here and deliver edicts from the Gold Dome but to take the wisdom of my community to the table where decisions are made,” he said.

He argues the issue of mandates should be determined by a three-way test. First, is the device or procedure prescribed by a doctor? Second, will it improve quality of life? And third, is it too costly for the average family?

Hearing aids, at $3,000 each, are what most families would consider costly. After replacing them every five years or so, it can mount to $40,000 per child.

Scarlett Giles has two children with hearing problems. Staff and students where her husband teaches high school pitched in for the first set, but she worries about when they wear out.

“If we don’t get this passed in the next two years, I don’t know what I’m going to do,” she said.

On the other hand, mandates raise the cost of insurance for everyone. Covering hearing aids for the 800 Georgia children that advocates say would be eligible would boost monthly premiums 25 cents for every policyholder.

Mandates like mammograms that apply to half the adult population inflate premiums more.

Insurance Commissioner Ralph Hudgens championed the idea of letting people buy policies designed for other states with fewer mandates, but he acknowledges that no companies have applied to sell them.

The companies don’t cover hearing aids and diet foods because they’re not medically necessary. After all, people can live long lives without being able to hear.

That’s where Lindsey’s quality-of-life test becomes a major departure from current Republican thinking.

Williams notes that early treatment often makes the difference between becoming a productive citizen or a lifelong dependent on taxpayers. And so, the quality-of-life test becomes more complicated because it’s not just about a patient’s happiness but about long-term savings for taxpayers.

“As health insurance premiums continue to increase for families and employers, it is important that we carefully consider any new requirements placed upon the fully insured health plans and how they would affect and protect consumers, the marketplace and future health care costs,” said House Speaker David Ralston, R-Blue Ridge.

The mandate commission will try to balance those issues when it releases its report before next year’s legislative session. In the meantime, three subcommittees will consider costs, alternatives and effectiveness.

The advocates for Ava’s Law and the hearing aids know they have a challenge, with employer groups like the Georgia Chamber of Commerce and the National Federation of Independent Business fighting mandates at every turn.

“We even have friends that tell us to our face, ‘You know, we don’t like mandates,’” Giles said.

GEORGIA MANDATES

Here is a list of what state law mandates Georgia insurance policies cover. Additional mandates also require coverage of treatments from specific health care professions such as psychologists, chiropractors and physical therapists:

Asthma prescription inhalers

Autism treatment as any neurological disorder

Bone-marrow transplants for breast cancer and Hodgkin’s Disease

Bone-mass measurement

Breast cancer mastectomies

Child cancer clinical trials

Minimum hospital stay for well-baby deliveries

Child wellness to age 5

Chlamydia screening

Colorectal cancer screening

Dental general anesthesia

Dermatologist direct access

Diabetes equipment and training

Heart transplants

Mammograms, PAP smears and PSA test for prostate cancer

Mental disorders

Morbid obesity

OB/BYN direct access

Off-label prescription drugs for people with life-threatening or chronic disabilities

Ovarian cancer tests

Pregnancy complications

Prescription contraceptives

Temporomandibular joint disorder

Source: Georgia Office of the Insurance Commissioner

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