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The inconsistent rhetoric of Blue Cross

Posted on March 11, 2010March 18, 2010 by Staff

Chris Fitzsimon

Blue Cross and Blue Shield of North Carolina Vice President Genie Komives and lobbyist Mark Fleming both appeared recently before a legislative study committee to oppose legislation that would require insurance companies to cover more comprehensive treatments and therapies for children with autism.

Sixteen states have already approved a version of the proposal that includes coverage of evidence-based behavioral therapy that helps children adjust to mainstream environments, helping the children and their families and saving money in the long run by reducing the need for institutional care.

A recent Centers for Disease Control and Prevention study found that roughly one in 110 children has some form of autism.

Komives told lawmakers that Blue Cross policies already cover many medical treatments, including speech and occupational therapy, though those treatments have annual limits that can force parents to pay for visits on their own.

She also questioned the effectiveness of expanded behavior therapies, despite significant evidence that shows they work, including a 2001 U.S. Surgeon General’s report.

Fleming told the committee that the proposal before them would be the most generous in the country if it were approved, a claim quickly contradicted by Lori Unumb, an attorney representing the national group Autism Speaks. Unumb pointed out that several states have no cap on the coverage.

Fleming tried again, claiming that states have only passed mandates in the last year or two, not enough time to assess costs or effectiveness. That was not true either. Unumb told lawmakers that several states had passed mandates as early as 2001.

Fleming’s last argument was that requiring more comprehensive cover for autism could raise premiums as much as 2.84 percent. But that claim came after lawmakers had already heard actuary Marc Lambright present a report that estimated the proposals would increase premium costs 0.4 percent.

When asked about the discrepancy, Lambright pointed to his methodology and similar research done in states that have already passed the mandate, such as Minnesota, where premiums have increased 83 cents per month per policyholder to provide the expanded coverage for autism.

The lobbyist for the North Carolina Chamber testified against the proposal, arguing that now is the worst time to increase the costs of insurance coverage and, remarkably, that the lack of consensus about its cost should give lawmakers pause.

By that logic, nothing would ever pass if a special interest merely showed up to oppose it, creating the dreaded lack of consensus.

There is something very close to a consensus that behavioral therapy works and would help families struggling to care for their autistic children while not increasing insurance costs significantly.

The consensus problem is with the rhetoric of Blue Cross.

Not long after Fleming and Komives were telling lawmakers that providing broader coverage for autism would raise premiums, Blue Cross spokesman Lew Borman defended recent pay raises for the company’s top executives, saying that “less than a third of a cent of the premium dollar goes to executive compensation, which means that executive pay has a nominal impact on premiums.”

Helping children with autism and their families would cost four-tenths of a cent of the premium dollar and that’s too expensive, but executive compensation that included a $4.08 million salary for CEO Bob Greczyn costs three-tenths of a premium dollar and it’s called nominal and doesn’t really matter.

At least we know where the company’s priorities are.

Chris Fitzsimon is executive director of N.C. Policy Watch.

1 thought on “The inconsistent rhetoric of Blue Cross”

  1. Rachel Adams says:
    March 16, 2010 at 6:07 pm

    This is ludicrous. I have a child with Asperger Syndrome. I have had to cut back on taking him to a psychiatrist due to the increase in the copayment amount and I’ve actually had him trying different therapies besides pharmaceuticals for some time because the meds are non-preferred (more expensive). I have BCBS of NC. This makes me sick for those families who have children who are on the full Autism Spectrum and have to have much more care for their children than I need. I don’t believe these people understand what they are doing to their customers or their constituents. They only see dollar signs.

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