A bill that would require health insurers to cover treatment for kids with autism is among a surprising number of insurance mandates to surface at the Utah Legislature and not because proponents expect a warmer-than-usual reception.
It's because the stakes are so high.
Patient-advocacy groups are banking on the likelihood that any mandate passed this year will be folded into the standard health policy that, come 2014, virtually all Utahns must have.
"Any mandate that becomes law will be grandfathered into Obamacare," said Sen. Todd Weiler, R-Woods Cross. "We've never had 14 mandate bills in a session. We've never had two that I can remember."
The federal health law calls for states to design an "essential benefits" package, the minimum set of benefits that most health policies will have to include.
States must base those benefits on their most widely sold health plans.
And states have to include coverage of care in these broad categories: ambulatory care, emergencies, hospitalizations, maternity and newborn care, behavioral and substance abuse treatment, prescription drugs, rehabilitative services, labs and X-rays, preventive care and chronic disease management and pediatric services, including oral and vision care.
But federal rules are vague on which specific treatment must be covered.
States that add mandates beyond those basics will be on the hook to pay for them for Medicaid beneficiaries and residents who get subsidies to buy their own plans.
Examples of such "excess" benefits, according to the Centers for Medicare and Medicaid, are coverage of in-vitro fertilization and Applied Behavioral Analysis [ABA] therapy for autism.
Research by states with these two mandates suggests in-vitro fertilization benefits raise average premiums by one percent. For ABA therapy, it's 0.3 percent.
Weiler is sponsoring a bill that would make it harder for mandates to pass.
It's backed by the insurance industry and Salt Lake Chamber of Commerce, which fears extra coverage requirements will result in higher insurance premiums for small business owners, some of whom may choose to stop offering health benefits.
The average family plan in Utah costs $12,618, of which employers pick up $9,073, according to the Kaiser Family Foundation.
For every "essential" medical treatment, gadget or service, there are dozens of "not-so-essential" ones, argued the Chamber in a blog post. The group singles out for criticism HB242, which would allow Utah's 88 athletic trainers to bill for their services.
Sponsoring Rep. Paul Ray, R-Clearfield, insists the legislation won't increase health costs. "It will just allow trainers to bill insurers directly instead of through another provider like a physical therapist," he said.
Bolstered by passionate pleas from parents and advocates of early intervention, a scaled-down version of the autism bill without a mandate is winning votes.
"The number of children with autism is growing," said the bill's sponsor, Rep. Ronda Menlove, R-Garland. "This is not a problem that is going to go away."
Ray said the insurance lobby persuaded legislative leaders to bundle the rest of the mandates and bring them before Business and Labor at one time, and he expects them to be killed. "I've never seen an industry with as much of a stranglehold on things," he said.
Tribune reporter Julia Lyon contributed to this story.