Hb 429 - Insurance: Insurance Generally
| Jurisdiction | Georgia,United States |
| Publication year | 2015 |
| Citation | Vol. 32 No. 1 |
HB 429 - Insurance: Insurance Generally
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Insurance Generally: Amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, Relating to Insurance Generally, so as to Provide that No Health Benefit Plan Shall Restrict Coverage for Prescribed Treatment Based Upon the Insured's Diagnosis with a Terminal Condition; Provide for Definitions; Provide for Penalties; Provide for Certain Insurance Coverage of Autism Spectrum Disorders; Provide for Definitions; Provide for Limitations; Provide for Premium Cap and Other Conditions; Provide for Applicability; Provide for Related Matters; Provide Effective Dates; Provide for Contingent Repeal; Repeal Conflicting Laws; and for Other Purposes
Code Sections: O.C.G.A. § 33-24-59.10 (amended), -59.18 (new)
Bill Number: HB 429
Act Number: 31
Georgia Laws: 2015 Ga. Laws 111
Summary: The Act prohibits a health benefit plan from restricting coverage for treatment of a terminal condition when the treatment is prescribed by a physician and is consistent with the best practices for treatment of the terminal condition, except in cases that are considered assisted suicide. The Act provides a limited autism coverage guarantee of $30,000 for covered insurance plans for children six years of age or younger with autism spectrum disorders.
Effective Date: O.C.G.A. §§ 33-24-59.10, -59.18, July 1, 2015; O.C.G.A. § 33-24-59.10, January 1, 20171
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History
House Bill (HB) 429 is the combination of HB 429 and Senate Bill (SB) 1 and, therefore, has two distinct parts.2 Section 1 addresses terminal conditions3 and Section 2 pertains to autism.4
Section 1: Terminal Conditions
In 1997, Oregon enacted its Death with Dignity Act, giving citizens with a terminal illness the option "to end their lives through the voluntary self-administration of lethal medications."5 Since the passage of Oregon's Death with Dignity Act, physician-assisted suicide has slowly gained acceptance; Washington, Vermont, and California have all passed statutes permitting the practice,6 while Montana permits the practice through judicial decision.7 According to a May 2015 Gallup poll, over half of Americans believe physician-assisted suicide is a morally acceptable option.8 The recent increase in acceptability may be from the highly publicized death of Brittany
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Maynard in November 2014, which created "a global dialogue" about physician-assisted suicide.9
Though physician-assisted suicide was an option for Maynard, many people with terminal conditions strive to maximize their life, but lack the financial resources to do so.10 Their fight for survival often becomes costly due to the high-priced, often experimental, drugs necessary to combat aggressive diseases. 11 For instance, Oregon citizen Barbara Wagner's last hope for survival was a $4,000 per month drug that her Oregon health plan did not cover. 12 However, because the drugs for physician-assisted suicide are inexpensive—in this case, only fifty dollars—Wagner's insurer agreed to cover them.13
Representative Ron Stephens (R-164th) also experienced the costs of a terminal condition after his father was diagnosed with aggressive lung cancer and prescribed a $5,000 per month drug.14 Though initially given three months to live, Representative Stephens's father's cancer is in remission over three years later as a result of the drug.15
Even though physician-assisted suicide is not a legal option in Georgia,16 death still results if a patient's insurance refuses to cover necessary and costly treatments the patient cannot afford alone. Representative Stephens introduced HB 429 to continue Georgia's pro-life tradition by ensuring that health plans cover all treatments necessary to combat a terminal condition, as long as prescribed by an appropriate healthcare professional.17
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Section 2: Ava's Law
Ava Bullard, the Act's namesake, is a ten-year-old girl from Lyons, Georgia who was diagnosed with an autism spectrum disorder when she was two.18 When first diagnosed, Ava did not speak, respond to her name, play with her toys, or even recognize her mother.19 Now, as a result of Applied Behavior Analysis (ABA) therapy, Ava is "completely indistinguishable from her peers . . . ."20
Experts agree that the key to an autistic child's future success is early diagnosis and treatment. 21 However, in January of 2015, Georgia was one of only twelve states that did not require insurance companies to cover ABA therapy, even though autism affects approximately 30,000 children in Georgia. 22 Without insurance coverage, the necessary ABA therapy is expensive—one Augusta family spent $115,000 within the first year of their son's diagnosis.23 Ava's mother, Anna Bullard, campaigned for seven years to guarantee insurance coverage for autism spectrum disorder treatment.24 On April 29, 2015,25 Georgia became the forty-first state to "mandate insurance for children with Autism."26
Legislation similar to Ava's Law was introduced in the Georgia General Assembly in previous years. Previous bills, similar to Ava's Law, include HB 309 by Representative Ben Harbin (R-122nd),27 SB
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191 by Senator John Albers (R-56th),28 and HB 559 by former Representative Chuck Sims (R-169th).29 Each bill was introduced in the 2013 session but did not pass out of its respective chamber because of "concerns about the high cost and questionable effectiveness of the treatments."30 Rather, the concept was given to the "non-legislative health insurance mandates committee," instead of a Georgia legislative committee, for review and a recommendation before the 2014 session.31 In the 2014 legislative session, then-Senator Tim Golden (R-8th)32 introduced the bill as SB 397.33 The bill was paired with the medical marijuana bill and renamed the Kids' Care Act, but ultimately failed because it never emerged from the House Insurance Committee.34
The Act finally succeeded in 2015 due to a compromise that lowered the amount of required coverage to $30,000 annually, but allowed Representative Richard Smith (R-134th) to introduce legislation in 2016 that will ask voters to "levy a 0.2[%] sales tax increase to raise as much as $300 million for autism treatments for children up to [eighteen]."35 Section 2 of the Act was initially introduced as SB 1 by Senator Charlie Bethel (R-54th) and was later combined with HB 429. 36 The Act passed both chambers unanimously.37
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Bill Tracking of HB 429
Consideration and Passage by the House
Representatives Ron Stephens (R-164th), Joe Wilkinson (R-52nd), Jason Shaw (R-176th), Matt Dollar (R-45th), Carl Rogers (R-29th), and Sam Teasley (R-37th) sponsored HB 429.38 The House read the bill for the first time on February 23, 2015,39 and the second time on February 24, 2015.40 Speaker David Ralston (R-7th) assigned the bill to the House Insurance Committee, which favorably reported the bill on March 11, 2015.41 The Committee noted the importance of distinguishing the values of Georgians from citizens of other states, namely Oregon, where patients can choose physician-assisted suicide.42 This discussion in Committee likely spurred the floor amendment offered by Representative Ed Setzler (R-35th) and Representative Stephens when the bill was on the House floor for a vote.43
Representative Setzler's amendment provided that "treatment," as defined in the bill, did not "include any medication or medical procedure, regardless of where actually prescribed, dispensed, or administered, which if prescribed, dispensed, or administered in this state would constitute assisted suicide in violation of Code Section 16-5-5."44 The importance of the amendment was discussed on the House floor and quelled worries of a "death panel." 45 The amendment ensures that HB 429 will not require Georgia insurance companies to finance an assisted suicide procedure when an individual moves to a state where assisted suicide is legal.46 This amendment sought to correct the unintended consequence of funding
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assisted suicide in other states, like Oregon.47 The House read HB 429 for the third time, with the Amendment to HB 429, on March 13, 2015.48 The House adopted the Setzler Amendment by a vote of 105 to 61,49 and passed HB 429 as amended by a vote of 170 to 0.50
Consideration and Passage by the Senate
Senator Charlie Bethel (R-54th) sponsored HB 429 in the Senate.51 The Senate read the bill for the first time March 18, 2015, and it was assigned to the Senate Insurance and Labor Committee.52 The Senate Insurance and Labor Committee favorably reported the bill by substitute.53 In Committee, HB 429 underwent significant substantive changes and emerged much lengthier, dealing with two pressing issues: insurance for terminal conditions and for autism spectrum disorders.54
The Senate read SB 1 on January 13 , 2015,55 and referred it to the Insurance and Labor Committee. 56 The Committee favorably reported SB 1 by substitute on January 27, 2015.57 The Senate passed the Committee substitute on January 29, 2015, by a vote of 54 to 0.58 SB 1 was read by the House for the first time on February 2, 2015, and for the second time on February 3, 2015, but it died in the House Insurance Committee.59 SB 1, or Ava's Law, was revived and usurped by HB 429 in the Senate Insurance and Labor Committee, and it became Sections 2A and 2B of HB 429.60
In Committee, HB 429 was an "available" bill for the incorporation of SB 1, and HB 429's sponsors were willing partners
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for passing the limited autism guarantee bill.61 In essence, HB 429 passed without opposition in the House and was in Committee when an agreement was reached to pass an autism guarantee bill.62
Section 2A and Section 2B of HB 429 provide for certain insurance coverage for autism spectrum disorders.63 Notably, Section 2A requires insurers to cover accident and sickness contracts, policies, or benefit plans to provide coverage for autism spectrum disorders for children six years of age or under...
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