Rapid City Journal, Feb. 17
Remove autism therapy insurance exemption
Autism sucks every bit of energy from parents. They shouldn’t have to also worry about the bewildering intricacies of small-group, large-group and individual insurance markets. State lawmakers should act to ensure fairness, protect children and invest society’s money wisely.
In some children, autism undercuts fledgling neural bridges reaching toward the outer world. Social cues and language skills get blocked, turning young minds increasingly toward frustrating mysteries.
Early intensive therapy creates new neural bridges in malleable young brains. Intensive, one-on-one, 40-hour-per-week training can pull some autistic toddlers - as many as one in seven - fully back from the abyss. Even those who don’t fully recover can gain connections that permit a better and more productive life. Later therapy helps, too, but brain patterns begin to harden around age 5. Afterward, it’s harder to teach and harder to unlearn.
This biology sets up an easy financial choice for society. We can help pay for costly therapy in the first few years - when it does the most good - or pay potentially higher costs over a lifetime. Autism is an expensive road for everyone, including taxpayers.
Insurance companies face a more complicated choice. They seldom benefit from savings passed along to future generations. Insurers live amid shifting allegiances caused by competitive changes in annual premiums and coverage. So when one insurer refuses to pay for costly therapy, others typically follow suit.
In 2014, state government mandated insurance payments for proven intensive autism therapies - at least among large-group policies. If all insurers live by the same rules, none can gain a price advantage by denying coverage. However, Obamacare initially required states to contribute funds for intensive therapy for policies purchased in the individual and small-group markets. To limit state costs, South Dakota exempted those policies. That Obamacare requirement has since disappeared.
This month, Sanford Health and Avera Health - two of the state’s largest insurers - took advantage of the state’s exemption, cutting therapy funds for some autistic children.
“It’s a price sensitivity issue in the South Dakota health insurance market,” Kirk Zimmer, president of Sanford Health Plan, explained to the Argus Leader. “Keeping a competitive product.”
Avera explained by email its cut would affect only holders of individual plans and not small-group plans. Sanford said it had mistakenly paid claims against individual plans and was halting the practice. Avera said it had initially hoped other insurers would follow its lead in covering exempted therapy claims, but they never did.
“We hope the discontinuation of coverage stimulates the conversation among insurance providers and regulators on how to best meet the need that exists,” Avera said in its statement. It’s no stretch to interpret that vague statement as a request to extend the therapy mandate.
Several South Dakota lawmakers are attempting to do just that.
Two bills introduced by Democrats and Republicans will seek to remove the state’s loophole for small-group plans. Each does the exact same thing: Cut the exemption.
Republican Rep. Sue Peterson of Sioux Falls and Democratic Rep. Ryan Cwach of Yankton introduced separate bills in the House, with Republican Sen. Brock Greenfield of Clark signing on as a co-sponsor of Peterson’s bill.
It would be heartbreaking for the parent of any autistic child to one day learn therapy coverage has been yanked. It would be especially aggravating to learn coverage was yanked due to the size of their employer. Suddenly, an arcane rule that governs insurance market classes will limit their child’s lifetime potential.
It’s time to close this loophole for the benefit of everybody involved.
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Argus Leader, Sioux Falls, Feb. 22
Preschool education should be state priority
It’s too easy to fixate on what qualifies as most outrageous among the time-compressed actions of the South Dakota state legislature each year.
That certainly holds true for the death of House Bill 1175 - which would have created an Early Learning Advisory Council - on a straight-line committee vote this week.
It’s easy to raise the alarm over House Speaker Steven Haugaard’s hyperbolic claim that educating children prior to kindergarten is an attempt at “instilling a socialist agenda into the system.”
It’s easy to recoil from the testimony of Florence Thompson, president of the South Dakota Parents Involved in Education, who leveled the charge that preschool is an avenue for indoctrinating young children into “the sexual orientation transgender agenda.”
It’s easy to decry that nine Republicans on the all-male committee summarily dismissed the efforts of the two freshman female representatives who crafted the bill through hundreds of hours of research.
Those things are important for South Dakota voters to mark. But focusing only on objectional rhetoric and poor optics takes our attention off the pervasive tendency toward poor leadership.
Too often, our state sacrifices enormous potential long-term returns at the altar of miserliness masquerading as “fiscal responsibility.” We make decisions on the exclusive basis of firmly held beliefs rather than facts, figures and precedence.
The deferral of HB 1175 to the 41st day shares a “talk to the hand” mentality that reflects other decisions made contrary to objective reality.
South Dakota is one of only seven states that did not even apply for a piece of the $100 million American Recovery and Reinvestment Act funding for early childhood development. Our share went to one of the states that bothered to fill out the form.
So no one can accuse these lawmakers of blindly following the popular crowd.
Further proof of that: South Dakota is one of only four state governments that doesn’t fund preschool. Only one of two states that doesn’t yet have an Early Learning Advisory Council, a prerequisite for further federal grants.
What’s the root cause of such insistence on being the last horse out of the gate?
Maybe it’s because, as a 2013 Pew MacArthur study found, South Dakota’s legislature is part of an elite group of 11 states that conducts worryingly few cost-benefit analyses to enlighten their policymaking.
House Bill 1175 did not mandate that every South Dakota child be ripped from the arms of wailing mothers and forced to attend preschool. It did not call for universal pre-K funded solely by the state.
What it would have accomplished is the establishment of a 12-person council, appointed by the governor, to study where preschool gaps exist in the state and allow South Dakota to begin receiving some federal funds for preschool programs, to the tune of $20,000.
Well-documented research indicates stellar returns for investing in quality pre-K access, ranging from three to 16 times back for every dollar spent. That includes money saved on remedial programs and reduced crime/incarceration rates as well as higher earning potential that comes from closing achievement gaps early.
A caucus that so often claims to be protecting South Dakota’s children with its legislative proposals throws the baby out with the bathwater again and again. The long-term good of the state is sacrificed for the short-term goal of hiding state tax revenues under the mattress.
That’s not leadership. That’s business as usual.
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Madison Daily Leader, Madison, Feb. 21
The South Dakota Senate Judiciary Committee voted this week to send a bill to the Senate floor that would reverse the state’s “presumptive probation” law enacted just six years ago.
A brief background:
A task force was established in 2012 to study variety of judicial system issues, including concerns of overcrowding in state prisons. In 2013, the Legislature passed and Gov. Dennis Daugaard signed the Public Safety Improvement Act which incorporated the recommendations of the task force.
One of the features of the act was that nonviolent criminals would be more frequently put on probation rather than being sent to prison. The policies was projected to reduce prison growth by more than 700 inmates over 10 years and to avoid more than $200 million in prison construction and operating costs.
The idea also was that rehabilitation, especially for drug offenders, would be more likely in a community-based, probationary setting, rather than in prison.
Since then, prison population growth has leveled off and we haven’t had to build more facilities. However, many offenders on probation have either violated their probation or committed new crimes, and county jails have been filled to overflowing.
So the 2019 bill, spearheaded by new Attorney General Jason Ravnsborg, is intended to reverse the presumptive probation policy, arguing that it ties judges’ hand when it comes to appropriate sentencing. Critics say the reversal would cost South Dakota more than $53 million over the next decade.
We think the issue deserves more discussion than just a few hearings during a legislative session. The judicial reform task force in 2012 included all sorts of constituents, including citizens, judges, law enforcement officials and counselors. Their study involved many factors and enjoyed broad input.
To reverse that work deserves the same treatment. A new task force should be formed to be inclusive, open to public input and thorough. This is an important issue that requires more discussion than it has gotten so far.
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