Surprising, I know, but there is now something that Assemblyman James Settelmeyer and I agree upon.

The State Assembly passed Assemblyman Ohrenschall’s AB162 this week. This bill requires insurers to cover early diagnosis treatment for children diagnosed with autism, up to $36,000 per year. The early treatment works wonders to improve the quality of life for children struggling with autism, and this bill promises relief for their families.

“This is a huge victory, not only for families, but for all Nevadans,” Speaker Barbara Buckley announced to reporters.

However, she conveniently failed to mention that “All Nevadans” does not mean…well… “All Nevadans.”

Thanks to amendment 433, the committee, citing concerns over cost, has excluded the children of state employees and medicaid recipients; indeed, these are the very families that need this coverage the most. Medicaid recipients, by the very nature of the Medicaid program, are a hair’s breadth away from economic disaster anyway. A diagnosis of autism in their child can financially wipe them out for the rest of their lives.

Although supporting the concept of the bill, Gardnerville’s Assemblyman James Settelmeyer spoke on the floor decrying the watered-down version which excludes these neediest of families. He pointed out that all families should be covered:  “I felt that the state should not be treating its employees any differently. Their children with autism count, as well.”

I wholeheartedly agree. This is insurance reform that our society desperately needs. The original bill was an astounding bit of progressive legislation in a traditionally non-progressive state, and it treated all autistic children as created equal. This amended bill is sort of like the Titanic: there weren’t enough lifeboats to save everyone, and the wealthy got to use the ones that existed.

A lifetime in the medical field has ingrained in me the core concepts of “Triage.”  In a nutshell, this is a method of sorting patients that enables medical professionals to exclude ethically those too gravely ill or injured so they can direct scarce resources to the remaining patients. Thus, the system utilizes thin resources to maximum benefit.  But, there was a caveat always mentioned in medical training: A medical professional should triage based on a patient’s medical need, not on their bank accounts.  This amended version of AB162 smacks of “financial triage”: a whole group of patients is excluded based solely on cost, in spite of their needs being identical to those lucky enough to be covered.

Nevada has already been treating its state employees as an unworthy underclass of citizen, cutting their pay and benefits and increasing their workloads, and this amended bill is yet another slap in the face to the people that keep the state running in spite of being demeaned and devalued by the very state they serve. In defending the bill as amended, Assemblywoman Sheila Leslie pointed out in session that some is better than none:  “The bill that you have before you today helps more than a few children. It’s the start. We need to cover autism for the state employees’ children, for our residents who are on Medicaid. Every child should have access to this treatment.”

Although I fully understand her point, the problems with this attitude–and indeed her very choice of words–are that a) this creates a subclass of Nevada families whose children are not worthy of concern from the state, and b) I’ll wager that the State Assembly never revisits the issue so the excluded families are covered just like the other families.

Let’s just say that I were to approach this with the same callous disregard as the committee showed for families struggling to support autistic children.  If the state is going to mandate that some families are not covered, why not a maximum income cap as a way to exclude coverage? Financially, that makes more sense to me, although from my more-normal humanitarian viewpoint,  it would still mean that excluded families will face financial troubles, even if they happen to be wealthier than Medicaid participants. Autism is not cheap, and it is truly an equal-0pportunity curse. Michael L. Ganz, MS, PhD, reported in a study that in 2003, a years’ worth of just therapies and behavioral support for autistic children cost $46,316. That doesn’t even include the medications or physicians’ bills or the costs of residential treatment and special tutoring. Dr. Ganz concludes that lifetime per capita incremental societal cost of autism is $3.2 million.

The bill now faces the NV State Senate, where it is expected to pass as amended, complete with built-in discriminations.

So, I’m in a bit of an ethical quandary here. Is it better to save a few and relegate the rest to financial extinction, or should we save none so that we don’t create a caste of uninsured untouchables? Perhaps our representatives at the State should have shown some backbone and covered everyone with this bill? If an umbrella is too small to cover everyone in a downpour, should we fold it up so that everyone gets soaked equally? Somehow, that doesn’t seem right. Or, when it starts to rain do we say, “You’re my grandmother, you’re getting over a bout of pneumonia, and you’re wearing a suede jacket, but I’m wearing Carhartts, a hat, and work boots. Therefore you should get the umbrella as you need the protection more than I.”  That’s only fair. Well, here’s an idea: how about we simply use an umbrella big enough for both of us?  Too bad, because the State Assembly has now handed us a small umbrella. Excluding poorly-paid state employees and Medicaid recipients from autistic coverage is the equivalent of keeping the little umbrella for myself and making my grandmother shuffle home in the rain.

I believe our representatives should be representing everybody, including their own state employees and the families dependent on Medicaid. Unfortunately, Nevada government keeps reminding me of that old, snarky statement on an employment evaluation:  “Keeps setting low standards and failing to meet them.”