Four-year-old Winston Ridley can read.

When he was 20 months old, a doctor told Winston’s mother that her son was a vegetable and would never be a contributing member of society.

Winston has autism. But thanks to treatment known as applied behavioral analysis, experts say, Winston has a chance to be a normal little boy and to grow into a fully functioning man.

Nearly 100 S.C. lawmakers are supporting a bill that would allow other children with autism to receive the same kind of treatment.

But the bill — with more than 80 co-sponsors in the House and another 16 in the Senate — is far from a sure thing. Insurers say the proposal would cost hundreds of millions of dollars and could hurt all S.C. residents.

Insurers say the higher costs would be passed along to consumers, making insurance too expensive for some as more mandatory coverages are added. They also say the measure would help only a slice of those who need it because it would not apply to at least 70 percent of the state’s autism patients.

The legislation, proposed by Rep. Nathan Ballentine, R-Richland, would require insurers to cover treatment for autism and other conditions known as pervasive developmental disorders.

Committees in the House and Senate will consider the proposal in the next few weeks.

And — despite the fact that the bill would not help her son because of the type of insurance they have — Winston’s mother will be there to tell legislators why it’s so important: It’s making her son better.

“This is my only shot,” Marcella Ridley said of the therapy. “This is the only chance he’s going to have.”

PAY NOW, PAY LATER

The treatment is expensive. It can cost up to $100,000 annually and generally lasts up to five years.

Insurance companies do not cover the cost, and few S.C. families earn enough to pay for the treatment.

Marcella Ridley and a group of other parents of children with autism have spent weeks and thousands of dollars trying to convince lawmakers of the bills’ merit. They have told lawmakers:

• The therapy works. Studies show nearly half of children who get at least 40 hours of therapy a week can be mainstreamed into first grade on time. Another 40 percent make substantial progress but still need treatment; the rest made minimal gains.

• It saves the state money. An autistic child who receives no treatment or not enough treatment almost always ends up institutionalized as an adult. That can cost the state up to $4 million per patient, studies have shown.

Seventeen other states have mandated some level of care for children with autism.

MAKING A DIFFERENCE

The bills — sponsored by Ballentine and Sen. Ray Cleary, R-Georgetown, and based on an Indiana law — are straightforward: They require insurance companies to cover autism and autism-related disorders.

An estimated 2,000 S.C. children under age 18 have autism, according to the state government. The great majority are eligible for at least some care through Medicaid.

According to the Department of Health and Human Services, the state paid more than $20 million for autism care in fiscal year 2005.

But Medicaid does not provide the levels of intensive, one-on-one treatment that autism specialists recommend. Plus, supporters of the legislation say, some of the money is delivered through Department of Education programs that fall far short of the treatments that have proven to be most effective.

Talk of broader coverage, however, is raising concerns from insurance companies and business organizations. They say:

• The proposal costs too much. It would lead to higher premiums because insurers would pass higher costs on to employers and the insured. This could cause smaller companies to stop offering insurance or to raise employee premiums to levels that make it too expensive.

• Benefits would be limited. Private insurers cover less than one-third of families with autistic children. The rest get coverage not addressed by the bills — through Medicare, some federal employee plans or large companies that find it cheaper to act as their own insurer — or have no health insurance.

Insurance companies “would like to help these parents, these unfortunate few parents that have children with autism,” said Larry Marchant, an industry lobbyist. “But we also have an obligation to try and keep (the cost of) health care as low as we can.

“We don’t want a situation where hard-working men and women in this state who can barely afford health insurance have to take on this mandate that everyone agrees would cause a huge cost increase in the market.”

If the bill requires insurers to cover autism patients regardless of age, Marchant said, it could cause premiums that individuals or families pay to increase by 25 percent. That would average about $200 a month, he said, for those enrolled in family plans.

If the mandate limits coverage to young children, cost increases would be much more modest, perhaps as low as $200 a year.

Sen. Cleary said he’s not persuaded by those arguments.

“If there are 10 people drowning in a boat and we can save three or four, do you go back home and say, ‘I don’t have a big enough boat?’ Or do you save who you can?” he said.

Although the bill has nearly 80 co-sponsors in the House, its future might well rest on a five-person subcommittee.

Rep. Dan Tripp, R-Greenville, is on the panel that is expected to vote on the bill April 4. Tripp opposes the bill.

“You are mandating this benefit that’s only affecting 20 to 30 percent” of children with autism, he said. “You’re passing a mandate on the backs of small businesses. The autistic children, they’re going to win. But people with health insurance are going to lose.”

CONTRIBUTING TO SOCIETY

For Marcella Ridley, Winston’s mother, the choice for her son was clear: With the therapy, he could have a future.

After Winston was diagnosed, “I remember driving around Columbia crying in the car, thinking, ‘Where is he going to make his friends? Is he ever going to get to go to a birthday party? Is he ever going to be invited to spend the night?’” Ridley said.

“I was so scared.”

Now, from 7:30 in the morning to 6:30 in the evening, Winston is in treatment of one kind or another. The one-on-one care aims to teach patients the most basic of skills — how to express needs or wants, how to play and behave.

“Every component of every part of our lives — basic things that we take for granted — must be broken down into tiny pieces and taught to Winston,” Ridley said. “We are racing against the clock in many ways. His best window of opportunity is right now.”

In some ways, Winston is lucky. His maternal grandparents are able to help pay for his therapy, which costs more than $75,000 a year. Marcella Ridley and her husband, Steve, an emergency department doctor, have health insurance through the S.C. Medical Association — but it does not cover autism.

Still, it’s sometimes hard to believe luck is involved.

The change in Winston’s development with the therapy was amazing, his mother said, especially once it was increased to 40 from 25 hours a week.

“As soon as we picked up the pace and really focused in on him, his abilities exploded,” Ridley said. “I don’t mean that he started talking in sentences, but he started making syllables, and he started forming sounds.”

Today, Winston’s sounds have turned into words that have turned into three- and four-word sentences.

Winston’s autism was profound. On a diagnosis measurement scale, it was rated one point shy of severe.

“But after three years of intensive (applied behavioral analysis) therapy, my son has taught himself how to read, he has eye contact, he knows love and expresses love.”

Compare that to what the doctor told Ridley — that Winston was a vegetable.

“He said Winston will never be a contributing member of society,” Ridley said. “He’ll never be able to measure up. Those were his exact words.”

FINDING AN ANSWER

Rep. Kenny Bingham, R-Lexington, the chairman of the House subcommittee considering the bill, is working on an alternative proposal. He wants to cobble together money the state already spends on autism and redirect it through Medicaid, making treatment available to all children who need it.

That way, Bingham said, the state could take advantage of the 3-to-1 match that the federal government provides for Medicaid. For every dollar the state spends on Medicaid, Washington will send back $3.

“It’s a state problem,” Bingham said, “and the state should take care of it,” instead of forcing private insurers to do so.

Such an approach could save the state money compared to the cost of institutionalizing children and adults with autism.

Bingham will try to amend the state budget bill this week in the House. He expects the bills’ co-sponsors to go along with him.

But some supporters say that is no solution. Other states have tried the Medicaid route, and “evidence has shown in other states that the state will go broke trying to fund it through Medicaid,” said Lorri Unumb, the mother of an autistic child and a professor at the Charleston School of Law.

Wisconsin has paid for applied behavioral analysis therapy through Medicaid since 1994.

The costs have spiked to the point that the state now is considering enrollment caps and limits on therapy, according to a study by the University of Wisconsin-Madison. The state also is considering requiring private insurance companies to cover autism.

Doing that is a step in the right direction, Marcella Ridley said.

Reach Gould Sheinin at (803) 771-8658.