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Four more states consider mandating health insurance coverage for autism therapies amid debate over who should cover treatment costs

Maryalene LaPonsie | February 16, 2011

As a complex brain disorder, the cause of autism is not yet known. Despite theories ranging from childhood vaccines to environmental toxins, scientists have yet to pinpoint how or why brains in 1 out of 110 children develop outside the norm. It also isn't clear why the rate of autism diagnoses appears to be accelerating. The advocacy group Autism Speaks cites government statistics that estimate the prevalence of autism is increasing 10 percent to 17 percent annually.

Early treatment of autism can lead to improved outcomes for those with the disorder. And that's the sticking point for many parents. Some health insurance companies don't cover common treatments for autism such as Applied Behavior Analysis (ABA). In response, there is a growing movement from parents and policymakers alike to mandate medical coverage for autism therapy.

Health insurance coverage and autism

The National Council of State Legislatures (NCSL) reports that 35 states have laws regarding autism and health insurance, and at least 23 states specifically mandate medical coverage for autism treatments. In addition, these four states have similar autism legislation pending:

  1. Virginia
  2. Ohio
  3. West Virginia
  4. Arkansas

The prospect of legislation creates passionate debate between parents fighting for what they perceive is their child's best chance for success and policymakers grappling with the question whether government should step in to dictate business practices to the private sector. Sometimes roles cross. In Michigan, Lt. Gov. Brian Calley - whose daughter has been diagnosed with autism - has publically championed government-mandated health insurance services, even while others in his party argue that such a mandate will only increase insurance costs for everyone.

The price of autism treatment

The cost of autism treatment is no small thing. Anecdotal evidence from parents indicates that the cost of intensive treatment can run upward of $50,000 a year. Some of the most recent research available on the subject comes from a 2006 study from the Harvard School of Public Health, which found that it costs an average of $3.2 million to care for an autistic person over the course of their lifetime. The total cost of care for all autistic individuals equals $35 billion per year.

Despite the large numbers, the Council for Affordable Health Insurance (CAHI) estimates that mandating coverage of autism treatments will only increase health insurance premiums by 1 percent. Should the trend toward increasing diagnoses of autism and greater use of treatments continue, the council believes premium increases could be more in the 1 percent to 3 percent range.

Along with the possibility that health insurance rates could increase, opponents of mandated treatment are also concerned with the appropriateness of medical insurance coverage for something that may be more accurately categorized as long-term care. The CAHI makes the argument that such services as occupational, physical and speech therapies are intended to help a child function, and therefore should be categorized as long-term care.

The question could be laid to rest should federal legislation be passed or health reform provisions identify as essential services such key autism treatments as ABA. Until that time, states continue to take a piecemeal approach to health insurance coverage for autism spectrum disorders.

Tags : health insurance mandates, pre existing conditions, medical insurance mandates

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