Autism Groups Push for Coverage Mandates

Published February 1, 2009

As the number of Americans diagnosed with the neurobiological disorder autism continues to grow, advocacy groups are increasingly calling for more insurance coverage for the condition and pressing state governments to require insurance companies to include it.

One in 300 people in the United States has autism, according to the National Institute of Mental Health.

But health care analysts note the therapies aren’t actually medical and have been handled by school systems. They say government shouldn’t require the disorder to be covered in all policies, as such mandates simply transfer public education costs into the private health care market.

Autism Speaks, a New York-based advocacy organization, is pushing health insurers in 10 states, including California, New York, and Ohio, to add autistic behavioral therapy to their policies in 2009.

Six states—including Arizona, Louisiana, and Texas—have passed laws requiring insurers to cover intensive behavioral therapy for autistic children, and Autism Speaks has endorsed bills in states such as New Jersey and Virginia. Lawmakers in other states, such as Illinois, are working on their own versions of similar legislation.

Costly Mandates

While acknowledging the treatments can be helpful, experts say the plethora of government mandates is bad for everyone who buys health insurance, because it raises costs significantly.

“Our concern doesn’t have to do with this particular mandate per se,” said Susan Pisano, vice president of communications for America’s Health Insurance Plans, a Washington, DC-based association of health insurers. “Our concern has to do with mandates in general. There are thousands of mandates across the country, [which] have added 20 to 50 percent to the cost of health insurance premiums.

“Cumulatively, the effect of these mandates makes health care coverage less affordable and accessible, which means fewer employers are able to provide coverage,” Pisano said.

Questionable Validity

Analysts also note doctors don’t consider behavioral therapy to be an actual medical treatment.

“Some of the services that advocates have been asking to be covered are traditionally taken care of by school systems,” said Pisano. “The American Academy of Pediatrics considers them to be educational as opposed to medical. Advocates are saying there isn’t enough money in school budgets to provide such therapy, so the discussion has turned to transferring the responsibility to the health care system. This is important to consider when employers and individuals are saying they already can’t afford insurance.”

Rising Costs

If health insurers are forced to include coverage for behavioral therapy in every policy they offer, industry professionals warn, parents may not be able to get their children all the treatment they need or are used to receiving.

“While the mandate would provide financial help, I’m not sure [parents] will want to give up some of the types of treatment their child is already receiving,” said J.P. Wieske, director of state affairs for the Council for Affordable Health Insurance.

“I can tell you that if the legislation passes, insurance companies are going to look at the average of kids with autism and come up with treatment plans that they deem suitable for this group, which will not apply to all kids,” Wieske continued. “There is a lot of individuality with this diagnosis, so this could create real problems. Parents may end up trading the problem of cost for another of coverage.”

In addition, said Wieske, mandating autism behavioral therapy coverage by insurers could add $50 to every American’s monthly insurance premium, likely exacerbating the problem of unaffordable health insurance.

Aricka Flowers ([email protected]) writes from Illinois.