Health legislation and the truth about autism

Health legislation and the truth about autism

Since US President Barack Obama signed the Affordable Care Act (ACA) in 2010, autism advocates have celebrated what they say is an important achievement in securing autism rights. They expected the new law would require insurance companies to cover the expensive and potentially lifelong treatments for those with incurable autistic conditions. However, the law left it up to states to define, under certain conditions, the “substantial benefits” to be provided by insurance companies.

Coverage requirements for autism treatment such as occupational therapy, speech therapy and behavioral counseling typically vary between states. The US Department of Health and Human Services has announced that it will consider adopting a national standard by 2016. States would decide by then which treatment insurance companies must cover them.

The costs

Applied Behavior Analysis (ABA) is the most common treatment for autism. However, it requires intensive, tailored therapies that often cost over $60,000 per year. Depending on the severity, trained therapists who use ABA often spend up to 40 hours per week with a child. New studies by researchers at the University of Pennsylvania have estimated that a lifetime's worth of autism treatment costs an average of $2.3 million.

The point of contention

The American Academy of Pediatrics, the American Medical Association, and the Office of the U.S. Surgeon General support ABA. However, insurance companies argue that ABA is primarily educational, not medical. Consumer advocates argue that ABA coverage is so expensive that it is driving up insurance premiums and making basic health care unaffordable for millions.

What the states have done

A total of 34 states — Indiana being the first in 2001 — and the District of Columbia have complied with autism insurance mandates that require companies to cover ABA and other methods of treating autism in some of their contracts. All states with an autism mandate require insurance companies to cover ABA for state employees. Additionally, state laws vary significantly. Some apply only to a single health policy, while others cover large companies and small groups.

The federal government began insuring ABA for its eight million employees, dependents and pensioners last year. Members of a military personnel's family were also placed under ABA insurance coverage.

But benchmark plans in many states with autism mandates do not include autism mandates. For example, lawmakers in Ohio are considering introducing a bill on autism. In Alaska, the state's insurance chief wrote to lawmakers confirming that the newly worded autism mandate applies to policies sold on the state exchange.

Habilitation and autism reporting

The federal government has listed 10 categories of autism health services that states must cover as part of their essential services. Two of them are about autism: habilitation and psychiatric care. These are defined as therapies for children with developmental disabilities. The Department of Health and Human Services has told states to disclose the benefits that fall under habilitation. In addition to the national standard in 2016, the government is also only considering a new health law or the autistic people.

Inspired by Kalpesh Z Makwana