In this article the problem whether insurance should cover treatment for autism is discussed. Proponents state that children with autism are in great need for costly medical treatment but they are often denied coverage by health insurance companies who would cover the same service for children without this diagnosis. Opponents assert that insurance should cover short-term needs, not the long-term care required by children with autism. Otherwise, insurance becomes unaffordable for the majority of population.
According to the Centers for Disease Control, autism, a complex neurobiological disorder, is diagnosed in 1 out of 88 children. And it becomes one of the fastest growing serious developmental disabilities in the US. Annual cost for services to a child with autism is estimated from 30,000$ to 72,000$, the sum of money not every family can afford. The lifetime societal costs of each person with autism are $ 3.2 million.
Autism Speaks presents eight arguments in favor of requiring private health insurance policies to cover the diagnosis and treatment of autism spectrum disorders for individuals under the age of 21. These arguments are supported by epidemiological, social, and economic studies of the children and families affected by autism and prove the significant long-term financial and public health benefits of this requirement.
The main idea of these arguments is that children with autism have a tremendous need for services from trained medical professionals, such as physical, occupational, and speech therapy. There is also broad agreement that early intervention is essential. No single treatment has been found universally effective, although Applied Behavior Analysis (provided in a 1:1 setting, for at least 20 hours per week), has the most research support.
But treatments for autism are difficult to access, often inadequate, and frequently delayed. As it was already mentioned, early intervention is crucial. So, parents face treatment expenses long before their child is eligible for services under Individuals with Disabilities Education Act, or IDEA. In addition, Medicaid operates as a short-term service provider, tending to push children through treatment as quickly as possible. Moreover, most insurance companies designate autism as a diagnostic exclusion. Thus, parents end up paying for therapies out of their own pockets or forego them.
In fact, the costs of the proposed benefit are small (less than one percent) and will have a modest effect on premium cost (50$ a year), but will improve the lives of thousands of children. Mandated private insurance coverage will decrease the lifetime costs of treating and providing services and will pay benefits, both economic and social, in the long run.
Representatives of the Council for Affordable Health Insurance, or CAHI, explain that mandates make health insurance more comprehensive, but they also make it more expensive because mandates require insurers to pay for care consumers previously funded out of their own pockets. It is estimated that mandated benefits currently increase the cost of basic health coverage from 20 to 50 percent. In fact, a particular mandate does not add much to the cost of a health insurance policy. So, many states have 40 or more mandates, and the accumulated impact of dozens of mandates makes health insurance unaffordable.
CAHI asserts that health insurance covers physical medical conditions of children with autism and should continue doing so. But autism advocates demand health insurance to cover areas that belong to education. In fact, the 2004 IDEA requires related services and treatments to children with autism to be provided by special education programs. If legislators are not satisfied with current situation, CAHI suggests that they create programs for children with autism and fund them from general revenues.
What is more, both the parties interpret the same data in a different way. Thus, Autism Speaks reports eight states with health insurance autism benefits. CAHI has tracked 39 states that have mental health benefit mandates on their books (of which 30 specifically include autism), 47 that have state mental health parity laws and at least three have habilitative services for children.