Mandating Insurance Coverage for Autistic Children

The Center for Disease control estimates that 1 in 110 children in America have an autism spectrum disorder, or ASD, and the number of children diagnosed has increased 57% in just four years (Rice 1-20). Almost everyone has had some experience with a child diagnosed with autism. These children reside in our communities, attend our schools, and may even be in our own family. Some states, such as Oklahoma, have individuals that are dedicated to passing mandated insurance coverage for children on the autism spectrum. They have been met with fierce opposition and have yet to succeed in getting any mandate passed in legislation. Only six states have specific laws that mandate insurance coverage for autism while 10 others have coverage for autistic individuals through mandates for the mentally ill (Kaminski). The lack of adequate health care for children with autism is a real problem in the United States and the number of families affected by this deficiency in coverage is only growing. States should mandate private insurers to provide coverage to children under 21 diagnosed with an autism spectrum disorder because the expense on the individual family is too great which results in a lack of treatment, left untreated the effect on autistic children as well as society is detrimental, and this is the only way to insure that autistic children receive adequate health insurance coverage.
Many opponents of laws mandating that private insurers cover autism treatments for children argue that the cost of individual premiums will rise and would result in more families not being able to afford health insurance. These opponents often include the health insurance companies, which have an interest in retaining a high profit margin, state Chamber of Commerce’s, as well as many in the Republican Party. Also, some individuals believe that they shouldn’t be forced to pay the high cost of coverage for a child with autism even though their particular family is not affected. The increase in health insurance premiums due to mandated autism coverage varies from state to state. While the state of Virginia, that recently passed these type of mandates, has forecasted a $4.88 rise in standard monthly premiums, other estimates have been much more conservative predicting a premium increase of only one dollar ("Evaluation of Proposed Mandated Health Insurance Benefits" 1-60). The average cost of covering an autistic child for one year is $36,000, which is about three to ten times the amount spent on health care for their neurobiological typical counterparts (Bouder, Spielman, and Mandell 953-957). This type of financial burden on a family can be insurmountable. Often times when parents cannot afford the treatments that their children need they are left with no options. Some low-income families can receive assistance through state insurance such as Medicaid, although many services such as applied behavior analysis, or ABA, may not be covered. Some opponents also argue that many therapies are offered through the school for free and are not based on a family’s income. Unfortunately, many autistic children rely on services that cannot be obtained at school. Early intervention is absolutely crucial to the development of children with autism. According to a report by Michael Guralnick, proper early intervention, before age 5, can reduce, and in some cases even prevent cognitive delay in children with disabilities (345-319). The increase in premiums that may result in these types of mandates would be minimal compared to the bankruptcies, stress, and lack of treatment for individual families.
I believe that autistic children who receive proper early intervention tend to be more productive members of society later on in their life. By passing mandates to cover these individuals we will be ensuring that they receive adequate and proper treatment. When autistic children receive proper treatment they have improved cognitive and behavioral skills that allow them not only to work, but also to be successful. The American Academy of Pediatrics recommends that as soon as an autism diagnosis is suspected in a child, treatment should begin immediately ("Evaluation of Proposed Mandated Health Insurance Benefits" 1-60). There is a small window of time in which treatment is found to be the most effective. Many children are missing this window of opportunity due to a lack in health insurance coverage. According to a study published in the American Journal on Mental Retardation, “when young children receive early intervention, we found that 48% of all children showed rapid learning, achieved average post treatment scores, and at age 7, were succeeding in regular education classrooms” (Sallows, and Graupner 438-417). With laws that mandate private insurers to cover these types of services, autistic children will be guaranteed to receive these treatments that evidence has shown to greatly improve functioning. With the cases of autism only rising in the United States, more and more families will find themselves struggling to afford care for their disabled children. It is also important to discuss what happens when children who do not receive adequate treatment grow up and no longer have parents to care for them. These autistic children could grow up reliant on the federal government for their care. By ensuring health insurance for them now we can give these individuals, as well as society, more hope for the future.
Some insurance companies do in fact cover autism treatments; although the caps on coverage are set so low autistic children are still left with gaps in treatment. Some families aren’t waiting for legislation to be passed. In the case of, Johns v. Blue Cross Blue Shield of Michigan, a family sued Blue Cross for denying their autistic child applied behavior analysis and were successful (Baldas). Blue Cross went on to include coverage of ABA to patients ages 2-5 (Baldas). In this particular case, the outcome was positive, but these types of lawsuits take time and may only impact a small segment of the country. In the meantime, these children are losing crucial time that could be spent in treatment. Opponents argue that instead of mandates legislators should be focusing on expanding existing laws such as the Individuals with Disabilities Education Act and coming up with more effective programs to help treat autistic children. While this is a great idea, it is only one small step in the right direction. Opponents also argue that by allowing insurance companies to sell policies across state lines more competition would be created and that may result in more coverage for things like autism. However, selling insurance across state lines would allow an insurer to choose their regulator resulting in coverage for only the healthiest Americans ("National Association of Insurance Commissioners"). Those with illnesses would find it even more difficult to obtain insurance. Insurance companies that chose to continue serving customers with more severe illnesses would be taking on the most risk and would eventually become too costly or die out all together. Interstate policies would also guarantee that insurers would be able to sell policies without obtaining a license from the particular state that the consumer resides in and would prevent state regulators from protecting consumers ("National Association of Insurance Commissioners"). The cost of health care premiums is determined by how healthy the members are. Selling insurance across state lines would allow these insurers to exclude anyone that isn’t healthy.
Children are innocent and rely on their parents and society to care for them. If we fail to provide them with proper health care and treatment the effect will not only be on the individual and their families, but the result will have consequences to us all. If appealing to your better nature is not an adequate reason for mandates then I appeal to your common sense. Many mandates are already in place and do not necessarily increase health insurance premiums. The cost of the possible rise in monthly premiums is diminutive compared to the ability to ensure that children who have these types of disabilities are given the opportunity not only to be healthy, but also to flourish. In the spirit of full disclosure I must admit that I have a personal interest in these types of mandates being passed. My oldest son was diagnosed at 5 years old with Aspergers syndrome, which is on the autism spectrum. Due to a gap in his insurance coverage he has been unable to receive applied behavior analysis. I may be emotionally biased on this subject but I also have the ability to realize the complexities in getting treatment and understanding what it is going to take to make it happen. The benefits of mandating health insurance coverage for autistic children far outweigh the risks. While insurance premiums may rise by a few extra dollars a month, this is a small price to pay to ensure that autistic children receive adequate health care coverage. If these children receive proper early intervention they will be able to contribute to our society. Without these types of mandates autistic children will lack the ability to reach their full potential. I believe that these types of mandates will eventually be passed and insurance companies will begin to cover the treatments that autistic children so desperately need, but it is up to us as a society to determine how long these children and families will have to wait.















Works Cited

Baldas, T. "Michigan Class Action Settlement on Autism Treatment Hailed as Landmark Case." National Law Journal (2009): n. pag. Web. 24 Feb 2010. .

Bouder, J., S. Spielman, and D. Mandell. "Quantifying the Impact of Autism Coverage on Private Insurance Premiums ." Journal of Autism and Developmental Disorders 39.6 (2009): 953-957. Web. 23 Feb 2010. .

Guralnick, M. "Effectiveness of Early Intervention for Vulnerable Children: A Developmental Perspective." American Association on Intellectual and Developmental Disabilities 102.4 (1998): 345-319. Web. 23 Feb 2010. .

"Interstate Health Insurance: Myth vs. Reality." National Association of Insurance Commissioners. The Center for Insurance Policy Research, Web. 24 Feb 2010. .

Kaminski, J. "OLR Research Report." Insurance Coverage For Autism. 27 Dec 2006. OLR Research Report, Web. 23 Feb 2010. .

Rice, C. United States. Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network. Atlanta: Center for Disease Control and Prevention, 2009. Web. 23 Feb 2010. .

Sallows, G., and T. Graupner. "Intensive Behavioral Treatment for Children With Autism: Four-Year Outcome and Predictors." American Journal on Mental Retardation 110.6 (2005): 438-417. Web. 24 Feb 2010. .

Virginia. Evaluation of Proposed Mandated Health Insurance Benefits. Richmond: Joint Legislative Audit and Review Commission, 2008. Web. 23 Feb 2010. .