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Autism, Health Policy, In the News, Pediatrics

A mandate for insurance companies to cover autism treatment

I was almost 21 before I had any concept of what autism was or what it meant, especially for those families affected by it. But in just a few weeks, I found myself immersed in the issues after taking a job as a behavior instructor for an early-intervention Applied Behavior Analysis (ABA) program.

So I took notice when California Gov. Jerry Brown signed SB 946 – a bill mandating that private insurance companies provide coverage for families seeking ABA therapy as autism treatment. The law will take effect in July 2012.

Insurers have argued that behavior therapy is more aligned with education than with actual health care, but in a Los Angeles Times column, David Lazarus points out these types of treatments are medically necessary. And pricey:

Autism, like nearly all chronic conditions, is expensive. It requires not just medical treatment but also extensive educational, behavioral and vocational support.

A study from the Harvard School of Public Health found that direct medical and nonmedical costs for a severely autistic person can run as much as $72,000 a year. People with milder forms of autism can face costs of about $67,000 annually.

Insurers are concerned about cost: A statement from the California Assocation of Health Plans (an industry group) predicted that SB 946 would drive up health care costs by $850 million a year. But the financial impact of the legislation varies depending on who you ask. The California Health Benefits Review Program conducted an evaluation of the bill for the state legislature estimating that annual costs of the law would actually be closer to $93 million – no small amount of change, but a far cry from $850 million.

The issue is certainly complicated, and there is still quite a bit of time before we begin to see how this will unfold. But as someone who now considers herself an advocate for early intervention and for ABA, I can’t help but wonder if this isn’t a win for many families in California.

Previously: Autism therapies: It still comes down to parents
Photo by Lance Nielson

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