Insurance Coverage For Autism Therapies

Sean Trende from RealClearPolitics [RCP] makes the case why a new Virginia law that mandates that certain insurance policies cover autism therapies should not be opposed by conservatives. Excerpts from the article:

What of the objection that the market should not be interfered with? In most cases, this is a very wise objection. But the dirty little secret is that there is no health care market [for autism therapies]. This is not a situation like automobile insurance, where a person may opt for a low-cost high-deductible plan, only to find themselves in a bind once a serious accident ensues. Insurance plans that cover this therapy simply aren’t available. And demand won’t create supply, because so few people participate in the insurance marketplace. Their plan is selected by a third-party provider, who frequently had little knowledge or interest in the individual needs of the people on their plans.

This is shocking for many parents of autistic children, who work hard, play by the rules, see a deduction for health insurance every month, and then find out that the ever-increasing insurance premiums that they pay will not cover the therapy that can help their child become a functioning member of society. This is exactly the kind of expensive catastrophic treatment that most expect to receive from health insurance.

And this isn’t an exotic therapy either. It is the only therapy that is proven to mitigate the effects of autism. It is what a doctor prescribes when a child is diagnosed with autism. Insurance companies simply do not offer it.

Finally is this “Obamacare lite?” The answer here is an obvious “no.” The mandate here is not that individuals purchase these plans. It is that large employers make plans that offer these benefits available to their employees – the employees do not have to select a health care plan after all. It is an attempt to make possible an outcome that would almost certainly occur in a true marketplace.

Trende is one of the reasons that the RCP blog is so popular. The style is always analytical, avoiding the polemical attacks. The one thing which confuses me about this issue is why coverage is not offered with very high premiums. Trende seems to indicate that it is because “so few people participate in the insurance marketplace.” But that seems to run counter to the fact that Trende noted about “autism now affecting one in seventy boys in the United States.”

I hope to follow this more closely in the future. This issue will only get bigger because, as Trende notes very personally, autism affects a rapidly expanding base, which includes my family.

The entire Sean Trende article is copied at end of post.
——————————————-
April 4, 2011
Conservatives–And Gov. McDonnell–Are Wrong About Autism Coverage
By Sean Trende

Last month, after years of wrangling in the legislature, Virginia finally passed a law that mandates that certain Virginia insurance policies cover autism therapies. It is actually one of the more restrictive laws of the 23 states that require such coverage: it only covers fairly large plans, has a cap on benefits of $35,000, and only covers children aged two to six. But it is a start, and will help countless Virginia families.

The right has exploded in response to this bill. The Virginia Tea Party and the National Federation of Independent Business have all pushed Governor McDonnell to oppose the bill. They insist that it represents an outrageous imposition on businesses and is “Obamacare lite.” Several conservative groups have wondered why the market is not allowed to work its magic. Governor McDonnell did not veto the bill outright, but instead modified the bill to include several amendments aimed at gutting an already weak measure.

The tragic reality is that for many families with children on the autism spectrum, treatment is a far-off dream. There is one treatment for autism that is known to be effective: Applied Behavior Analysis (ABA) therapy. This critical therapy helps retrain the brain to “reinstall” the connections that are missing. Most parents have used variants of ABA therapy when raising their own children. If you’ve ever given your child Skittles for using the bathroom properly while potty training, you have the idea. You’re essentially retraining your child’s mind such that soiling themselves is no longer acceptable. With a child on the autism spectrum, the same behavior reinforcing techniques are used to teach children how to sit down when asked; to turn their head when their name is called; to look you in the eye; to draw a line; to wave “goodbye”; to point to something they want; and so on, to an almost infinite universe of tasks that parents of typical children take for granted.

The problems with the therapies are twofold. First, it has to be done early. Most are familiar with the concept that children pick up languages extremely quickly, but lose this ability as they grow older. The brain simply has extraordinary “rewiring” capabilities, which disappear with age. In other words, this is not something that can be addressed through normal “special ed” once a child becomes school age. If a parent misses their opportunity with a young child, it is largely gone.

Second, it is expensive. Extraordinarily so. In the Richmond, Virginia area there are three schools that provide these services. Tuition ranges between $35,000 and $57,000 per year. That does not include occupational therapy, speech therapy, and other therapies these children frequently requires. ABA generally requires one-on-one (or near one-on-one) intervention, which means parents must pay their therapists’ salaries, in addition to the overhead of the school, etc. Very few parents can do this.

This leads to the two reasons it was a mistake for Governor McDonnell to gut the bill, and why the Virginia legislature would be wise to override the veto. First, it is bad politics. Autism now affects one in seventy boys in the United States. This means that, should Governor McDonnell or a Virginia legislator ever want to seek higher office, virtually every one of their potential constituents will know a family with a child on the autism spectrum. Many will have a child in their immediate family on the spectrum. In other words, this is no longer an obscure disorder that is highlighted only in award-winning 80s movies. It is mainstream today, and is of critical importance to the families affected by it. Any politician will have to explain to a lot of potential supporters why they would not support increasing the availability of treatment. This is the type of issue that can easily overcome party loyalty for voters.

Second, and quite frankly more importantly, it is bad policy. Children who do not receive ABA therapy don’t disappear. They go to public schools, who struggle with them and end up spending large sums of money on personal aides and special education classrooms to live up to their obligations under the Individuals with Disabilities Act. Many, sadly, go on to institutions. “Investment” is all too often a catch word for “I just want to spend a ton of money,” but in this instance it really is an investment that will ultimately pay off with lower tax bills, fewer social services demanded, and smaller government.

What of the objection that the market should not be interfered with? In most cases, this is a very wise objection. But the dirty little secret is that there is no health care market. This is not a situation like automobile insurance, where a person may opt for a low-cost high-deductible plan, only to find themselves in a bind once a serious accident ensues. Insurance plans in the Commonwealth that cover this therapy simply aren’t available. And demand won’t create supply, because so few people participate in the insurance marketplace. Their plan is selected by a third-party provider, who frequently had little knowledge or interest in the individual needs of the people on their plans.

This is shocking for many parents of autistic children, who work hard, play by the rules, see a deduction for health insurance every month, and then find out that the ever-increasing insurance premiums that they pay will not cover the therapy that can help their child become a functioning member of society. This is exactly the kind of expensive catastrophic treatment that most expect to receive from health insurance.

And this isn’t an exotic therapy either. It is the only therapy that is proven to mitigate the effects of autism. It is what a doctor prescribes when a child is diagnosed with autism. Insurance companies simply do not offer it. It is the equivalent of having a child break an arm and finding out that the insurance company doesn’t cover setting the wound, or enduring a severe cut to the leg, and finding out that insurance won’t cover stitching it up.

Finally is this “Obamacare lite?” The answer here is an obvious “no.” The mandate here is not that individuals purchase these plans. It is that large employers make plans that offer these benefits available to their employees – the employees do not have to select a health care plan after all. It is an attempt to make possible an outcome that would almost certainly occur in a true marketplace.

One year ago, my son would not respond to his name. He did not smile and yell “daddy” when I came home from work. Like an infant, the only way he knew how to express a desire was to scream and thrash, but he was almost three and weighed forty pounds. Potty training was a distant dream. In the year since he has begun receiving ABA therapy, all of these things have changed. It is in everyone’s interest, both in the Commonwealth of Virginia and in other states, to help other children receive this life-changing therapy.

Sean Trende is Senior Elections Analyst for RealClearPolitics. He can be reached at strende@realclearpolitics.com.
Page Printed from: http://www.realclearpolitics.com/articles/2011/04/04/conservatives–and_gov_mcdonnell–are_wrong_about_autism_coverage_109450.html at April 04, 2011 – 08:47:25 PM CDT

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About Jorge Costales

- Cuban Exile [veni] - Raised in Miami [vidi] - American Citizen [vici]
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