Ever since US President Barack Obama signed the Affordable Care Act (ACA) in 2010, autism advocates have been cheering, what they believe is a major achievement to secure autism rights. They expected the new law to mandate insurance companies to cover the expensive and potentially lifetime treatments for those having incurable autistic conditions. But the law has left it to the states to define, subject to some parameters, the “essential benefits” to be provided by the insurance companies.
The coverage requirement for autism treatment, like occupational and speech therapy, and behavioral counseling, usually vary between states. The US health and human services department has said that it'll consider putting into place a national standard by 2016. The states, until then, would decide what treatment insurance companies have to cover.
Applied behavior analysis (ABA) is the most common autism treatment. But it calls for intensive, customized therapies that often cost over $60,000 annually. Depending upon the severity, trained therapists using ABA, often spends as much as 40 hours a week for a child. New studies by researchers of the University of Pennsylvania have estimated that a lifetime treatment of autism involves an average cost of $2.3 million.
The point of contention
The American Academy of Pediatrics, the American Medical Association, and the US Surgeon General's office endorse ABA. But insurance companies argue that ABA is mostly educational and not medical. Consumer advocates argue, covering ABA is so expensive that it causes insurance premium to rise and makes the basic health inclusion unaffordable to millions.
What the states have done
A total of 34 states-Indiana being the first in 2001-and District of Columbia, have passed autism insurance mandates that require the companies to cover ABA and other autism treatment methods in some of their policies. All states having an autism mandate, require insurance companies to cover ABA for the state employees. The state laws differ widely beyond that. Some are applicable only on an individual health policy, while others cover large corporates and small groups.
The federal government, since last year, has begun covering ABA for its eight million employees, dependents, and retirees. Members of a military personnel's family, have also been brought under ABA insurance coverage.
But benchmark plans in many of the states having autism mandates doesn't include autism mandates. The legislature in Ohio, for instance, is considering to move an autism bill. In Alaska, the state's insurance chief has written to lawmakers, confirming that the newly formulated autism mandate will apply on policies that are vended on the federal-run exchange.
Habilitation and autism coverage
The US federal government has listed 10 categories of autism healthcare services that states must cover under their essential benefits. Two of them are about autism: habilitation and mental health services. These are defined as therapies for children having developmental disabilities. The health and human services department has told the states to reveal the services being covered under habilitation. The government is also mulling a fresh healthcare law only or the autistics, besides the national standard in 2016.