State law requires insurers to include coverage for autism in comprehensive healthcare policies. Now, lawmakers want to go a step further, requiring coverage of a particular autism treatment: applied behavioral analysis. Insurers are resisting. They don’t question the effectiveness of the therapy; they just say it doesn’t fit the definition of “medical” treatment. Their position reflects how crucial parts of the healthcare system are wedded to the status quo, regardless of what’s best for patients. State lawmakers have passed a bill to overcome the insurers’ resistance, and Gov. Jerry Brown should sign it.
Researchers have found that a person’s brain makes crucial internal connections partly in response to genetics and partly in response to interactions with the environment. Autistic children don’t interact in the usual way, so their brains don’t make the proper connections. Applied behavioral analysis attempts to provide the interactions they’d been missing, encouraging their brains to adapt and make the right connections. Studies have shown that these techniques can help autistic individuals of any age, for example by teaching them to communicate effectively. And when preschoolers receive an intense program of applied behavioral analysis, they may make so much progress that they no longer need special education classes.
The therapy is offered to preschoolers by regional centers for the developmentally disabled, which are jointly funded by the state and federal governments. But the regional centers treat only the most severely disabled, leaving many parents to come up with the tens of thousands of dollars needed to pay for private care. Those who can’t must rely on the special education classes provided by increasingly strained school districts.
The therapy, however, doesn’t look like medical treatment. Although it’s prescribed by a doctor and overseen by a board certified professional, it can be administered by students or family members. That’s education, not medicine, insurers say. But it’s a form of education that’s designed to solve a medical problem, not improve grades or test scores. That’s why it should be considered medical treatment.
Late in the last session, lawmakers rushed through S 946, by Senate President Pro Tem Darrell Steinberg (D-Sacramento), to require most private health insurance policies to cover applied behavioral analysis for the full spectrum of autism disorders. Twenty-seven other states already have similar requirements. The mandate would be temporary, avoiding any potential conflict with the minimum coverage standards that the federal government is slated to issue in 2014. Under the healthcare reform law, though, those standards must include coverage of “behavioral health treatment.”
Insurers warn that the measure would add $200 million to the annual cost of health insurance; advocates say the change would increase premiums by less than 1%. The more children who receive the therapy early, however, the more costs from autism that schools, the state and taxpayers will be able to avoid down the road. Policymakers should shift the incentives in the healthcare system so that they reward the most efficient and effective paths to good health, rather than staying locked in a status quo that is slowly bankrupting the country. Requiring insurers to cover an unconventional but effective treatment for autism is a part of that effort.