autism, autistic treatment, insuring autism

Wisconsin Joins National Debate on Autism With New Insurance Bill

February 05, 2009 05:31 PM
by Christopher Coats
In hopes of joining other states that require insurance companies to provide autism coverage, Wisconsin lawmakers are pushing for a proposed health care mandate.

Paying for Autism Treatments

According to the Wall Street Journal, somewhere between one in 500 and one in 166 Americans suffer from autism, though the cause of the condition, and treatments for it, remain subjects of tense debate.

Recently, parents and advocacy groups, such as Autism Speaks, have begun to push state legislatures to implement mandates requiring insurance companies to cover autism treatments.

Lawmakers in Wisconsin have joined the ranks of Pennsylvania, South Carolina and Virginia in an effort to make at least some degree of autism coverage obligatory. Some states have offered qualified coverage, dictating how much may be spent on a child’s care each year or in their lifetime.

Reactions: Debating treatment cost and effectiveness

Insurance companies warn that the mandates will result in a sharp increase in premiums for all policyholders, while critics of the actual treatments in question are also vocal opponents.

Much of the protest stems from the inclusion of Applied Behavior Analysis, or ABA, in autism treatment programs. ABA is a time-intensive social approach to treating autism, requiring environmental modifications, and has been credited by advocacy organizations and parents alike for helping to ease the social and behavioral challenges faced by autistic children.

“If it wasn’t for his early years of ABA, I don’t think he’d be brushing his teeth, showering, getting his own snack,” Lisa Parles, mother of a 17-year old autistic child, told ABC News. “[W]hich for the future, as an adult, is going to have a huge financial impact.”

Stressing the costs of caring for autistic adults who have not undergone treatment of any kind, proponents of ABA have argued that the early investment will help avoid a much higher cost later on. According to ABC News, ABA therapy can cost up to $100,000 a year.

However, the effectiveness and definition of ABA therapy, which can require up to 40 hours a week for several years, have been called into question by critics and insurance companies. The definition of ABA as an educational rather than medical treatment has hindered insurance companies’ acceptance of the practice and their willingness to cover the treatment.

“Our view is that applied behavior analysis therapy is primarily used to change behavior to achieve educational objectives rather than address clinical problems,” wrote representatives from Kaiser Permanente, a managed care organization, in response to a push to require broader autism coverage. “It is not required to be provided by people with clinical training or a clinical license and is best provided in a home or school setting rather than a medical setting.”

In addition to questions surrounding treatment efforts, insurance companies have also suggested that individual states could impact autism in a much more cost-effective way, sparing business owners and other policyholders increased premiums.

"Estimated, private employers will see over $90 million a year in higher costs due to this new health care mandate," R.J. Pirlot of the Wisconsin Manufacturers and Commerce told his local Fox 11 channel. "For roughly $6 million annually Wisconsin can eliminate the waiting list for autism services."

Qwidget is loading...

Background: California’s autism increase

The recent push to expand coverage follows a surge in the number of cases of autism in the United States. Although critics have been quick to suggest that the increase is due to a change in criteria and early detection efforts, a California study released in January suggested that the spike was genuine.

According to the study, cases in California rose from 205 in 1990 to more than 3,000 in 2006.

Related Topic: Controversial autism treatments

As there is no confirmed cause or cure for autism parents have consistently sought out new treatment programs; Applied Behavioral Analysis is hardly the only one to attract controversy.

Last year, the U.S. government abandoned a study of chelation, a process that removes heavy metals from the body. Some parents feel chelation is a miracle cure for autism, while several researchers assert that the treatment might be detrimental.

Comparing the treatment to chemotherapy, proponents of chelation were quick to attack the last minute decision to skip the study.

“Children are given huge doses of chemotherapy and radiation in a desperate effort to save them from cancer—fully knowing the side effects themselves can be deadly,” wrote the authors of a blog on autism, Age of Autism. “It’s a fair risk most parents are willing to take to help a sick child.”

Reference: Autism


Most Recent Beyond The Headlines