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Health insurers want taxpayers to pick up the tab for autism care

There they go again. The health insurance industry has once again made clear its policy of sticking California taxpayers with the bill of caring for children with autism.

In an opinion piece published last week in Capitol Weekly, Patrick Johnston, the President and CEO of the California Association of Health Plans, argued that applied behavior analysis (ABA), an evidence-based therapy, should be administered by untrained public school teachers rather than trained medical professionals. What goes unmentioned is that, under this switcheroo, the cost would be absorbed in local school taxes rather than by private insurers.

Mr. Johnston’s assertion was accompanied by the same inflated cost analysis health insurance lobbyists have floated without success in Sacramento and 27 other state capitols that have required health care plans to stop discriminating against families dealing with children with autism and cover ABA treatment. Rather than estimates, we have real-life experience over several years in states that have enacted autism insurance reform showing that the impact on premiums is consistently well under 1 percent, or less than the cost of a cup of Starbucks per person per month.

ABA provides a level of early intervention for children diagnosed with autism that starts before they enter school and that has been scientifically proven to improve their functioning and help them achieve independence in the future. In the process, the need down the road for taxpayer-funded special education and social services declines. An independent analysis by the California Health Benefits Review Program estimated the initial savings for California taxpayers at almost $140 million, money that could help offset education and other critical services that are being cut. 

The nation’s largest autism science and advocacy organization, Autism Speaks, worked with Governor Brown’s administration and Senate President Pro Tem Darrell Steinberg to help craft SB 946, which awaits Gov. Brown’s signature. SB 946 provides a much-needed solution for families and California taxpayers, while shielding insurers from unreasonable financial exposure.

The issue involves agreements the state Department of Managed Health Care (DMHC) negotiated with Blue Shield of California and Anthem Blue Cross to begin reimbursing families for the costs of ABA. The fact that Governor Brown’s administration was able to negotiate these agreements just six months into office is a tribute to his commitment to the issue. The flaw found in the agreements is cured with clarifying language advanced by Senator Steinberg, who has long championed the needs of California’s families dealing with autism and other mental health issues.

The DMHC agreements require that ABA be supervised by licensed professionals. But California does not license Board Certified Behavior Analysts, the professionals who are trained to design and supervise ABA. Through Senator Steinberg’s legislative efforts, SB 946 would enable either state-licensed or nationally certified providers to supervise ABA therapy, as they do in most other states, providing the relief intended through the DMHC settlements.

What is particularly remarkable about the autism insurance reform movement is that it has succeeded across all regions of the nation and in states of every political persuasion, ranging from Vermont and Massachusetts to Texas and Arizona. An attempt to nullify the Arizona law earlier this year met with a veto from Governor Jan Brewer. In Washington, President Obama just renewed the Combating Autism Act which was originally enacted by President Bush.

At a time of mounting political dysfunction both in Congress and statehouses around the nation, the fight for families caring for loved ones with autism has risen above the partisan fray. This can be explained in part by the fact that more and more of us are now personally affected by autism. In fact, estimates of the number of children diagnosed with autism has risen to 1 in 110 (1 in 70 for boys.)

By signing SB 946, the California Legislature and Governor Brown will be able to bring relief to thousands of California families struggling with the costs associated with autism by providing the opportunity for their children to live a healthy and independent life.

Autism has become a public health crisis and an economic drain on limited state resources, which is why policymakers across the country are listening. On behalf of the thousands of California families struggling to pay for their children’s care, SB 946 would be a positive step that is long-overdue.

Rather than pit taxpayers against health insurers, Governor Brown needs to do what’s right for California’s children and sign SB.946.

Peter Bell is the executive vice president for programs and services at Autism Speaks.

 


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