THE debate over mandating insurance coverage for a wide range of autism treatments has been heated at times in Oklahoma. Advocates have portrayed opponents as heartless cads who want children to suffer. Instead opponents were reasonably concerned a broad mandate could significantly increase insurance rates, making policies unaffordable for many. Oklahoma lawmakers ultimately rejected the mandate.
So when Obamacare passed in 2010, mandate proponents cheered. Surely Obamacare, which includes everything from “free” birth control pills to classifying 25-year-olds as “children” on a parent's insurance policy, would mandate autism coverage, right? Wrong.
Stateline.org reports that “instead of creating a national standard for autism coverage, the administration bowed to political pressure from states and insurers and left it to states to define, within certain parameters, the ‘essential benefits' that insurance companies must provide.”
“Far from smoothing out those differences, critics say the ACA will add a new layer of complexity,” Stateline reported.
For the time being, states without an autism mandate won't have to mandate autism coverage. And even some states with a mandate may not have to include autism coverage in the minimum-level policies sold through their health exchanges. That may surprise some, but it shouldn't. Valid cost concerns remain.
The most widely used treatment, applied behavior analysis (ABA), requires hours of intensive, one-on-one therapy. It can cost as much as $60,000 a year. A study by researchers at the University of Pennsylvania and the London School of Economics estimated the lifetime cost of treating a person with autism is $2.3 million.
Those numbers caused even federal officials to be hesitant, and they undermine claims previously advanced by local supporters of an autism mandate.
In 2008, former state Sen. Jay Paul Gumm, D-Durant, distributed an actuarial study conducted by James Bouder of the Vista Foundation, a Pennsylvania-based autism advocacy group. It predicted an autism mandate would have minimal impact on Oklahomans' insurance rates — but only because it assumed few with autism would benefit from the mandate.
At that time, 63 percent of private-sector workers in Oklahoma were enrolled in an employer's self-insured plan. Those plans are exempt from state insurance mandates under federal law. When that group was combined with the uninsured, the Bouder study estimated up to 70 percent of Oklahomans with autism would get no benefit from a mandate. Of the remaining 30 percent, the Bouder study estimated only about one-third would actually seek treatment. The study then assumed those seeking treatment would use just 30 percent of the proposed $75,000 annual benefit, on average.
In other words, the study noted few would receive the benefit, then predicted those who did would largely ignore it and those who used it would not use it much. Lawmakers were understandably skeptical.
Instead, they pursued other proposals providing broader benefit to those with autism. Lawmakers increased in-state training for behavioral therapists. They provided scholarships to children with autism, allowing those kids to attend schools designed to maximize benefits for that population. Today, the positive result of these efforts is undeniable.
As understanding of autism grows, treatments undoubtedly will improve and insurance will increasingly cover them. This doesn't mean Oklahoma lawmakers were wrong to hold off on an autism mandate. When even the fiscally profligate Obama administration worries that open-ended autism coverage might be a budget buster, Oklahoma Republicans' caution was clearly justified.