CA Considering Making Autism Therapy Mandatory for Insurers

Insurance companies have, for the past two decades, been increasing their attention to the treatment and coverage of autism in their plans.

Autism is a neural development disorder which affects millions of people worldwide; it has no known cure, and the reasons for the development of this disorder (though there are many sub-types and variations) are also still misunderstood. Those with moderate to severe autism are normally unable to function independently in society, being limited by their stunted interpersonal skills, inability to relate to the world realistically and compulsive behaviors. Children with autism show marked improvement with early and consistent intervention through various therapies, and adults also require intensive work to acquire and retain social skills. For this reason, autism is an expensive and mysterious disorder, and many insurers have declined to cover it, while others have dealt with it on a case-by-case basis.

The California legislature is considering 4 bills addressing autism, autism treatment and health insurance. California Senate President Pro Tem, Darrell Steinberg, is the sponsor of two of those bills, one of which is Senate Bill 166. Senator Steinberg’s bill would make health insurance providers cover at least some kinds of early-intervention autism therapy for children, something which has been inconsistent in the industry so far.

“On a case by case basis, some insurance companies are covering it, and some are not,” said Steinberg.

Early identification of autism and treatment from the beginning for autistic children is much more effective, Senator Steinberg argues, and such early intervention has better and bigger impacts in the long term when contrasted with later treatments.

Applied Behavioral Analysis is the health care standard for therapy for autistic children, and it focuses on teaching the children from a very early age how to relate with others on a personal basis, among other things. It is a very expensive form of therapy, with the costs often exceeding $100,000 per year. Considering the fact that many families have more than one autistic child, as the disorder seems to be hereditary though the gene has not yet been identified, this throws insurance companies’ opposition to mandating autism treatment into a different light. Industry representatives state that mandating therapies such as ABA and those for other disorders will ultimately lead to much higher premiums for everyone overall.

“There’s that old notion of investing a little bit now to save a lot of money later,” Steinberg stated. “I think that applies not only to government, but to healthcare companies as well.”

The Senator said he does expect some resistance to this new bill from health insurance providers, as mandating a certain level of care across the board is rarely received warmly by those companies, as well as by his peers in the California Senate and House.

“We expect some controversy, and that’s OK. (Opponents) will make the argument that the additional mandate will cost the policy holders some additional money.”

Twenty-five states have passed such laws, where insurers are required to have basic coverage of treatment for autistic people.