On September 24th, the Washington Post published a very misleading article entitled “Autism treatment benefits could be jeopardized by federal health law provision” (By Phil Galewitz, Kaiser Health News; see same article at “Parents Fear Health Law Could Derail Autism Coverage”). Why does Kaiser Health News use scare tactics? Their interests certainly do not appear to be aligned with the interests of all children with autism spectrum disorders (ASDs) and their families. Are the interests of the author aligned with the interests of the insurance companies? Health insurers take every opportunity to avoid playing any role in efforts to make evidenced-based therapy accessible to those children who need it. Or, is the author just uninformed? For those who may not fully understand the pros and cons of state autism insurance mandates, please read this post.
Most state autism insurance benefits mandates do not apply to the vast majority of children with ASDs. For example, 86% of Florida’s children with ASDs do not benefit from Florida’s autism insurance benefits mandate. On the other hand, under the federal Affordable Care Act, all families could have access to health plans with mandatory coverage for children with ASDs. (See “Q&A: Autism Benefits Mandates – Basic Information.”) Further action at the federal level is essential if more than a small minority of children with ASDs are to have access to the health care they need to live meaningful, happy lives and to have a chance to become contributing members of society.
If you expect an autism insurance benefits mandate in your state to help you, your family, or your friends, it is important that you take the time to understand the scope of the mandate. Most articles and online summaries only discuss the mandated benefits, not the extensive exemptions. Florida passed its mandate in 2008. (See “Florida’s Autism Insurance Benefits Mandate: Who Will Benefit, Who Will Not, and Why?”) Florida’s legislators and Governor Crist were praised for their accomplishments. The press was overwhelmingly favorable (even this Washington Post article estimates 50% coverage). Yet, only 14% of Florida’s children actually qualify for benefits under health plans that are subject to Florida’s autism insurance benefits mandate. Behavioral Lifeboat is researching the extent of coverage of all state mandated autism benefits.
State autism insurance benefits mandates should be viewed as a very small first step. The primary reason that more of Florida’s children are not eligible for mandated benefits is that self-insured plans are exempt from the mandate. (See “Q&A: ERISA Preemption – Basic Information.”) In Florida (as in most states), 68% of the insured private sector employees of employers with 50 or more employees are enrolled in self-insured plans. (See “Florida’s Autism Insurance Benefits Mandate Who Will Benefit, Who Will Not, and Why?: Chapter 4 – Q: Which health plans are exempt from the autism insurance mandate?) Most of the state autism insurance benefits mandates, including Florida’s, are based on the same model legislation (see “Q&A: Autism Speaks State Autism Insurance Reform Initiative.”). They are all similarly limited in scope because of the federally mandated exemption for self-insured plans as well as other extensive exemptions (for example, see Florida’s exemptions, such as 4% covered by exempt individual plans, and 25% of employees in the private sector worked for exempt small employers – as well as 21% uninsured).
Sadly, the Washington Post article appears to advocate for preserving the status quo and to attack the Affordable Care Act by leveraging uncertainty – making families fear that they may lose benefits under state mandates that may not actually apply to them. The article states:
“Autism treatment benefits could be jeopardized by federal health law provision. . . . Now more than half the states have such requirements, but that success could be in jeopardy as federal officials set new national standards for health coverage. . . . Parents worry the essential-benefits provision could reopen the debate over covering treatment for autism and spark another showdown with insurers. . . . ‘Fear runs through my mind,’ said Ann Rounseville of Newton, Mass . . . .”
The only way to overcome the exemption for self-insured plans is through federal legislation. Great strides have already been made at the federal level:
- The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Mental Health Parity Act): The Mental Health Parity Act eliminates discrimination by plans that voluntarily cover mental health conditions, including ASDs. Many families receiving new benefits in 2011 for their children with ASDs may incorrectly attribute the benefits to a state insurance mandate when, in fact, the benefits were required by the Mental Health Parity Act. (See also Mental Health Parity Watch – Understanding the Law.)
- The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act (Affordable Care Act): The Affordable Care Act sets the table for more dramatic change. Depending on how the legislation is implemented, health plans with mandatory coverage for children with ASDs could be made available for all families.
For more details, see “Q&A: Autism Benefits Mandates – Basic Information – Q: Are there any exceptions to ERISA preemption?”
If autism insurance benefits are important to you, your family, or your friends, don’t attack the Affordable Care Act, embrace it. Federal legislation is the only meaningful way to help all of America’s children with ASDs. Health plans must play a role in efforts to make evidence-based therapy accessible to those children who need it. Contact the Obama administration, the Department of Health and Human Services, and your representatives in the US Senate and House. Contact the nonprofits that advocate for such legislative change, including Autism Speaks/Autism Votes and the Autism Society of America. Contact the Washington Post and Kaiser Health News. Let them know that existing state autism insurance benefit mandates exclude too many of America’s children with ASDs. Tell them that you want the essential benefits package under the Affordable Care Act to include coverage for diagnosing and treating ASDs.
© 2011 Behavioral Lifeboat, Inc.