State Autism Health Insurance Laws Should Be a Part of a National Benefit Package
This blog post is by Stuart Spielman, Senior Policy Advisor & Counsel for Autism Speaks.
At the request of the Secretary of Health and Human Services, the Institute of Medicine (IOM) is undertaking a study on “essential health benefits” – the benefits that must be provided by insurance purchased through the competitive marketplaces created under the new healthcare reform law. The IOM will be holding public hearings in Washington on January 13th and 14th to consider the policy principles that should be taken into account in defining specific elements of the benefits package. The IOM has sought comment on a number of questions, including the methods the Secretary should use in evaluating state health insurance coverage laws for inclusion in the national benefit package. Autism Speaks has recommended that the Secretary judge these laws by the following principles:
- Efficacy in improving benefits and services to populations at risk of poor health outcomes. For individuals with disabilities, state health insurance coverage laws can remedy coverage determinations that reflect bad health policy. Arbitrary decisions regarding medical necessity, denials based on artificial distinctions between habilitation and rehabilitation, and faulty judgments that specific treatments are experimental can entirely shut out vulnerable populations from access to health care.
- The benefit of a law relative to its cost. Market decisions regarding coverage may place undue emphasis on short-term economic costs rather than longer-term gains. A broad-based calculus should be used when evaluating state health insurance coverage laws: extended life, reduced disability, and improved community integration should all be considered when evaluating laws that affect people with disabilities. A required benefit that enhances a child’s ability to live safely at home and diminishes special education and social services costs pays for itself.
- Continuity of care. Americans, particularly disabled Americans, make fundamental choices based on health care. They decide where to live and for whom to work with an eye on benefits and services. State health insurance coverage laws influence their decisions. These laws, which are often the result of years-long efforts by mothers and fathers and children, deserve deference, as people continue to rely upon them. Failure by the Secretary to include in a national essential benefits package laws that protect people with disabilities would reduce their coverage and jeopardize their health.
These principles underscore the value of state autism health insurance coverage laws. The burdens of autism are exacerbated by gaps in insurance coverage that result from the denial of benefits for proven treatments. Children with autism are more likely than other special needs children to delay or forego care entirely. Their families have greater out-of-pocket costs, diminished work hours and lost income, and more negative health plan experiences.
Twenty-three states have responded to the challenges faced by individuals with autism and their families by requiring comprehensive coverage. Cost analyses suggest that the long-term benefits of autism health insurance laws will be substantial relative to their modest cost, which is often estimated at less than .5% of premiums. Millions of Americans now rely on these laws to establish a standard of care.
Existing state autism insurance coverage laws remedy the failure of the market to provide effective coverage for a significant public health challenge. Judged by any standard – justice, cost to benefit, or maintaining quality care for a vulnerable population –these laws should be integral to a national essential benefit package.