(MintPress) – Rely on minimal special needs services from the public school system, or pay for therapy that can improve an autistic child’s abilities at an estimated $30,000 to $50,000 per year?
It’s a tough emotional and financial decision that many parents of children with autism must face in the United States, since not all states require insurance companies to cover autism treatments like specialized therapy. Though most families in America caring for a child with autism have health insurance, most plans exclude treatments that many parents believe would benefit their children.
In response to this shortage, some states like Georgia, one of 18 states that currently doesn’t require insurance companies to cover therapies for children with autism, are working to enact legislation that would require insurance to cover early intervention care for autistic children.
Ava’s Law, named for Ava Bullard, an 8-year-old girl from Lyons, Ga. with autism, whose mother, Anna, has advocated for expanded autism coverage, would mandate insurance companies pay for extensive, intensive services for children diagnosed with autism.
“[Ava’s Law] would be hugely beneficial,” said Judith Ursitti, director of state government affairs for Autism Speaks. “What’s happening now is that there aren’t that many providers … Kids are screened at their 18- and 24-month check-ups and pediatricians are prescribing treatments, but families have no way of accessing them because they are not covered by health insurance.”
Ursitti told Mint Press News that states like Georgia lack providers because there isn’t constant funding. She said that in Florida there are about 1,500 board-certified behavior analysts, but in Georgia there are only about 100.
Still, some insurance companies are leery about the bill.
Russell Childers Jr., of Americus, Ga., chairman of the Government Affairs Committee for the Georgia Association of Health Underwriters, said the professional organization wouldn’t favor the law because the group doesn’t favor mandates in general.
Childers added that with the expected increase in insurance costs due to federal health reforms, he and the industry oppose any mandates that could add to that expense.
But according to the bill’s author, State Rep. Ben Harbin (R-Evans), an analysis of similar programs in other states, it’s estimated that implementing Ava’s Law would cost policyholders just 33 cents per month. He added that the bill actually saves taxpayers money in the end, since they wouldn’t have to pay for years of special education classes for students whose autism went untreated.
“We know if we can do the early treatment and we can get them back into normal range classes, then we don’t have to spend all additional money through the school system,” Harbin said. “Really, you’re making an investment. What we’re doing is we’re saying this should be covered by insurance companies because otherwise in Georgia there’s nowhere for these people to turn.”
“It’s interesting,” said Usetti, “because we have actual claim data from states that have had these laws. The average premium impact is 32 cents, which is less than a postage stamp. It’s pocket change. Insurers talk about projection — we have actual data from states that have had this [type of legislation] for multiple years.
“We’re definitely concerned about the cost of health care and want to spend health care dollars wisely,” she said. Adding that Ava’s Law is a wise investment because if children don’t receive care today, society will pay much more for their care later in life.
Benefits of therapy
Bullard says after Ava’s diagnosis, she was told to expect her daughter would be in special education classes for the rest of her life. Not willing to give up, Bullard paid for Ava to receive an applied behavior analysis treatment and says she saw a “dramatic improvement” in Ava. For example, Ava now attends regular third-grade classes.
Like Bullard, Melissa Solares of Evans, Ga., knows all too well how expensive therapy for autism can be and is hopeful Ava’s law will be successful. Solares and her husband paid out of pocket for their son Arturo, who is now five, to receive intensive therapy after he was diagnosed with autism.
Non-verbal and not potty-trained as a toddler, Solares said she thought her son was destined for a life of special education classes. But since the therapy began, Arturo is now enrolled in regular preschool and Solares says she feels that putting him in therapy changed the “path of his trajectory.
“I feel like my son’s life depends on this,” Solares said. “It’s important that these children in Georgia have a chance … We need help. You go five miles away (to South Carolina), and these children are getting the services they need.”
Ursitti stresses that the current version of the bill, which was drafted by professional from all different areas of care, only requires insurance companies to cover evidence-based treatments, meaning insurance companies would not be required to cover experimental treatments, but just those that have proven benefits.
“We’ve been told there are 30,000 children with autism in Georgia. Not all will have private health insurance,” Usetti said. “Even if half — 15,000 — can access care, that’s a ton,” she added, since coverage not only affects the quality of life for the child with autism, but it also affects the child’s parents and siblings.
Autism facts
Autism is the fastest-growing developmental disability in the United States with about 1 in 88 births, or between 1 and 1.5 million Americans, having an autism spectrum disorder.
It is not yet known if the increase in the amount of persons diagnosed with an autism disorder is due to more parents and doctors becoming familiar with the disease and diagnosing more people with the disorder, or something else.
“The rates were flat through the late ’80s, and then suddenly a massive rise happened,” said Eric Fombonne, professor of psychiatry at McGill University in Montreal. The rise is probably not due to a mysterious global environmental exposure, he says, but “it’s more likely to reflect new concepts of autism worldwide.”
According to the Autism Society, caring for these persons costs the U.S. an estimated $60 billion each year, but the amount can be reduced by nearly two-thirds if the person with autism receives an early diagnosis and care. Still, the group says the cost to care for a person with autism through their lifetime is around $3.2 million — and that’s just for one person.
Due to the stigma and lack of awareness on mental health issues, data regarding how many people around the globe have autism is not known, as most studies come from the U.S., Canada and the U.K.
“Even though it seems like anybody and everybody has heard of autism, in many places in the world it’s still sort of a new topic,” said Charles Zaroff, assistant professor of psychology at the University of Macau in China.