The Autism News | English


 

Parents of children with autism lauded the governor’s decision to sign into law a bill that requires health insurers to cover behavioral health treatments for their kids, but questions linger about the therapy and whether the coverage will continue after the main provisions of the federal health law go into effect in 2014.

The law, Senate Bill 946, will be in effect only from July 1, 2012, through July 1, 2014. After that, either the requirement will be covered under the federal law or the state will have to decide what to do next.

In his signing message, Gov. Jerry Brown expressed reservations about the law and the therapy, saying, “There are remaining questions about effectiveness, duration, and the cost of the covered treatments that must be sorted out.

“There is still much work to be done,” he concluded.
Health insurers’ view

The law’s chief critics, health insurers, read that to mean the governor questions whether they should cover these costly treatments, while the parents of autistic children and their supporters say Brown’s reluctance reflects nothing more than the pressure applied by insurance lobbyists.

“There’s not a lot of controversy in medical communities about the effectiveness of the treatment,” said Kristin Jacobson, who represents the Alliance of California Autism Organizations, which is made up of about 40 groups. “The insurance industry was very effective in raising concerns, and luckily the governor was able to see beyond that.”

The therapy at the center of the debate is called applied behavioral analysis, or ABA, and it’s a one-on-one form of intervention that focuses on encouraging appropriate behaviors among children with autism while discouraging destructive behaviors.

Many medical organizations consider applied behavioral analysis the most helpful treatment for autism, a condition that affects 1 child in about 110. While the therapy ranges in price from $36,000 to $75,000 a year, California is the 28th state to require insurers to cover it.

The California trade group that represents health insurers argues the therapy is an educational service, not a medical service, and contends the new law will drive up health care costs by almost $850 million a year.

“Adding more benefits, particularly those that are nonmedical and are high-dollar services, policymakers will have to weigh and measure their desire to make sure people have those nonmedical services with the ability to make coverage affordable,” said Nicole Evans, spokeswoman for the California Association of Health Plans.

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