Autism Insurance: An Investment In Maryland's Economic Future

            The Maryland legislature is now considering bills (SB 759, HB 783) that would require comprehensive insurance coverage for autism, including coverage of evidence-based treatments like Applied Behavior Analysis (ABA).   Twenty-three States already have similar laws.  In this environment of budget deficits, it is natural to look at new laws through the lens of costs.   Most people have a sense that the societal cost of autism is high, but few realize how high.

            In 2007, researchers at Harvard conducted a study which found the average lifetime costs to society for each person with autism is nearly $3.2 million (i).  These costs included direct medical costs, non-medical costs like special education and supported employment, and indirect costs like lost productivity.   But it is never wise to immediately accept one study without corroborating evidence.   A separate 2007 study, conducted using a different data source by researchers at Yale, looked only at the direct medical costs and arrived at a figure very consistent with the Harvard team’s result (ii).   The Yale authors noted the importance of covering these costs, like SB 579/HB 783 will.  They state “if public and private insurance programs are not designed so that coverage for people with ASDs is appropriate, access to care for these patients will be compromised.”

            Perhaps even fewer people realize the timing of these costs across a person with autism’s lifespan.   The Harvard researchers write:

Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood.  Adult care, which has the largest lifetime cost of all direct costs, is typically more than 5 times larger than the next 3 largest costs, which include care incurred during childhood. 

Their data show that the large majority of societal spending happens after age 18.   Non-medical and indirect costs make up the lion’s share of that adult spending.  So it is spending like adult employment programs, sheltered living arrangements and the lost wages of unemployed individual with autism and their caregivers that strains and will continue to strain Maryland’s economy.

            Can we do anything about it?   Can comprehensive autism insurance help?   The answers are yes and yes.  By providing access to therapies like ABA to more people with autism earlier in their lives, those individuals can learn the skills and build the competencies they need to become more independent and productive in society.   The investment in intervention more than pays for itself over time. 

           That statement is not wishful thinking.  It is the conclusion of additional cost research.  

 In a 1998 study, researchers associated with Ohio State University performed a cost-benefit analysis of providing three years of ABA-based early intensive behavioral intervention (EIBI) to children with autism (iii).   They used cost data from Pennsylvania and a formula to estimate the savings.   They reported “the corresponding cost-benefit savings of EIBI services per child with autism or PDD ages 3 – 22 years averages … from $214,801 to $246,551 with inflation.”   Those savings for school aged individuals are important, but the big costs are over the lifespan.   It was here, when the savings from reduced support and increased wages were considered, that the per-person savings became really remarkable: “the corresponding cost-benefit savings of EIBI services per child with autism or PDD ages 3 – 55 year averages  ... from $1,635,061 to $2,765,535 with inflation.”    Compared to the total costs found by the Harvard study, this analysis shows the lifetime costs could be cut in half.

            Again, one study is nice but it needs confirmation.   More recently, a team at the University of Houston took cost data from Texas and conducted a very similar cost-benefit analysis (iv).   Despite the different location, the results were quite similar.   They found that “comparing the reported actual cost of a special education program to a three-year EIBI program (and a [resulting] 72% special education offset), savings of $208,500 per child are achieved.”    This finding is within a few thousand dollars of the school-age result of the Pennsylvania study.  These authors did not perform an analysis of the impact of early ABA on adult services, but they estimated that if the school-based special education savings were applied Texas-wide it could result in over $2 billion in savings over 18 years.

            Pennsylvania and Texas are not Maryland, but we have reason to believe similar results would apply here.   Maryland legislators have seen evidence of the reduction in the costs of adult dependency first hand.   They have heard testimony from individuals with autism who were very impaired as children but whose parents sacrificed to fund early ABA programs.   These impressive individuals showed legislators their pay stubs.   The message was clear – people who might have been burdens to society are instead taxpayers.

            Comprehensive autism insurance in Maryland can make such stories widespread.  Without autism insurance, we may not pay now but we will pay much, much more later.   Realizing the savings of effective autism intervention is important to ensuring Maryland’s economic strength long term.  We can’t wait any longer to make this investment in our future. 

Wil Gehne

Study Sources:

(i)  Ganz, M. L. (2007) The Lifetime Distribution of the Incremental Societal Costs of Autism.  Archives of Pediatric and Adolescent Medicine, 161, 343–349.

(ii)   Leslie, D. L. & Martin, A. (2007) Health Care Expenditures Associated With Autism Spectrum Disorders. Archives of Pediatric and Adolescent Medicine, 161, 350-355.

(iii)  Jacobson, J. W., Mulick, J.A., & Green, G. (1998) Cost-benefit estimates for early intensive behavioral intervention for young children with autism: General model and single state case. Behavioral Interventions, 13, 201-206.

(iv)  Chasson, G.S., Harris, G.E. & Neely W.J. (2007) Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism. Journal of Child and Family Studies, 16, 401-413.