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.  

Make 2011 the Year for Maryland Autism Insurance

Great news out of Annapolis this week.   A bill has been introduced in the State Senate to require comprehensive insurance coverage  for people with autism.  If made law, this bill, S.B. 759, would expand coverage beyond the existing requirement for insurers to cover speech-language pathology, physical therapy and occupation therapy for their members with autism.    The new coverage would include behavioral health treatments like Applied Behavior Analysis (ABA) and leave room for coverage of other evidence-based treatments.   Few treatments have an evidence basis on par with ABA, but it is valuable that the bill leaves room for future advancements in the science of autism intervention.

It's exciting that the new bill specifies coverage for services overseen by Board Certified Behavior Analysts (BCBA) and delivered by paraprofessionals.    That model, tutors for home programs who are college students trained by a BCBA, is what has worked for many of us.  Additional great news is that the bill would cover "devices that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual."   This means that those of us with non-verbal children could get help with  augmentative and alternative communication devices.

Full text of the bill is available here: http://mlis.state.md.us/2011rs/billfile/sb0759.htm

A similar bill is expected soon in the House also.   Please contact the Senator and Delegate representing your district and let them know the positive impact this bill would have on your family and other families you know in Maryland.    Hearings on the bill are expected in March, so please turn out in Annapolis to support the bill then too.

If your Senator or Delegate is hesitant about the bill, it may be because of cost concerns in this difficult economy.   Note for them that 22 other States already have similar laws.  The independent cost estimates that have been performed in  these States have shown the costs are reasonable.  Surely Maryland, the wealthiest State in the nation, can afford to do what 22 other States have.    More importantly, we can't afford not to do it.   The savings that result from helping people with autism early, and enabling them to be less dependent on public services over time, far outweigh the costs.    There are a couple published papers demonstrating this.   I'll be posting about that research in the next few weeks. 

Wil Gehne