Point of View

Time for insurance companies to cover those with autism in NC

May 7, 2013 

State lawmakers have an opportunity to right an unfortunate injustice this legislative session. Currently in North Carolina, the nearly 60,000 individuals with autism and their families face unfair financial hardship because of an inequality in their health insurance coverage.

To correct this, House members from both sides of the aisle have introduced House Bill 498, which requires private health insurance companies and the N.C. State Health Plan to cover the diagnosis and treatment of autism.

Thirty-two states require autism insurance coverage; eight more are considering it. This legislation has afforded thousands of families in other states access to autism treatment that until now was available only in select corporations and through the federal government’s TRICARE insurance program. The 40 House sponsors of HB498 have taken an important step toward assuring this same access to autism treatment for North Carolina families.

Today, one in 88 Americans are born with autism, a noncurable but treatable neurobiological disorder that affects communication, social interaction and behavior. The National Center for Disease Control describes autism as one of the nation’s most critical health issues, and its incidence is on the rise. Autism affects more children than cancer, AIDS and diabetes combined.

And it does not differ from other noncurable chronic medical conditions that health insurance routinely covers, including asthma, diabetes and hypertension.

The cost of autism care is $90 billion a year in the U.S. – a heavy burden on the families who live with the disorder but cannot afford appropriate treatment. These families are paying health insurance premiums, yet their child with autism is excluded from coverage.

Unreimbursed out-of-pocket expenditures for medical care and autism treatment put families in financial insecurity, debt and even bankruptcy as they use savings and retirement funds to pay for needed therapies.

Alternatively, families are forced to make the agonizing decision not to provide their child with evidenced-based therapies known to improve symptoms dramatically.

While the costs of autism care are staggering, the cost for autism health insurance coverage is minimal. The insurance industry’s own claims data show that autism insurance coverage generates an increase in premiums of less than 1 percent.

In our state, that small investment would yield big returns. Autism treatment focuses on diminishing or controlling symptoms that can range from mild to quite severe. Research shows that symptoms of autism can be improved by appropriate therapies that improve the quality of life for the individual and his or her family, which reduces the long-term costs to society of caring for untreated children. Every new child diagnosed with autism will cost an estimated $3.2 million over a lifetime. Early diagnosis and intervention can reduce this cost by two-thirds. Autism insurance coverage will help make this happen.

Autism insurance coverage would reduce costs to schools because children with autism would receive a head start on appropriate therapies before they entered the school system.

Autism insurance coverage would also attract new health care jobs to North Carolina. Availability and access to board-certified behavior analysts and other autism treatment providers would grow if lawmakers require autism insurance coverage.

Along with many community partners and lawmakers, the Autism Society of N.C. has been working tirelessly to pass autism health insurance coverage. This year, we encourage lawmakers to make it a reality.

Tracey Sheriff is CEO of the Autism Society of North Carolina.

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