Autism deserves coverage

by Jeff Mayo, General Manager and Associate Publisher
05.01.09 - 02:36 pm
Viagra? Covered. Autism? Nope.

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Most insurance companies operating in Oklahoma cover Viagra and other erectile dysfunction drugs, but few cover autism.

On Monday, Oklahoma House Democrats walked out of the legislative chambers after the Republican leadership refused to consider legislation that would mandate insurance companies pay for medical costs associated with autism.

Autism is a complex neurological disorder that inhibits a person’s ability to communicate and develop social relationships. It is often accompanied by extreme behavioral episodes. The Centers for Disease Control and Prevention (CDC) says autism now affects 1 in 150 children. The increase may be partially attributable to improved early identification in children ages 1-3, but the number is staggering.

In the past two years, six states—Texas, Pennsylvania, Arizona, Florida, South Carolina and Louisiana—passed laws requiring coverage of behavior therapy for autism. In addition to Oklahoma, three states—Kansas, Missouri and Michigan—are considering coverage in their legislative sessions this year.

The Democrats, walkout highlights a lack of debate on this topic and shows that the Republican House majority is not interested in debating critical issues facing Oklahomans.

Democrats have been pushing Nick’s Law for two years now. The law would require health insurance companies in Oklahoma to cover the diagnosis and treatment for autism. The law carries the name of an 11-year-old Edmond boy who has the condition.

The Republicans did pass a bill that would regulate behavioral analysts and increase training for autism therapists, but that will not have much effect if working Oklahomans can’t afford to pay for treatments out of pocket.

Cost estimates for covering autism show a range of one to three percent increase in insurance rates, depending on the study and coverage amounts.

Autism advocates say that treatments for autism are difficult to access, often inadequate, and frequently delayed. Denied coverage by private group health insurance companies, parents are often forced either to pay out-of-pocket or forego the treatments their children need.

Advocates go on to say that by improving outcomes for children with autism, mandated private insurance coverage will decrease the lifetime costs of treating and providing services and will actually result in an overall cost savings in the long-run.

The truly sad thing is that insurance companies will not cover this medical condition without a law mandating it.

The Republicans argue it’s just a matter of determining whether insurance companies can continue to provide insurance (read: make large profits) within state requirements. I do not believe it is that simple. We need to address this issue for the sake of creating better Oklahomans, not just maintaining profitable insurance companies.

Where is the “family values” party when autism strikes a child and bankrupts a family trying to get treatment? Republicans are quick to point to their conservative values that make us believe they want to promote a family’s well being, but defeating bills that would help children show otherwise.

This is an issue of addressing a medical emergency in our state. Without addressing autism at an early age just as we do enlarged tonsils, broken limbs and chickenpox, it is very likely treatment will cost more as the child’s condition worsens over time. These children, and their families, deserve better from us.
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