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Autism coverage

Published February 6, 2013 1:01 am

Utah should outlaw discrimination
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

For the sake of Utah children, who have the highest rate of autism in the nation, the Utah Legislature should require insurance companies to cover the cost of autism treatment.

Thirty-two states — most of them not as blatantly self-labeled as Utah's "family-values" state — already have laws similar to the one proposed by freshman Sen. Brian Shiozawa, R-Cottonwood Heights, who is past president of the Utah Medical Association. SB55 rightly recognizes that thousands of Utah children diagnosed with autism spectrum disorder would benefit if insurers covered the cost of early treatment.

The bill requires coverage of the diagnosis and treatment of autism, including speech, occupational and physical therapy, along with applied behavior analysis for up to $50,000 a year for children under age 9 and $25,000 for children ages 9 to 18.

Data collected by Autism Speaks, a national advocacy group, shows that autism coverage increases premiums an average of just 31 cents per member, per month. Still, the Salt Lake Chamber and insurance companies are likely to fight the legislation.

To address concerns that small employers might drop insurance coverage altogether because of the cost of adding autism coverage, Shiozawa included exceptions to the mandate. The bill wouldn't affect self-insured companies. And owners of small companies could seek a waiver from the requirement if they can prove the cost of coverage would increase premiums by at least 2.5 percent in a year.

Last year legislators came up with a much watered down version of autism coverage: three pilot programs covering just 300 children 2 to 6 years old. It has done little to help. ABA therapists charge about $50 an hour, and studies show intensive therapy, or 25 to 40 hours a week, is the most beneficial. The largest pilot program has yet to treat a single child.

A recent national study reported that Utah's rate of autism is 1 in 47 children; the national figure is 1 in 88. That translates into a total of 18,532 children in the Beehive State who have been diagnosed.

Treatment for many of those children can mean the difference between being able eventually to function at a high level in society and remaining dependent on family or state care.

Allowing insurers to refuse autism coverage also permits them, in some cases, to deny coverage for the child's other medical needs. This discrimination by insurance companies should not be tolerated, especially in Utah, where children and families are said to be a priority.




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