Mandates and Out-of-Pocket Spending

The Politics of Autism includes an extensive discussion of insurance.

Molly K. Candon and colleagues have an article at Pediatrics titled "Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder." The abstract:

BACKGROUND: The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers.

METHODS: We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and the share of total spending paid out of pocket for ASD-specific services. We used administrative claims data from 2008 to 2012 from 3 commercial insurers, and took a difference-in-differences approach in which children who were subject to mandates were compared with children who were not. Because mandates have heterogeneous effects based on the extent of children’s service use, we performed subsample analyses by calculating quintiles based on average monthly total spending on ASD-specific services. The sample included 106 977 children with ASD across 50 states.

RESULTS: Mandates increased out-of-pocket spending but decreased the share of spending paid out of pocket for ASD-specific services on average. The effects were driven largely by children in the highest-spending quintile, who experienced an average increase of $35 per month in out-of-pocket spending (P < .001) and a 4 percentage point decline in the share of spending paid out of pocket (P < .001).

CONCLUSIONS: ASD mandates shifted health care spending for ASD-specific services from families to insurers. However, families in the highest-spending quintile still spent an average of >$200 per month out of pocket on these services. To help ease their financial burden, policies in which children with higher service use are targeted may be warranted.

Pushback Against Reckless Congressman

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Natalie Allison at the Nashville Tennessean

A day after U.S. Rep.-elect Mark Green drew national attention for his remarks suggesting a possible link between vaccines and autism, another Tennessee Republican in Washington took a stand for the public health benefits of vaccinations.

"Vaccines take deadly, awful, ravaging diseases from horror to history," U.S. Sen. Lamar Alexander tweeted Thursday.

The senator's remarks were followed by a terse 30-word statement from the Tennessee Department of Health later in the day Thursday, beginning with the phrase "Vaccines do not cause autism."

Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, tweeted a quote from a video he shared of him previously speaking about vaccines in the committee.

"Sound science is this," Alexander said in the committee meeting. "Vaccines save lives. They save the lives of people that are vaccinated. They protect the lives of the vulnerable around them, like infants and those who are ill."

Green, a Republican state senator from Clarksville who is also a physician, will be sworn-in to the U.S. House of Representatives, his first term, Jan. 3.

Vaccines take deadly, awful, ravaging diseases from horror to history.

Vaccines save lives. pic.twitter.com/kewCNQTslM

— Sen. Lamar Alexander (@SenAlexander) December 13, 2018

Tennessee Department of Health Statement on Immunizations Thursday, December 13, 2018 | 04:29pm NASHVILLE – Vaccines do not cause autism. Vaccines save lives. The Tennessee Department of Health welcomes discussion with Tennessee clinicians and scientists who would like to examine the evidence on this topic. ###

Disgrace: Congressman-Elect Pushes Autism-Vaccine Notion

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Natalie Allison reports at The Nashville Tennessean:

A soon-to-be congressman from Tennessee told constituents Tuesday he believed vaccines may be causing autism, questioning data from the Centers for Disease Control and other institutions disproving such a theory.

Not only did Republican Mark Green, a Congressman-elect from Clarksville who is also a medical doctor, express hesitation about the CDC's stance on vaccines, he also said he believed the federal health agency has "fraudulently managed" the data.

His remarks came in response to an audience question at a town hall meeting in Franklin from a woman identifying herself as the parent of a young adult with autism. The woman was concerned about possible cuts to Medicaid funding.

"Let me say this about autism," Green said. "I have committed to people in my community, up in Montgomery County, to stand on the CDC’s desk and get the real data on vaccines. Because there is some concern that the rise in autism is the result of the preservatives that are in our vaccines.

Felicia Sonmez at WP:

Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said that it was shocking that a newly elected congressman “would openly espouse such blatant antiscience and discredited views.”

“The science is clear: Vaccines do not cause autism or the other things the antivaccine lobby alleges,” said Hotez, whose recent book, “Vaccines Did Not Cause Rachel’s Autism,” draws on his experience as a vaccine expert and the father of an autistic child.

He added that without Green’s “immediate reaction and heartfelt apology, he deserves censure or exclusion.”

A spokesman for Green did not respond to a request for clarification of the congressman-elect’s claim that the CDC’s data may have been “fraudulently managed.”

Green was recently elected president of the Republican freshman class. He last year withdrew as President Trump’s nominee for Army secretary amid criticism of his past comments about Islam, evolution and LGBT issues.

Protesting Restraint

In The Politics of Autism, I discuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

Sawsan Morrar at The Sacramento Bee:

A small group of former students, advocates and parents gathered in front of the California Department of Education Monday to demand the closure of a school where a teen with autism stopped breathing and later died after being restrained by staff.

Nearly a dozen protestors said they were demanding the immediate closure of Guiding Hands School in El Dorado Hills. Those gathered also said they believed state regulators didn’t do enough to prevent the death of Max Benson, 13, who died Nov. 29, a day after school staff put him in a face-down restraint for an extended period of time.
...
Katie Kaufman, 20, a former Guiding Hands student who attended the school for two years until she left in 2012, attended Monday’s rally. Kaufman said she was put in a face-down prone restraint multiple times, and was once body slammed onto a cement floor resulting in a bloodied chin.

Doug Johnson at Fox40 Sacramento:

The Autism Services Market

 The Politics of Autism includes an extensive discussion of autism service providers.

Ronit Molko at Forbes:

The autism services market is estimated to be worth around $5 billion to $7 billion annually and it’s growing, with a total addressable market estimated between $50 billion and $90 billion. The majority of the services provided to individuals with autism are behavioral services and are provided at home, in school, or in a clinic setting. Most of these services are based on the science of applied behavior analysis, or ABA, which is a scientific method that employs specific techniques and principles to impart skills and bring about meaningful changes in behavior. ABA is the most widely funded treatment option that private insurance companies, or state or federal programs, will cover.

...
 While the current national players are acquiring smaller providers to grow their platforms, there are still many underserved communities and many opportunities for organic growth. As of 2016, it was reported that the top nine multi-site providers accounted for nearly $400 million in revenues – almost 40 percent of the market share, but the market, and these companies, have grown considerably in the past two years. Despite the efforts by investors to consolidate the market, there is still space for more providers on the national level.

A Death in El Dorado Hills

In The Politics of Autism, I discuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

At a California school, an autistic student stopped breathing after nearly an hour under prone restraint. Sawsan Morrar and Phillip Reese at The Sacramento Bee:

The boy, identified by the Sacramento County Coroner’s Office as Max Benson, 13, became unresponsive while in the restraint hold and died a day later at UC Davis Medical Center.

The incident took place Nov. 28 at Guiding Hands School on Windplay Drive, according to the El Dorado County Sheriff’s Office. Benson became unresponsive while being held in a ‘prone restraint’ for nearly an hour, according to a source familiar with the investigation.

In a letter sent to the school’s site administrator, Cindy Keller, on Dec. 5 from the California Department of Education and released to The Sacramento Bee through a California Public Records Act request, state regulators found “sufficient evidence” that the facility had violated multiple state rules governing how and when physical restraints can be used on students.

Those violations included using an emergency intervention — the prone restraint — for “predictable behavior,” using an emergency intervention as a substitute for the student’s personally-designed behavior intervention plan and using the restraint for longer than necessary.

Social Media and Twice-Exceptional Students

 In The Politics of Autism, I examine the role of social media in the development of the issue.  Social media can spread vaccine disinformation, but they can also provide autistic people and their families with a way to connect with one another and to press for government action.

Twice-exceptional students are both gifted and disabled.  Many are autistic. At Education Week, Sasha Jones writes:

Twice-exceptional parents are not the first to take advantage of online connection, offering support and information to those hungry for it, and even driving state and national-level change. The advocacy group Decoding Dyslexia, for example, grew out of social media and now has branches in all 50 states, 42 of which have passed dyslexia-specific laws.

Robbi Cooper, a parent involved in policy and advocacy at Decoding Dyslexia Texas, says that social media connects advocates involved in various parts of the legislative process and builds support from lawmakers and administrators.

"Social media allows the door to open when the door's not locked. If the door is locked, then they won't let you in—but that doesn't mean there's nothing you can do," Cooper said, indicating that continued growth and research can serve as the key. "Once they start listening to you and start taking you seriously, then they unlock the door."