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Tuesday, January 5, 2016

Hillary Clinton and Autism

Hillary Clinton has made a policy statement on autism.  Here is the summary:
Today, Hillary Clinton is announcing a wide-ranging autism initiative—including screening, diagnosis, treatment, services, safety and legal protections for individuals on the autism spectrum across the lifespan, steps to ensure they are treated with dignity, partnerships to help them secure employment, support for families and caregivers, and a commitment to increase research funding to deepen our understanding of autism. More than 3.5 million Americans are believed to have autism spectrum disorder (ASD). According to a CDC estimate, one in every 68 children in the United States was identified as having ASD in 2010. And the costs of treatment and services are beyond the abilities of most families. Improving support for children and adults on the autism spectrum and their families can vastly improve their lives and open the door to more sustainable costs for Medicaid and other public programs as services are delivered using integrated, community-based approaches. And these proposals will not only help people with autism and their families but also will benefit others with developmental disabilities.
Hillary Clinton believes that our country must make supporting individuals and families with autism a priority—for the millions of people living with autism and their loved ones, and millions more who will be diagnosed in the future. As president, Clinton will:
  • Conduct a nationwide early screening outreach campaign to ensure that all children, and in particular children from underserved backgrounds, can get screened for autism.
  • Push states to require health insurance coverage for autism services in private insurance plans as well as marketplace plans offered in the state so that people with autism are not turned away.
  • Launch the Autism Works Initiative to extend new resources and establish public-private partnerships that will connect people with autism with employment opportunities.
  • Authorize the first-ever adult autism prevalence study in the U.S. so that we improve our understanding of how to identify, serve, and support adults on the autism spectrum.
See reports by Ken Thomas at APSam Frizell in Time  and Sarah Karlin in Politico.

Clinton's statement notes that most states have already adopted insurance mandates.   As I point out in The Politics of Autism, however, the mandates have various limitations.  Moreover:
Sixty-one percent of Americans with employer-sponsored health insurance are in a self-funded plan, in which the employer takes direct financial responsibility for enrollees’ medical claims.[i] Employers that self-fund typically contract with an insurance company to run the plan. Workers then get cards that bear the name of the insurance company and often look just like those from a traditional plan, so many do not even know that they are in a self-funded plan.[ii] Most of the time, the distinction makes little difference -- unless the employees are seeking coverage for a family member with autism. The catch is that the state mandates do not apply to self-funded plans. A federal law (the Employee Retirement Income Security Act of 1974, or ERISA) exempts self-funded plans from most state insurance laws, including mandated benefits. When South Carolina passed its mandate, the Unumb family was in a self-funded plan, so Ryan could not benefit from Ryan’s Law. As lawyers, the Unumbs knew about this exception all along, but for many autism families in states with insurance mandates, it comes as an unpleasant surprise. [emphasis added]

[i] Henry J. Kaiser Family Foundation, “2014 Employer Health Benefits Survey,” September 10, 2014. Online:
[ii] Lorri Shealy Unumb, letter to families, Autism Speaks, February 2014. Online: