The Politics of Autism includes an extensive discussion of insurance legislation in the states.
Sen. Tom Apodaca, a Hendersonville Republican who sponsored the autism insurance bill, said the legislation was the product of negotiations with insurance companies – which for years have opposed legislators’ efforts to require coverage.
Those companies ultimately supported last year’s bill, which caps adaptive behavioral treatment – a broader term for programs that include the Applied Behavior Analysis sessions Abbey attends – coverage at $40,000 per year and limits it to patients age 18 and under.
“We don’t need to put anybody out of business, but we do need to cover the families,” Apodaca said.
Apodaca’s bill won’t provide universal autism coverage in North Carolina, in part because the state can’t regulate federal insurance programs such as Medicaid. Autism advocacy groups say they’ll continue to lobby at the state and federal level to expand coverage further.
“I think all insurance legislation is generally incremental; you almost never get everything you want the first time around,” said Jennifer Mahan, director of advocacy and public policy for the Autism Society of North Carolina. “You’re going to have to make compromises or you won’t see legislation passed.”
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In addition to Medicaid recipients, the new law doesn’t include people whose insurance isn’t part of a large-group health plan provided by a company with 50 or more participants.
“State insurance laws cover a limited number of plans,” said the Austism Society of North Carolina’s Mahan. “This does not provide coverage for everyone out there.”
Given the steep cost of ABA programs, many families of children with autism can’t afford to sign up. “Insurance coverage is one of the big barriers to getting access to treatment, and for some people it will continue to be,” Mahan said.of negotiations with insurance companies – which for years have opposed legislators’ efforts to require coverage.
