How Will Obamacare Affect Autism Coverage?

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As any family raising a child with autism knows all too well, the medical costs required to get these children the help they need are staggering. A study by the London School of Economics found that autism-related health costs have tripled since 2006, to $126 billion per year. They also estimate that the total cost of autism therapy over the course of a lifetime can reach as much as $2.3 million.

Many families believed that President Obama’s health care reform would require insurance companies to ease their burden by requiring coverage for methods proven to help people with autism, but this may not be the case. The law requires insurers to cover ten “essential health benefits” categories, including mental health. Autism should fall under this category, but pressure from states and insurance companies led the federal government to postpone creating federal standards for autism treatment until 2016. This gives the states wide leeway in determining which services will be covered under policies sold on its state insurance exchanges.

Currently, 34 states require insurance companies to offer benefits for autism treatments in existing health plans, but nearly 1/3 of those will not require plans on their Obamacare exchanges to offer similar benefits. There are also 16 states that don’t require any autism benefits at all.
What does this mean for families who are already struggling to stay afloat, while getting their children the help they need? For families living in one of the 34 states requiring coverage, they will be able to keep the coverage they currently have, but will not be eligible for any federal subsidies they may have received through the Obamacare marketplace. For those living in states that don’t require coverage, it may mean that no help is in sight, for the time being.

Insurance companies say that covering autism therapies will lead to higher premiums for all of their customers. While there is some truth to this, consider the even higher cost of housing and providing for the thousands of autistic adults who will be entering the system within the next 10 – 20 years. Getting these children help while they are young will significantly reduce this burden on the system in years to come, and will allow more of these people to live as independent, tax-paying citizens further down the road.

At the end of the day, there are no easy answers. As the rate of autism continues to rise, these issues will continue to affect millions of families across the country. Clearly, the “autism epidemic” affects everybody, even those who are not personally raising children with the disorder. Early intervention has been proven to make a huge difference in future outcomes for children with autism, and by 2016, it may be too late for many of them. One thing is clear, the autism crisis is not going away, and it will affect far more people than just the individuals who are living with the disorder.

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Laurel Joss About Laurel Joss

Laurel Joss is a freelance writer with a Master’s Degree in Early Childhood Education. She worked as an RDI® Program Certified Consultant and has published articles in Autism Spectrum Quarterly and on her blog www.remediatingautism.blogspot.com. She is a mother to two children, one of whom is on the autism spectrum.