Wednesday, April 12, 2006

"The State" Paper Opines That Insurance Has a Role to Play in Treating Autism

The State - Wed, Apr. 12, 2006

State, insurance both have roles in autism treatment

WHEN THE LEGISLATURE passed a law last year requiring insurance companies to cover brain illnesses the same way they cover bodily illnesses, lawmakers carved out a handful of exceptions that had more to do with politics than policy.
So this year, one of the left-out groups — parents of children with autism — is back at the State House. These parents argue that there’s no reason for an insurance company to cover treatment for a child with cancer but not a child with autism.
This year’s request is for more than just parity, though; it’s to require coverage for whatever treatment a physician orders — a standard that few insurance companies follow for other conditions. We doubt such a request would get very far inside the State House if not for the financial argument. And that argument actually works against the request, by helping to clarify the tricky question of when treatment is the responsibility of insurance companies and when it becomes the responsibility of the state.
The financial argument for requiring insurance companies to provide intensive treatment for children with autism is that it will save the state money in the long run: Severely autistic children who don’t receive sufficient treatment nearly always end up institutionalized, at a cost to the state of up to $4 million over a lifetime. But up to half the children who receive this treatment, at a cost of about $100,000 a year, can function normally by age 6; another 40 percent make substantial improvement and still need some special care, but not as much as they would have otherwise.
Since treating these children would benefit all South Carolinians financially, through lower state spending obligations, it doesn’t seem right to require just those South Carolinians who have private health insurance to cover the costs, as an insurance mandate would do.
So the general direction the House is taking makes sense: It voted to provide intensive coverage to 3- to 6-year-olds through the state-federal Medicaid program.
But there are two major problems with the House plan.
The first is the funding. Representatives voted to use $7.5 million from the sale of the State Hospital on Bull Street to fund the first year of the increased coverage. That’s money that won’t be available to keep the program operating the second year. Worse, it might not even be available the first year. Not only has the property not yet been sold, but it’s not at all clear that a court will allow the state to spend the money this way. If this is a smart investment of public money — and we believe it is — then lawmakers need to use real, reliable money to pay for it.
The second problem is that House members propose to let insurance companies completely off the hook for providing equitable coverage for autism. That didn’t make sense last year, and it doesn’t make sense this year. Insurance companies should be required to use the same standards to decide what treatment to pay for when a child has autism as when a child has any other illness.
That might not result in a high-enough level of care to allow autistic children to lead normal lives, and if it doesn’t, that’s where the state — acting in its own interest — should take over and make up the difference.

© 2006 The State and wire service sources. All Rights Reserved.


Anonymous Anonymous said...

I am a grad student at USC in the Media Arts Dept and a mother of a nine year old child with high-functioning autism. Tomorrow I am presenting part of a photo/text exhibit at the State House (Thurs. April 13th from 9-12). I am including some info. on Ryan's Law to try and get more support. The Gov. and Lt. Gov are supposed to be there, we need as much support as possible--the event is for Grad Student Research in SC but my project is about autism, awareness and support on new laws--sorry for late notice but I just found out how important this could be, many legislators are supposed to attend.
Thanks for all you are doing to help these beautiful children and being a resource of research,
Tiffany Teso

3:25 PM  

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