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Last year, the only large health plan in the state that covered it, Blue Cross and Blue Shield of Minnesota, announced it was stopping. Dozens of other families, who get coverage through the state’s high-risk insurance pool, learned it will disappear under federal health reform. “Everybody’s feeling like their coverage is at risk,” said Larsson.
Larsson, whose institute has spent $387,000 on lobbying since 2008, says the insurance mandate is critical for those families. He points to studies describing this type of therapy, also known as Applied Behavior Analysis (ABA), as far and away the most effective.
Insurance industry is wary
The insurance industry, though, is skeptical. Glenn Andis, a psychologist at Medica, said that health plans cover many types of autism treatment, such as speech and physical therapy, but often draw the line at ABA. It’s far more expensive than other types of treatment, he said, without proof that it’s more effective.
Andis notes that an expert panel examined the scientific literature for the state of Minnesota, and concluded in February that the evidence was “far from robust.” Yet the panel, called the Health Services Advisory Council, recommended that the state pay for an unlimited amount after supporters flooded the group with personal appeals. Andis called it a “political decision” rather than a scientific one. “Why should we pay 10 to 20 times more for something that shows no greater evidence?” he asks.
Andis said he’s also troubled that parents have been led to believe that 40-hour-a-week treatment is their only hope. “Yes, they’re going to get some behavior change, there’s no doubt about it,” Andis said. But “at what cost?... Is that the most effective and most efficient way?”
One autism advocate, in fact, has publicly criticized the proposed law. Idil Abdull of Burnsville, founder of the Somali American Autism Foundation, says that advocates sometimes exaggerate the need for intensive therapy, and a mandate like this would be a blank check.
“This bill asks unlimited hours for ABA, for unlimited age, forever,” she testified in March. Abdull, who has complained about disparities in treatment for low-income children, said it would be fairer to put some limits on autism services, and make them equally available to rich and poor.
Supporters, though, say the fears about costs are overblown. Sen. Chris Eaton, DFL-Brooklyn Center, one of the chief sponsors, estimates that about a third of young children with autism might need intensive treatment, typically for about three years.
Michael Wasmer, of the national group Autism Speaks, says that autism mandates in other states have not been as expensive as some feared. On average, they cost health plans 31 cents per member per month. He acknowledges that most states have dollar caps — typically $36,000 to $50,000 a year — and age limits (from 6 to 21). But he cited a recent Missouri study that found a negligible impact on insurance premiums.
In any case, advocates argue that the cost pales compared to a lifetime of special education and support services.
“It would be really penny-wise and pound-foolish,” said Eaton. “These people will cost millions of dollars over their lifetime if we don’t give them treatment now.”
Maura Lerner • 612-673-7384