Expanded health coverage is a must to help autistic kids

Any child could be born with autism. Patients with autism spectrum disorder are fragile and vulnerable members of our society and should have access to necessary medical care. In recent years, the majority of American states have passed legislation which ensures that this population receives basic mental health services. The alternative is untenable.

In Hawaii, SB 2054 SD3 would require health insurers, mutual benefit societies and health maintenance organizations to provide coverage for autism spectrum disorder treatments.

"Health insurance coverage for children with autism is a priority because 1 in 88 children are affected by autism, and there is strong evidence that autistic children respond to early intervention and therapy, which health insurance would help provide," according to Senate Health Committee Chairman Josh Green.

Autism is a mental health disorder where individuals have communication difficulties, social deficits and delays in cognitive development, the severity of which can be highly variable.

This past week, I saw one long-term patient who, as a youngster, was too debilitated for his single mother to care for him. She eventually resorted to placing him in a home but upon visiting him found the conditions to be so poor she brought him back home. Part of his condition involves continuously picking at his skin so that he has ongoing infections and extensive scars that have developed over time. Mom’s burden is enormous but without better access to care for her son, she somehow manages.

Another patient seen this week with mild autism is married to a deaf woman. He was able to work at a simple job for much of his life, but symptoms worsened and he could not continue. As the Affordable Care Act, sometimes called Obamacare, began to change the landscape, he lost his insurance, could not get his medicines and deteriorated further. He and his wife ended up homeless and are now in a shelter fighting their way back to normalcy.

Before the Mental Health Parity Act (MHPA) was signed into federal law in 1996, health insurers were not required to cover any mental health services. The MHPA requires that annual or lifetime dollar limits on mental health benefits be the same as limits for medical and surgical benefits. Since then, requirements for mental health coverage have continued to expand both under both federal and state legislation, but more is needed.

The governor, some legislators and most payers are concerned that SB 2054 will add an onerous financial burden to an industry in transition. However, if the projected cost is passed on to consumers, it would likely result in a 0.25 percent premium increase, or roughly $1 on everyone’s insurance bill. In the long run, however, the result could well be cost savings. The chances are that appropriate care for those with autism spectrum disorder will be cheaper than emergency visits and hospital admissions that result from lack of access to necessary mental health services. Early intervention and evidence-based therapies for autistic children, their families and caretakers are essential.

If a child in your family was born with autism, would you want your son or daughter to have access to health care? SB 2054, if passed, ultimately will benefit all concerned.
 

Ira Zunin, MD, MPH, MBA, is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com