Without further clarification from Secretary Sebelius, the Affordable Care Act could actually result in less coverage for individuals with autism spectrum disorders.
Congress directed the Secretary of Health and Human Services to define the ten essential health benefits (EHB) that comprise the minimum insurance coverage required by the Affordable Care Act. Instead of defining them herself, Secretary Sebelius has directed each state to define the essential health benefits, jeopardizing existing health care benefits for individuals with autism and ignoring the intent of Congress to ensure coverage for vulnerable populations.
Secretary Sebelius's most recent guidance requires states to defray the costs of state mandates that exceed the essential health benefits. This means that, if a state chooses a benchmark plan that doesn’t include ABA-based treatment for autism and that state already mandates insurance carriers to cover ABA-based treatment for autism, then the state will be responsible for the additional cost of that coverage. In these challenging economic times, such guidance could cause states to repeal their autism mandates or allow them to expire.
Thirty-two states currently have enacted autism mandates, which are laws requiring insurance carriers to provide coverage for ABA-based autism treatment. Those laws are the result of years of coordinated, tireless efforts of families, advocacy groups, and individuals with autism. In states without autism mandates, insurance carriers typically do not provide coverage for ABA-based autism treatment. The intent of Congress was that the Affordable Care Act would require ALL states to provide ABA-based autism treatment.
While ABA can be costly, the cost of doing nothing is far greater. Clinical trials have demonstrated that ABA-based early intensive behavioral intervention significantly improves the clinical outcomes for children with autism. Children with autism who receive this medically necessary intervention narrow -- and sometimes eliminate -- the developmental gap that autism creates between children with autism and their typically-developing peers. Without this intervention, studies have shown that individuals with autism will cost society millions of dollars over the course of their lives in special education costs, lost economic opportunities of family members, health care costs, assisted living costs, and more. All of society benefits when individuals with autism have access to the health care that they need in order to fulfill their potential.
By signing this petition, you are protecting the health care benefits of individuals with autism by urging Secretary Sebelius to honor the intent of the Affordable Care Act to include ABA-based behavioral health treatment for individuals with autism as part of the mental health Essential Health Benefit.