Filling the autism void
MASSACHUSETTS MAY have the best health care in the country, but it doesn’t cover the treatment for the fastest-growing health threat to children - autism.
Autism affects brain function and impairs communication, social interaction, and sensory modulation skills. The most recent statistics show that 1 in 91 children has autism, with the incidence four times as high in boys.
More than 500 babies born this year in Massachusetts will soon be diagnosed with autism. What their parents will learn first - what my wife, Laurie, and I have learned from our son Dougie - is that while the hopes and dreams for their child may change, they will also intensify.
Parents will learn that, with early intervention, children with autism can make significant strides - a fact backed up by extensive studies. They’ll find that their pediatricians and neurologists will prescribe intense one-on-one speech, occupational, physical, and behavioral therapies. And then they’ll be dismayed to discover that, though they’ve always paid their health care premiums, their health plans will not cover these services.
Why don’t health plans cover treatments for the fastest-growing health threat to children? There is a contradiction between the role of schools versus that of medicine and health plans. Federal law stipulates that schools provide services necessary to allow all children to “access the curriculum.’’ While critical to helping children with autism excel in the classroom, this in no way replaces their need for therapy to improve long-term brain functioning - not only to get through an average day, but to lay the foundation for the rest of their lives.
School superintendents are powerful in asking health plans to step up to ensure that children with autism, like all others, are sent to school ready to learn. They expect health plans to provide glasses to students with poor eyesight, or even chemotherapy to children with cancer, so they have every right to expect that children with autism will receive out-of-school autism therapy.
Foundations like The Doug Flutie Jr. Foundation for Autism and Advocates for Autism of Massachusetts work hard to fill the gaps in services and opportunities for children with autism. We also work to make up for the absence of the lead player in supporting the treatment of any medical condition: health plans.
In the health plans’ absence, parents are left to pay privately or see their children go without autism therapies.
Those of us who can afford it (comfortably or through extreme means) see the incredible difference these services make in our children’s ability to communicate, learn, function as part of the family and the community, and simply stay safe.
Those who can’t afford it face the pain of being unable to give their child services proven to radically improve their developmental outlook.
Autism coverage isn’t just the right thing; it’s the financially smart thing. This coverage will cost just $2.28 per member per month. Alternatively, the average lifetime cost for an adult with autism is estimated at $3.2 million. Research shows that with effective early intensive intervention up to 47 percent of individuals can lead independent lives without state-funded supports. Additionally, they will each make an estimated $1.7 million contribution as taxpayers, bringing the actual savings of autism coverage per person to $4.9 million. While not all individuals will achieve this outcome, even moderate gains result in significant savings to taxpayers.
The Legislature is considering a bill that requires health plans to treat autism as a medical condition and pay for its treatments. Fifteen states have already passed similar legislation. This state needs to join them in ending insurance discrimination against people with autism.
Doug Flutie is a former professional football player and the cofounder of the Doug Flutie Jr. Foundation for Autism.