Cost of autism care mandate debated


For a change, we're not going to talk politics today.

Sure, Nevada's autism health-insurance mandate became a red-hot campaign topic in September, with Senate Majority Leader Harry Reid, D-Nev., making a major issue of Republican candidate Sharron Angle's opposition to the pending requirement.

Rather than discuss the back-and-forth between the candidates and their affiliated interest groups, though, we want to ask a simple business question: How much will that autism regulation really cost, anyway?

A big Nevada insurer who didn't want to discuss the political hot potato on the record has crunched the numbers and found the mandate will add 2.2 percent, or about $100 a year, to Nevadans' annual premiums.

That's a "very significant impact," given that most new mandates add less than 1 percent to premium costs, said J.P. Wieske, executive director of the Council for Affordable Health Insurance in Alexandria, Va.

Autism's effect on insurance policies sold in Nevada will be steeper than usual because the condition costs so much to treat. A study from the Harvard School of Public Health found that autism care for one patient can run $72,000 a year. The Centers for Disease Control and Prevention estimates that just under 1 percent of the country, including 730,000 people up to age 21, battles an autism-spectrum disorder.

Nevada's mandate requires insurers selling policies in the state to cover up to $36,000 a year of autism-related care starting Jan. 1, though the state exempted its Medicaid program after officials found it would cost the program $30 million over two years for coverage of autism.

Those are big numbers, so naturally, autism advocates and insurance trade groups alike make potent economic appeals supporting their side. Mandate proponents acknowledge it costs to treat autism, but they argue it's more expensive to let autistic kids languish and end up institutionalized or on disability for life.

Ralph Toddre, a commissioner for the Nevada Commission on Autism Spectrum Disorders, pointed to studies that say it can cost millions over a lifetime to provide custodial care for autistic adults who lacked treatment as children. One study, from the Harvard School of Public Health, pegged the cost at $3.2 million, though Toddre said he's seen reports pushing the estimate to as much as $8 million.

"The bottom line is, you can pay for it now, or you can pay an awful lot more later if you don't treat it," said Toddre, who has two children, ages 12 and 9, with the condition.

And Jan Crandy, a Las Vegas advocate with a 17-year-old autistic daughter, took issue with the 2.2 percent premium impact. She said actuarial research developed in early 2009 to support the mandate forecasted a smaller premium effect of around 1 percent.

Wieske's council published a 2009 study that also set Nevada's autism premium impact at roughly 1 percent, but Wieske said the group is updating its numbers, because the council's initial assumptions didn't account for "explosions" in the number of autism diagnoses and the condition's care costs. He said he now believes the Nevada insurer's projection of a 2.2 percent premium impact is likely to be at least fairly close to the actual effect. The state's actuarial study also acknowledged that the future costs of some therapies were "uncertain" due to increased insurance coverage.

Assemblyman James Ohrenschall, D-Las Vegas, sponsored the mandate, which passed the Nevada Legislature 63-2. It likely won't be clear until 2011 just how much the mandate will cost, Ohrenschall said, but with thousands of kids statewide grappling with autism-related conditions, the Legislature needed to assist.

"The market was not helping these children," Ohrenschall said. "These are families who work very hard and pay a lot of money to have health insurance, and then it didn't cover what they needed."

But any noticeable premium jump could price some Nevadans out of health insurance altogether, Wieske said.

"We know from past studies that fewer people buy coverage as it becomes more expensive. It's the simple reality," Wieske said. "There's a balancing act there."

Susan Pisano, a spokeswoman for Washington, D.C.- based trade group America's Health Insurance Plans, said her association isn't concerned about the autism mandate itself. Rather, the organization's issue is with policy requirements in general, which she said typically become law without regard to their effects on health-care quality or costs. Nor do mandates always come from scientific evidence that certain treatments will help, she said.

The 50 states have passed 2,133 mandates on health insurers, according to Wieske's group. Nevada ranks No. 10 in the nation for its number of insurance mandates, with 52 such requirements.

"Over the last 20 years, we have seen the enactment of literally thousands of mandates across the country that have made the cost of coverage higher, and have put insurance coverage out of reach of more employers," Pisano said. "If you're a parent and you want services for your children, you're not going to be persuaded by that argument, but the other piece of this is that we've got consumers, patients and employers saying to us, 'If health-care costs continue to go up, we're not going to be able to afford what we have now."

Autism mandates in particular have grown popular among states in the past two to three years. Nearly half the states, 23, require insurers to cover it. Some of the surge comes from high-profile advocacy efforts in front of state legislatures, Wieske said, while part of the push involves sympathy for a condition that largely affects small kids. Plus, it's only been in recent years that doctors began to better understand autism and its treatments, he said.

But at least part of the jump in autism mandates originated with subtle attempts to shift the cost of care for the condition away from school budgets and into private insurance, Pisano said. Wieske agreed, noting that interventions such as speech therapy were typically covered through school districts and states, until widespread budget crunches pinched what the public sector could or would provide.

"It's absolutely true that we don't want to leave these children untreated," he said. "The question we have is whether insurance is the appropriate way to cover it. If these treatments were for an adult who had a stroke, you wouldn't find health insurance covering it. It might be covered under a long term-care policy. That's what this issue is really about -- money that was meant to be spent on (autism care) through various programs in schools is gone, so if they can, they want to foist those costs off onto insurers."

Advocates such as Toddre and Crandy say Nevadans are paying for autism care one way or another, and private health insurance provides the best venue for delivering treatment. More kids will be diagnosed with autism than with childhood cancers, juvenile diabetes and HIV combined, Toddre noted, yet insurance covers expenses for the latter three ailments.

"It's just not right. If there's an effective treatment out there that can help a lot of kids have a better quality of life and have a chance at a life as we know it, to deny that opportunity is just wrong," he said.

Besides, said Crandy, defraying the cost of pricey, unexpected conditions is the purpose of health coverage.

"A lot of people will never get cancer, and cancer treatment is expensive. That's what risk pools are for," she said. "Everybody is paying in so that everything that's covered can be treated."

Contact reporter Jennifer Robison at jrobison@review journal.com or 702-380-4512.

 

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