ONE out of every 68 children under the age of 8 in the U.S. — and one out of 42 boys — are on the autism spectrum, the U.S. Centers for Disease Control and Prevention announced in March. That’s about 30 percent higher than the 1-in-88 rate estimated in 2012.
While not a curable disorder, it is treatable. Research has shown that early, intensive neurodevelopmental therapies have an enormous long-term benefit for children as they age, and for their families and for society.
Yet, Washington remains in a minority of states without an insurance mandate to cover these therapies. The Legislature has failed to act, and so has the state insurance commissioner.
But a series of lawsuits since 2010 has begun to change that. One insurer after another — including Group Health, Medicaid, the state employees’ plan, and, just this week, Premera — have settled suits and begun coverage. The suits accuse insurers of perverting the intent of Washington’s Mental Health Parity Act, which requires equal coverage for illnesses of the mind and body.
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Next up is Regence BlueShield. The state Supreme Court will hear arguments next month in the case that Regence lost at the trial court level. If the pattern holds, the state’s largest private insurer will soon follow suit.
At issue is insurers’ interpretation of the state’s mental-health parity law, enacted in 2005, which requires coverage of “medically necessary” services to treat a disorder. Insurers instead rely on an older state law mandating intensive behavioral therapies under the age of seven, but not for older children.
The real issue of a so-called “autism mandate” is cost. In a letter circulated to state lawmakers in March, an actuary hired by a Regence affiliate estimated such a mandate would cost between $8.8 billion and $28.3 billion a year.
But that wild estimate used costs far above the norm, and is contradicted by studies in some of the 31 states currently with an autism mandate. In February, Missouri’s insurance commissioner found the Show Me State’s autism mandate amounted to just two-tenths of 1 percent of overall insurance claims costs and was “very unlikely” to have any impact on premiums.
Early intensive behavioral intervention for children with autism is an investment in their future. The treatment works. It offers a fuller, richer life as the child grows up.
And it saves an estimated $1.5 million over the person’s lifetime, according to a 2011 study in Minnesota. Often, those lifetime costs are borne by public human services, so Washington has a vested interest in ensuring early therapies are more widely available.
With such public interest, and a state law mandating parity, the state Office of the Insurance Commissioner Mike Kreidler should have stepped up and issued an interpretation mandating coverage, or the Legislature could have clarified the law. Nine years have passed since the state parity law was enacted and too many children have not received the treatment they needed.
Instead, Kreidler and the Legislature left enforcement to class-action lawyers, in particular attorneys Rick Spoonemore and Ele Hamburger.
These attorneys’ settlement with Premera this week is a significant victory for families raising children with autism. True mental-health parity has a long way to go, but it is now a journey a little less far.
Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Sharon Pian Chan, Lance Dickie, Jonathan Martin, Erik Smith, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).