Pa. families want autism covered by health plans
Families with autistic children are hopeful that this will be the year when insurance companies finally begin to cover autism treatments.
Insurance policies rarely provide coverage for the behavioral and psychological therapies that parents, pediatricians and therapists say are vital to helping children with the developmental disorder.
“Autism is a treatable disorder,” said Cindy Waeltermann, the director of the Autism Center of Pittsburgh and mother of two autistic sons. “With early intervention, many of these kids can lead successful, productive lives.”
House Speaker Dennis M. O’Brien, R-Philadelphia proposed House Bill 1150 — named for the estimated 1 in 150 children now diagnosed with some form of autism — early this year. The House approved it in July. It would require health insurance companies to pay up to $3,000 per month for the care of autistic people.
The Senate is expected to consider the bill when members return to session this fall.
“I think it’s something that’s long overdue,” said state Sen. Jane Clare Orie, R-McCandless.
Orie, who heads the state Legislature’s Autism Caucus with O’Brien, is hopeful it will be signed into law by the year’s end.
Although Gov. Ed Rendell also supports the measure, the bill has powerful opponents.
Pittsburgh-based Highmark Inc., the state’s largest insurer with more than 4 million members, opposes the move.
“Highmark philosophically opposes health insurance benefit mandates,” the company states on its Web site. “Mandates cause health insurance premiums to increase, eliminate choice for our customers and lead to higher uninsured rates.
Experts said they believe that early diagnosis and intensive therapy can lead to improvements in behavior, communication and learning disabilities — the trademarks of autism spectrum disorders.
Without support from insurance providers, parents and the state Department of Welfare shoulder the financial burden for those treatments.
“If they see that scarlet letter A (for autism), it’s denied,” said Waeltermann about insurance claims.
“The autism mandate alone will increase Highmark’s annual claims expense by $27.5 million,” the company stated.
Opponents also argue that because self-funded insurance plans — those offered by larger employers — are federally governed, the state’s mandate won’t affect the plans covering the most people and could unfairly burden smaller employers.
Both Highmark and the Pennsylvania Chamber of Business and Industry believe because the state covers autism therapy through medical assistance, insurance providers should not be forced to pick up the tab.
“This legislation would result in a cost shift from the public to the private sector that would fall directly on the businesses and individuals, particularly those that are unable to self-insure and least able to absorb premium increases,” said Floyd Warner, director of the state chamber.
Waeltermann disagrees, claiming research shows premiums would increase by less than 1 percent. She added that by continuing to rely on the state’s medical assistance program, taxpayers foot the bill.
O’Brien estimated his bill would save the state $22 million annually.
HB1150 would place a $36,000 annual limit for insurance benefits. Anything beyond that would be picked up by medical assistance programs.
Kim Motosicky, the mother of an 11-year-old son with the autism diagnosis of Asperger syndrome, said she fears continued reliance on state aid.
“(The state) will never be able to guarantee there will always be something there for (autistic children),” said Motosicky, of North Buffalo.
“I would like to see the Senate do the right thing instead of playing political games,” said Waeltermann. “Do the right thing for the kids.”