Heather Nichols of Lawrence said she considers herself lucky.
Once a stay-at-home mom, she said she was able to return to work as a financial analyst to help pay for the $1,000 per month for treatment of her 3-year-old son Josh’s high-functioning autism.
“I feel fortunate that we can pay for it. Other people, whose kids are more severe, must pay more than that,” Nichols said Thursday.
And experts say it is that high cost of treatments that results in many children with autism not getting diagnoses and not getting needed developmental therapies.
Nichols and her husband, Jason, are pushing for passage of Senate Bill 12, which would require insurance companies to cover the diagnostic evaluation and treatment for autism disorders.
Currently, most policies exclude this coverage.
A public hearing at the Statehouse in Topeka was packed with parents of autistic children, medical professionals and advocates pushing for the bill.
Opposing the bill are insurance companies and business groups, who say requiring coverage would drive up the cost of insurance for everyone else and may cause some employers to stop providing coverage.
William Sneed, representing America’s Health Insurance Plans, said Senate Bill 12 would “unwisely shift the cost of what is a very difficult public health challenge.”
The measure was also opposed by the Kansas Association of Health Plans, Blue Cross Blue Shield of Kansas, and business groups including the Kansas Chamber.
State Sen. Ruth Teichman, R-Stafford, chairwoman of the Senate Financial Institutions and Insurance Committee, said she didn’t know whether the committee would work on the bill.
“I’m very concerned with getting those children services,” Teichman said. But, she added, she was also concerned that a mandate on insurance companies could increase premiums.
But Nichols and doctors who treat autism say providing coverage would increase early intervention, and that in the long run would be less expensive for taxpayers.
Early treatment will improve the development of children with autism, allowing about half of them to attend school and be successful without any special support, said James Sherman, a professor in the applied behavioral science department at Kansas University.
“The future savings to the state of Kansas of effective early intervention, in terms of adolescent and adult services not needed, as well as the positive contributions of the people as workers and citizens when they become adults, is easily in the millions of dollars for each child served,” Sherman said.
Nichols, who could not attend the hearing but has been active in pushing for the legislation, agreed, saying, “Basically without treatment, these kids will never be able to live independently.”
Comments
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toe (anonymous) says…
Socialized medical care one bill at a time.
spankyandcranky (anonymous) says…
I'm all for providing coverage to increase early intervention and cause less expenses for taxpayers in the long run. I'm curious if insurance companies already do this for people who suffer from downs syndrome? Not that the two conditions are the same, but there are some similarities in that both kinds of people have difficulties leading 'normal' lifestyles. People that are autistic tend to have trouble functioning in society because they thrive on consistency and patterns, and have touble when constants are changed, such as people or locations. I believe that both conditions exist from birth, and it's not like either one is reversable, so I feel like insurance companies should have similar policies on their intervention and treatment of both.
denak (anonymous) says…
My cousin, Lauren, is autistic. She was lucky because all of her needs were met by my uncle's insurance. She is now in college.Not all people who are autistic are "vegetables." There is such a wide spectrum and so many behaviors associated with this disorder that it makes absolutely no sense to not cover the cost of evaluation and treatment.A lot of these children can and do grow up to become productive citizens with the right treatment.Without the treatment, they become a burden on society. Or the burden for caring for them destroys mom and dad's marriage.Dena
RogueThrill (anonymous) says…
toe is hilarious. He would likely pin a medal on the mother's chest for having the baby but once that baby is here then screw 'em. Let them fend for themselves, laissez fair and all that.
observing (anonymous) says…
My heart goes out to families of children with autism. But the other side of the picture is the sheer cost involved, whoever is paying. This family is paying $1000.00 a month, but I hope that this and all families get what they pay for. The much-lauded ECAP program in Lawrence does good things for many people, but their pricing structure is such that a family can pay a whopping hourly fee for the services of a professional, which for the most part (in many, many cases) is provided by a graduate student clinician. ECAP and similar programs, who may provide good services (if you assume that the one-size-fits-all model of ABA they promote is good service for everyone) should take care when recommending the frequency and level of services, and be more honest with families when it comes to how their fee structure is organized, how they determine frequency of service, when they decide that ABA is no longer appropriate, and how much a family should truly pay for what are therapies that a graduate student is doing to learn his or her job.
kuhusker (anonymous) says…
Starting today, every single page I visit on LJWorld.com pops-under an ad every time I click. Thus if I visit 6 pages during a visit to the site, I have 6 ads pop up. This is new behavior today, and is very annoying. I am suing Safari. Has anyone else experienced this?
kuhusker (anonymous) says…
That should say "using" Safari:-)
kuhusker (anonymous) says…
I found a solution for the pop-ups...not sure how long it will last, but it is working for now. Basically, you need to go into your cookies database and delete all cookies from zedo.com. In Safari you can go to Preferences/Security and search for zedo.com and delete them. Not sure how it works in other browsers, but I imagine they all have a similar facility.Once I did this, the pop-ups stopped appearing...for now, at least :-)But, users shouldn't have to do this. The LJworld webmasters should not be using this sleazy method of advertising in the first place!
redmoonrising (anonymous) says…
I got one when I opened an article from the main page. Wouldn't have noticed because it only showed on the task bar, didn't pop up. So far none since. Thanks for the advice on how to stop them.
alm77 (anonymous) says…
kuhusker, why can't you click on "Safari" (upper left hand corner) and then click on "Block Pop Up Windows" (from the drop down menu?)... Is autism currently not covered because most treatments are still considered experimental?
Satirical (anonymous) says…
This is odd. Services for most autistic children and adults are currently provided by the government. Everything from day care, education, housing etc. is provided by taxes. What is odd is that liberals want to take something out of the hand of the government and give it to the private sector. Perhaps advocates of this bill think the services will increase if insurance were forced to cover autism, or be mandatory in more circumstances than what the government covers (neither of which necessarily would be the case if the bill passed). Aren't insurance companies infamous in what they don't cover. Aren't many people clamouring for universal government healthcare b/c of the alleged deficiencies of the private market? Just seems to be contradictory to me.The immediate result of forcing insurance companies to cover autism is a drastic rise in rates, but not a reduction in taxes. So immediately there will be a burden to anyone who has insurance, and may prevent others from getting insurance b/c the cost is too high. The immediate net result spells trouble in these tough economic times.
Gootsie (anonymous) says…
I guess I'd like to see services for handicapped be based on the family's income and worth. I know one person who takes all the state money they can squeeze out, and both parents live in very nice homes and have sizeable bank accounts. I kind of resent that my tax money goes to help those who could most certainly help themselves or their own children for whom they choose not to be financially responsible for...
puff312 (anonymous) says…
Satirical - Actually, only a few kids receive help from the government. The government does fund The Autism Waiver and the MRDD Waiver (for the Mentally Retarded & Developmentally Disabled), which provide the funding for the services you mentioned. However, the waiting list to receive these waivers is endless. To get one of these waivers is like hitting the lottery. It might happen, but probably not.Also, 8 other states have passed this legislation. Studies done after that legislation passed, show that insurance premiums only increased by 1% or less, which equals $40 annually or $3 per month. This is far less than it will cost us as taxpayers 10-20 years down the line when these kids have to live off taxpayers because they can't function independently because they didn't receive the early intervention that would have allowed them to do so. The incidence of autism has exploded in the last 10 years, which means that in the coming years, there are going to be WAY more autistics who enter their adult years and have to live off the taxpayers because they didn't get the help they needed.You might educate yourself next time before you talk.
puff312 (anonymous) says…
alm77 - to answer your question, no the treatments are not still considered experimental. The American Academy of Pediatrics and National Institute of Mental Health both endorse ABA Therapy for autistics. Many, many studies have documented the effectiveness of ABA, in particular the Lovaas study done at UCLA in the 80's.Insurance companies claim ABA is an educational treatment so that it should be the responsibility of the public schools, which are already overburdened and suffer budget cuts routinely. The fact is that autism is a neurobiological medical condition, and insurance should cover its diagnosis and treatment.To not do so shows what's really the issue here--corporate greed.
Satirical (anonymous) says…
Puff312…I don’t know where your apparent animosity towards me comes from. Or do you personally attack everyone who has an opposing view to yours? If you want to educate me, then how about you provide some links to back up your "facts". I know many people with autism, and all of them get a lot of help from the government. Everything from a monthly stipend, to free housing, to day providers and case workers, etc. My evidence is of course anecodotal, but I have yet to see opposing evidence that shows the help is as rare as you claim. Of course the people with autism that I am familiar with are adults, not children.My question still is, why force this on the private sector at time of a shaky market? Why not just pass legislation to make the government handle these early intervention services that you claim will end up saving money, and costs so little?
Satirical (anonymous) says…
Puff312…“To not do so shows what's really the issue here—corporate greed.”What you call corporate greed, I call trying to stay in business. Your one-sided arguments talk about how the public schools are already overburdened but don’t mind if an insurance companies struggle, go out of business, or raise their rates and insure fewer people. You act as if the only entity which would be negatively affected is the insurance company, when it is clear the impact would be larger.This is a social cost whether it is covered by the private sector or government. So again, why should the private sector be forced? If this treatment is proven beyond a doubt, which you seem to imply, then why not keep it with the government which already handles this issue?
puff312 (anonymous) says…
Government programs like Medicare are very flawed and can't support anything more. Besides, whether the government pays for it or health insurance pays for it--either way, you pay for it either as a taxpayer or an insured! But, health insurance companies are at least more qualified to administer it.You are right--autistic adults get a lot more funding and services than children. It's a bit backwards since if they got the help when they're little, they probably wouldn't need it as adults.Also, Senate Bill 12 has a provision to allow small businesses with less than 50 employees to opt out. So, the bill is friendly to small businesses.
puff312 (anonymous) says…
Why should insurance cover the medical treatment for an obese smoker who chooses to live that way, but won't cover treatment for an autistic child who can't help that they were born with a pervasive developmental disability?
Satirical (anonymous) says…
Puff312…I agree Medicare is very flawed (so you oppose universal healthcare too?)I agree it is a benevolent society’s duty to care for those who can’t care for themselves. So autism in many cases is a social cost. My concerns are: (1) why should the private sector take over only a small aspect of care for people with autism when it might be more efficient to keep their care with the government who provides the majority of the care (2) my guess (without doing any research) is that this program isn’t as proven as you would lead to believe, since if it were proven the government would take care of it like they do for Medicare, early childhood education, etc. (3) the costs to the insurance sector would cause an increase in rates, and therefore by supply and demand theory push some people off insurance, and possibly force lay-offs in the insurance industry which would be bad in these tough economic times. Companies don’t just eat costs, they either pass them on to the consumer or decrease costs in other areas like the number of employees.There may be sensible answers to all of my concerns, and maybe the insurance companies would be in the best position to handle this problem. As a fiscal conservative, I generally favor the efficiency of the private market over the inefficient and wasteful government. But again, I don’t think I am a bad person for taking a critical look at the repercussions of this legislation.
xbusguy (chris Ogle) says…
Insurance: insurance against loss through illness of the insured ; especially : insurance providing compensation for medical expenses___________________________________Seems pretty clear to me.
puff312 (anonymous) says…
I already pointed out that the costs are less than you think. Premiums have been shown to increase by less than 1%, or $3/month for family coverage.ABA is a proven therapy, but the government is not equipped to handle its administration. Read the book Overcoming Autism by Lynn Kern Koegel. She has treated autistic children for years at UCSB in CA. There are many books on ABA that I've read, but I especially like this one because it's written by the clinician and a mother.I don't think you are a bad person. I just think that if you feel so strongly against the bill, you probably should do the research just to make sure you're right.
alm77 (anonymous) says…
puff, thanks for the info. I have a friend who couldn't get his insurance to cover something they considered "experimental" even though it had been around for a very long time. I just figured it was one of their many, many loopholes. Of course insurance companies should cover it (and of course they'll say anything not to).
srj (anonymous) says…
Not sure if ordering insurance companies what to do is a fair or right thing to do, but we are in a new era of government, like it or not.
Danimal (anonymous) says…
We wonder why health insurance is insanely expensive in the US and then we do something that will only make it more expensive. The fact that I can't health insurance for less than $120 a month and I go to the doctor maybe once every two years (because I'm healthy) is ridiculous. Insurance laws in Kansas are insane, and I'm not trying to make fun of disabled people, I'm just saying they don't make any sense. I guess it's all a matter of whether or not your ailment is popular or not. When is our nation going to start doing things to restore social mobility and not just further cement all of us in place? If I was an insurance company I would just fold my business and move to another state.
geekyhost (anonymous) says…
I have a four year old with autism, and he currently receives 12 hours of services per week, including preschool, speech therapy, and occupational therapy. KU MED recommends he receive 25-40 hours of intensive therapy per week, including what he is receiving and ABA. That is a level backed by research to show the highest level of benefit and reduce the amount of government services he'll require later in life.IF the government fully funded the autism waiver program, his services would be covered, but he is currently #145 on the waiting list -- and in this budget year, it's doubtful he'll ever get a slot. There are less than 50 individuals receiving these services in the entire state. He'll age out of the underfunded autism waiver program once he hits school age and "graduate" to the 4-5 year long, unfunded waiting list for older children. We can debate whether or not the government should be more heavily funding these programs, but it's counter productive to argue that the government should be funding them if you're going to turn around and tell me the government can't fund them either.If the government is unable to fund services, it seems smart to shift the cost to insurance companies. That is, after all, why I pay premiums. Arguing that you shouldn't pay for my child's therapy is like me arguing that I shouldn't pay for your broken foot or cancer treatments. Neither my child, nor society should be punished for his bad luck of being born to a family that can't afford to cover the cost of his therapy out of pocket. I don't think an extra $3 per month is too much to ask in order to have more kids who grow up to be tax paying citizens rather than tax payer burdens, do you?
reagandrive (anonymous) says…
As a parent of a child with autism I do expect my health insurance to cover medical conditions. Autism is a medical condition - it is a complicated neurobiological condition. It is not a learning disdorder. Is learning effected by this medical condition, often it is . Just as the diagnosis of diabetes, cancer, and other illnesses are covered, so should the diagnosis and treatment of the medical condition autism. It is WRONG for insurance companies to ignore years of medical research and the knowledge of medical experts. Just as cancer patients have had to battle in the past to have treatemtens approved, so must we, and it is now high time that insurance companies do what they are supposed to do - help cover medical treatment.