Autism Coverage and the Hidden Man

Republicans still need remedial instruction, it appears, on the meaning of free markets. Occasionally, they get it right. When President Obama passed healthcare reform that coerces uninsured individuals to sign up for health insurance or pay big penalties, for instance, members of the Elephant Clan raised a ruckus over the abrogation of personal economic freedom.

But if you want to buy an insurance policy that doesn’t include coverage for cancer screenings or reconstructive breast surgery, then you are not free to do so. Republicans in the General Assembly routinely vote for laws requiring individuals to purchase health insurance plans that may provide coverage options they do not want.

The most recent case in point: Gov. Bob McDonnell has signed a bill requiring health insurers to offer treatment for autistic children ages 2 to 6. (The law will cap annual coverage costs at $35,000, would not apply to self-insured companies and would exempt businesses with 50 or fewer employees, according to the Times-Dispatch.)

Before anyone accuses me of being insensitive to the challenges of autism, let me quickly say that I am very sympathetic to the plight of parents raising an autistic child. Raising a “normal” child (if there is such a thing) is difficult enough. I can only imagine the emotional and financial roller coaster that people go through with an autistic child. My heart goes out to them.

But I am sympathetic to other people with all kinds of medical maladies, from broken bones to heart attacks, from diabetes to lung cancer. And I am aware that adding millions of dollars of new liabilities to policies that cover those basic illnesses will require insurers to raise rates. Thus, for every family that benefits from the new autism coverage, some other family will lose coverage for everything because they find the new-and-improved package to be unaffordable.

The problem isn’t autism so much as it is the whole panoply of mandated benefits. Autism is only the latest in a long list of requirements that make basic health care insurance so expensive and unaffordable to many. Among the categories of coverage mandated by Virginia law:

  • Pap smears
  • Hemophilia
  • Prostate-Specific Antigen (PSA) testing
  • Colorectal cancer screenings
  • Infant hearing screenings
  • Biologically based mental illness

Click here to see the State Corporation Commission’s full list.

Any single mandate appears to be defensible. Autism coverage seems no more unreasonable than, say, hemophilia. The problem is that the costs add up. Unlike the advocates of reconstructive breast surgery or autism, however, there are no organizations representing the interests of people who lost health insurance coverage because they or their employer could no longer afford it. They are the “hidden man.” There are thousands of them but politically they do not exist. Therefore, their interests go ignored.

Advocates of free markets understand that there is always a hidden man who loses when someone passes a seemingly altruistic law. But Republicans, like Democrats, are suckers for anyone with a heart-rending story that tugs at their heart strings. No one wants to seem indifferent to the travails of an autistic child, so Republicans abandon their free-market principles.

Now the cost of health care insurance in Virginia will rise, the number of Virginians who cannot afford it will increase, and the champions of government-run health care will blame the “failure of the free market.”


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