Republican leaders in the House of Delegates have endorsed a bill to expand coverage for children with autism. Existing law requires health insurers to reimburse autism treatments for children between 2 and 10 years old only. The proposed law would eliminate the cap.
The expanded coverage, which would help an estimated 10,000 people, would cost the state about $237,000 in additional healthcare insurance premiums, according to the Washington Post. Neither the WaPo nor Richmond Times-Dispatch provided an estimate of how much the measure would cost all Virginians, not just state employees.
A summary of SB1693, submitted by Sen. Jill Vogel, R-Winchester, states that “health insurers, health care subscription plans, and health maintenance organizations” would be required to expand coverage. A companion bill, submitted by Del. Bob Thomas, R-Stafford, has been introduced in the House of Delegates. Neither piece of legislation has been subjected yet to a cost-impact analysis.
The problem is real enough. The Virginia Autism Project says 25,000 to 30,000 Virginians between the age of 2 and 18 have been diagnosed with the condition. The organization estimates that as many as 15,000 lack healthcare coverage. Autism experts contend that early diagnosis and intervention can significantly reduce the cost of services at a later age — although early years are already covered, and the bill would extend benefits into the teenage years.
Autism is widely regarded as a spectrum disorder. Children with mild symptoms can be mainstreamed in school. Others often are placed full-time or part-time into special classes. The most severe cases require placement in expensive, resource-intensive private schools with specialized facilities and staffs. Federal law posits the right of a child with autism to have a public education, and the cost of providing that education is creating fiscal stress for many school districts.
Bacon’s bottom line: Having a child with autism can create tremendous financial stress on a family. There is no consensus on what causes the condition. No one advances the argument that autism in a child is caused by parents’ behavior. Therefore, a reasonable argument can be made that the cost burden should be socialized, or shared by society at large, just as many other health care conditions are.
But the political economy of autism is such that there is only one organized voice in the debate — the voice of parents of children with autism. There is no “anti” autism voice. No one wants to be pilloried as hostile to families grappling with autism. Only a beast would suggest that the interests of others — taxpayers, insurance payers — also are worthy of consideration.
I’ll play the beast. My purpose here is not to argue against the bill but to say we need more information about how much it cost and who will pay. There is no free lunch. If the General Assembly mandates an expansion of insurance coverage, the money must come from somewhere.
The Washington Post quoted Republican leaders as saying that the bill would cost the state only $237,000 in extra insurance premiums. Where did that figure come from? How many state employees would benefit from the expanded coverage? How much money on average would families with children with autism collect in additional benefits? How much would state employees pay in higher premiums? (Are the higher premiums paid by state employees even included in the $237,000 number, or does that figure include the state share only?)
The articles don’t even address the private insurance market or Medicaid. Would the mandate apply to large, self-insured employers? Would it apply only to group plans affected by state mandates? Would it apply to Obamacare insurance plans? Would it apply to state Medicaid coverage? How much might government pay through the back door in higher subsidies for Obamacare plans and Medicaid?
We know the answers to none of these questions. Terrified of looking less than compassionate, Republican leaders are signing up for a law, the cost of which is a giant question mark. The beneficiaries of the bill — the families of children with autism — are highly visible and easy to identify. Needless to say, Democrats in the legislature, always eager to strike a pose of caring and nurturing, have no interest in pressing for answers. Unfortunately, in this debate, no one represents the invisible man, the ordinary Virginian who will pay higher taxes or premiums to cover the higher costs.
Perhaps, after quantifying the costs, all Virginians would agree that expanding autism coverage is a good thing to do. But it’s hard to draw that conclusion without quantifying the costs. The fact is, we just don’t know. Pardon the cynic in me, but if we don’t know the answers, it’s because someone doesn’t want us to know. And if someone doesn’t want us to know, it’s because they know someone is getting screwed.