My view: Access to insurance coverage for autism treatment makes sense

By Ben McAdams

For the Deseret News

Published: Wednesday, Nov. 20 2013 12:00 a.m. MST

Brandon Mizar talks with his son Noah who suffers from autism Tuesday, Aug. 13, 2013.

Scott G Winterton, Deseret News

Enlarge photo»

Autism spectrum disorders are a group of developmental disabilities, often diagnosed during early childhood. What normally unfolds as a hectic but joyous time for the parents may quickly become a baffling, frightening period as they try to cope. Some children with autism do not learn to speak as normal children do; some have tantrums; others withdraw into themselves.

More children are diagnosed at earlier ages — a growing number of them by 3 years of age. However, most children were not diagnosed until after they were 4 years old. The Centers for Disease Control reports that 1 in 47 children in Utah are in the autism disorder spectrum, compared to 1 in 88 nationally.

People with ASDs have a different way of understanding and reacting to people and events in their world, due to the way their brain processes information. Although there is no medical test to diagnose ASDs, qualified professionals who conduct psychological and behavioral evaluations are able to determine whether a child is autistic.

The majority of children identified as having ASDs did not have an intellectual disability. But normal communication is often difficult or impossible. That’s where treatment and therapy makes a difference for the child and the family that struggles to provide help. The earlier a child receives treatment, the better the child tends to do. This often means in the future, there’s less need for government support services provided at taxpayer expense.

As one Utah advocate for autism treatment has said, “You wouldn’t say that insurance shouldn’t cover surgery or medication to treat a brain disease, but in Utah we accept a situation where there’s no coverage for this all-too-common brain disorder.” As mayor of a county that self-funds its health insurance plans, I’ve identified a path to change that — at least for county employees and their dependents.

My proposed 2014 budget includes a health insurance benefit package that includes autism coverage. It offers those dependents with an autism spectrum disorder diagnosis up to $36,000 in annual coverage for children ages 0-9 and $15,000 in annual coverage for those ages 10-18. It is included in a proposed budget that is structurally balanced and has no tax increase.

Salt Lake County may well be the first county to take this step, but 34 states have enacted laws that require coverage for the treatment of autism that include coverage of Applied Behavior Analysis (ABA). A growing number of companies that self-fund their health benefit plans are including coverage for ABA, including Home Depot, Microsoft, State Farm, IBM and Wells Fargo. Thirty years of medical research shows ABA is an effective treatment.

Annual medical expenditures per child with an ASD range from $2,100 to $11,200, and intensive interventions may cost five times as much. Families living with ASDs have unique stresses. Many parents even report having to stop work to care for their child with an ASD. Most parents will do anything they can to help their child, incurring great emotional and financial stress.

As a parent, and as mayor, I want to do what I can to support parents as they care for their children with autism and also to help ensure they are productive employees by lessening the financial strain. The cost of adding autism treatment to our insurance plans is modest in the context of an $870 million annual budget. The relief I see in the faces of parents as they’ve learned about this potential option is priceless.

Ben McAdams is the mayor of Salt Lake County.

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