Closing the Insurance Gap for People wi th Aut ism

All parents struggle to provide and do the best for their children. Parents of special needs children share this same basic commitment. But, due to financial and other hurdles, their struggle can become much tougher. Too often, many of these moms and dads are forced to contend with school districts, local governments, and a society that can seem indifferent to their loved ones.

We are recovering – slowly, haltingly – from the longest recession since the Great Depression. New York State is suddenly struggling to control its long-neglected finances. As a reformer and limited government advocate, I believe these cost-containment actions are necessary, if overdue. But we must also remember that during these tough times the most vulnerable among us demand our attention. Families raising special needs children, struggling to make ends meet, are being particularly hard hit. Health care costs continue to rise despite cratering household incomes.

According to the Centers for Disease Control and Prevention, one out of 110 children nationwide has autism. Sadly, the disorder’s incidence is much higher among boys. To this day it remains unclear what causes this neurobiological condition, but its effects can be seen in children across the cognitive spectrum, ranging from severe speech impairment to milder forms of social disengagement.

Studies have shown that families raising children with autism will typically spend over $1 million during the lifetime of the child and devote more than 1,000 hours annually to treatment and care. The emotional, financial, and personal strains are enormous. These costly trends have only been accelerated by the poor economic climate.

As an assemblyman I have met with hundreds of parents of autistic sons or daughters. Many have vivid and frustrating stories to tell about difficulties in getting insurance coverage for their loved ones. While a government takeover of private medical decisions is not the answer, it must be understood that necessary and immediate treatments for autism spectrum disorders such as speech therapy are currently not covered. In 2010 stories of families taking second mortgages on their homes to pay for their child’s mandatory treatment have become too common.

The Empire State’s guaranteed issue insurance law means most medical conditions get covered, but providers limit autistic patients to certain treatments and therapy options. Until now. It is rare that I can report good news from our nation’s most dysfunctional legislature. I am usually fighting Albany’s fiscally irresponsible proposals and opposing tax increases, yet some good can be found in the state Capitol. This week I am proud to report that after working for several years on this front, we have now passed, with my support, legislation which would for the first time close the insurance gap for many autism patients.

Here’s how it works. The commissioner of health, in consultation with the insurance superintendent and the commissioners of mental health and mental retardation and developmental disabilities, is charged with responsibility for recommending regulations identifying treatment and therapy options. Prior to these new insurance options, coverage will be according to treatment guidelines issued by the American Academy of Pediatrics. The bill is expected to reduce out-ofpocket costs for health consumers and result in savings for New York State.

This legislation is not perfect, but will help alleviate some of the burden on tens of thousands of families in New York. The insurance lobby in New York is one of the most powerful, and getting this passed was no easy feat. If the measure is signed into law by Governor Paterson, New York would join 20 other states that already require some form of autism coverage by its insurance carriers. For all the families out there fighting the good fight let’s continue to push and make New York the leader, not the follower, in supporting our precious kids!

Greg Ball represents New York State’s 99th Assembly District in Albany and is a candidate for the 40th State Senate District seat currently held by Vincent Leibell.