EDITORIAL
Covering autism
Gov. Kasich acted properly in moving to close a troubling gap in Ohio’s mental-health care and insurance coverage
12/31/2012Children with autism can lead healthy and productive lives, with proper treatment and early intervention. But thousands of Ohio families can’t get either, because insurers don’t offer adequate coverage.
This month, Gov. John Kasich took a big step toward remedying the problem, when he announced that Ohio will require health-insurance plans to cover autism services for children by 2014. The new policy directive will make such services available to state employees and their 40,000 covered children, after approval by five state employee unions.
Autism services also will be included in Ohio’s “essential health benefit” package, which federal law requires in every state starting in 2014. The package outlines minimum coverage that insurers must provide.
Ohio’s tax-funded Medicaid program for poor and disabled residents already covers autism services for roughly 40 percent of Ohio’s children. But most employer-sponsored health plans don’t include such coverage.
Mr. Kasich is, in effect, finishing the job the General Assembly undertook six years ago, when it passed mental health parity measures that generally require insurance companies to treat mental illness in the same way they treat other medical needs. The legislation, however, excluded autism spectrum disorder.
Autism is not considered a mental illness. Rather, it is a neurodevelopment disorder that is often characterized by impaired social interaction, communication difficulties, lack of empathy, withdrawal, and repetitive, even self-abusive, behavior.
Early intervention and comprehensive services represent an investment to help children affected by autism do better at school, find employment, stay engaged, and lead productive lives. As such, they serve society’s broadest interests.
Arguments by business groups, including the Ohio Chamber of Commerce, that expanded autism coverage will place unreasonable burdens on struggling businesses are shortsighted and off target. Similar expansions of coverage in other states have raised insurance costs by less than 1 percent.
Moreover, without the change initiated by Mr. Kasich, the federal government would be more likely to set its own mandates when it reviews all state health insurance coverage in 2016, “Having something in place provides a level of protection,” Eric Poklar, spokesman for the Governor’s Office of Health Transformation, told The Blade’s editorial page.
One in 88 children — including 60,000 Ohioans — have autism spectrum disorder, the U.S. Centers for Disease Control and Prevention estimates. Males are four times more likely to have the disorder.
Ohio’s austism coverage will include initial screening and development of a treatment plan, one-on-one treatment to develop communication and social skills, and speech or occupational therapies. Altogether, insurers will have to cover as many as 70 visits a year.
Coverage is not unlimited. But Governor Kasich’s plan provides a reasonable balance between the need to provide adequate coverage for autism and the cost concerns of business.
This year, Michigan also mandated autism coverage. But unlike Ohio, it has yet to extend a similar mandate to coverage of mental illness. Michigan ought to join the 43 other states that have done so.
Meanwhile, in placing Ohio among 32 other states with similar mandates on autism, Mr. Kasich should be applauded for helping to close a troubling and risky gap in Ohio’s mental-health care and insurance coverage.