With large health insurance companies lined up to fight it, Gov. Jim Doyle and Senate Democrats are pushing a requirement that health insurance include autism treatment.
Seventeen other states already have such a law, but in Wisconsin the idea is meeting opposition from Republicans and a business community that fears higher health insurance costs.
“At the end of the day, it’s really a fairness issue,” said Amy Masek, director of development and outreach for the Wisconsin Early Autism Project. “Individuals with autism should have the same access to health insurance coverage everyone else has.”
Most insurance companies don’t cover autism because it is classified as an emotional disorder rather than a neurological medical condition. As a result, many people now wait more than a year for state services that treat delayed speech and other social and motor skill problems characteristic of autism.
Democrats hope to eliminate the waiting list by requiring insurance coverage, although state services would still be available to those who have no insurance.
“To me, this is about what basic insurance is all about,” Doyle said. “We don’t have any problem when we’re talking about cancer coverage.”
The mandate was proposed by Doyle in his budget and included in the plan passed by the Democratic-controlled Senate, but removed by Republicans in the Assembly. A special bipartisan committee of lawmakers from both houses is working on a budget compromise, but the autism issue has not been discussed yet.
Wisconsin Manufacturers & Commerce, the state’s largest business group, and America’s Health Insurance Plans, which represents more than 1,300 insurance companies, oppose the plan.
Insurance companies fear the requirement will lead to higher insurance costs that prompt small businesses to drop their coverage.
“The problem with this mandate, like any other new health care insurance mandate, is inevitably they drive up the cost of health insurance coverage,” said R.J. Pirlot, director of legislative relations with Wisconsin Manufacturers & Commerce.
Pirlot said he didn’t have any evidence to show that was the case in other states that have an autism coverage requirement. But he said lawmakers should, at the very least, look at a pending report on the proposal’s cost from the state Commissioner of Insurance before taking action.
The Legislative Fiscal Bureau looked at the effect on the state employee health insurance plan, which covers 162,000 people, and determined the mandate would add $8 million in expenses per year. The state now spends about $40 million through Medicaid on autism services.
But Doyle said the lack of insurance coverage for autism has resulted in too much unmet demand for treatment. And studies have shown that the earlier a person can get treatment, the more successful it can be, he said.
People who receive treatment early also are less likely to need costly services, such as special education, later on, said Masek, who has an autistic 14-year-old son.
The number of children in Wisconsin schools receiving special education services due to autism increased from 203 in 1992-1993 to 4,361 in the 2004-2005 school year. It is estimated that about 11,000 Wisconsin children have been diagnosed with autism.
Nationwide, about 560,000 people under age 21 are autistic, according to the Centers for Disease Control and Prevention.
Those with autism, also known as autism spectrum disorder, usually show symptoms before age 3. They typically have impairments in social, communicative, and behavior development as well as abnormalities in cognitive functioning, learning, attention, and sensory processing.
Doyle planned to be part of a rally Tuesday in Milwaukee with 200 autistic children, their families, teachers, health care providers and others who work with those with autism.
A separate bill mandating coverage, introduced by Senate Majority Leader Judy Robson, has 18 Democratic sponsors in the Senate and 33 co-sponsors in the Assembly, including two Republicans.
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