Parents Urge Passage of Bill to Require Autism Coverage

A busload of Loudoun County parents traveled to Richmond on Monday to speak before a state panel considering a bill that would require health insurers to cover treatment for children with autism.

Some brought their autistic children to the hearing, which lasted five hours and featured testimony from parents across the state as well as insurance industry lobbyists.

House Bill 1588 would require insurers to provide up to $36,000 a year per child for autism treatments, including an intensive and costly therapy program known as applied behavior analysis, or ABA. ABA, which has been approved by the U.S. surgeon general as a treatment for autism, is rarely covered by insurers in Virginia, and parents who choose it often pay thousands of dollars a year in out-of-pocket expenses.

Carol Nunez, a Sterling resident who brought her 6-year-old autistic son, Ethan, to the hearing, said she and her husband, Rick, spent almost $5,000 for therapy services covering potty training.

"ABA came into our home at 8 a.m. in the morning till 8 p.m. at night for four weeks," she said. "It was successful. He's now 100 percent potty-trained at home.

"ABA is most effective if applied early," she added. "Had we had insurance to cover [more treatments], I can't fathom the changes we would have seen."

Del. David E. Poisson (D-Loudoun), who sponsored the bill with Del. Robert G. Marshall (R-Prince William), told the state panel that the cost of providing the additional health coverage would be far less than the cost to taxpayers of institutionalizing autistic children who receive insufficient treatment.

"Admittedly, in the near term, mandating this coverage could add slightly to the cost of health insurance in Virginia," he said. "But whatever the cost, and no one can say for certain what it will be, it pales by comparison with what it will be if we fail to invest now in early intervention services."

The panel, the Special Advisory Commission on Mandated Health Insurance Benefits, will make a recommendation to the 2009 General Assembly on passing the bill.

Speaking on behalf of the Virginia Chamber of Commerce, Keith Cheatham expressed concern that the legislation would lead to higher insurance premiums.

Doug Gray, a lobbyist for Virginia health insurance companies, questioned whether therapy treatments for autistic children should be considered medical or educational services.

"ABA is described as an education service by federal law," he said. "Many borderline health-care services are not covered by health insurance. For example, if a kid with [attention-deficit hyperactivity disorder] needs a tutor or a special school, it would be provided by educators."

Poisson, responding to Gray's comment, said that the ABA program "originates with a medical diagnosis, and only an MD can make that determination. ABA is a necessary medical treatment."

Casandra Oldham of Leesburg cried as she told the delegates about her sons Gareth and Korlan, ages 4 and 2, who have been diagnosed with autism.

She said she and her husband, Bill, have seen improvement in their sons through the ABA program but cannot afford to pay for the amount of therapy the boys need. Providing both sons with 40 hours of therapy a week would cost the family nearly $14,000 a month, she said.

"I've been put in a position that no mother should ever be put in," Oldham said. "When I found out that baby Korlan was also autistic, I had to decide: Should I give one more therapy than the other? Or should I give them both equal amounts, but less?"

Having run out of savings, the Oldhams are raising money through yard sales, bake sales and car washing, she said.