In his post Implementing Reform: Children with Special Health Care Needs, Professor John Jacobi notes that providing “health insurance” to children with special health care needs (“CSHCN”) does not ensure that their needs will be met. Many private health insurance plans do not cover services such as occupational, physical, or speech therapy for CSHCN. Private plans frequently limit coverage for such therapies to otherwise healthy children who need therapy to facilitate their recovery from an illness or injury.
Through their power to regulate insurance, states can require private plans to extend coverage for needed therapies to CSHCN. For example, in legislation passed earlier this year, New Jersey became one of an estimated 15 states to specifically require insurers to provide treatment for individuals with autism. Children with autism have benefited from a wave of recent legislation — 8 states enacted laws related to autism and insurance coverage in 2009 alone. Children with other special needs have been largely left behind. Many go without services; others may be shoehorned into an inappropriate autism diagnosis. A recent documentary, Autistic-Like, tells the story of parents pressured to accept an autism diagnosis in order to access state-funded services for their son. While New Jersey’s autism mandate is admirably broad, requiring private insurers to cover occupational, physical, and speech therapy for individuals with “autism or another developmental disability,” other states’ mandates are strictly limited to children on the autism spectrum.
Insurance mandates are attractive to legislators because they are off budget. They are not, however, without cost. The Council for Affordable Health Insurance, an insurance industry association, estimates that “an autism mandate increases the cost of health insurance by about 1 percent.” Mandates like New Jersey’s, which extends beyond autism, could lead to even greater cost increases. Piecemeal reform that privileges some special needs over others has costs of its own, however, not the least of which are borne by children living with labels that do not fit.