Opinion

By Representative Nathan Ballentine

 

Every day in South Carolina parents hear the dreaded words from the doctor: “Your child has autism.” That moment changes their lives forever.

In March 2014, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded the prevalence of autism had risen to 1 in every 68 births in the United States, more than twice the 2004 rate of 1 in 166.

This has forced the country to consider how to serve families facing a lifetime of supports for their children. A 2006 Harvard study estimates the lifetime societal cost of caring for a child with autism at $3.2 million. In the aggregate, Autism Speaks estimates the United States is facing $137 billion annually in costs for autism.

A big part of that cost is treatment. By far the most effective treatment is applied behavior analysis (ABA), which is endorsed by the U. S. Surgeon General and the American Academy of Pediatrics.

Parents fortunate enough to have insurance that covers the expense of ABA tell of dramatic improvement they see over time in their children. Words like “miraculous” and “stunning” are used, usually with tears. We’ve all heard their stories. We’ve all seen the tears.

The State of South Carolina moved to ensure health insurance coverage for children with Autism to receive ABA 10 years ago through the State Health Plan and some large group health insurance plans. However, there is a segment of South Carolina’s population that currently receives no coverage for ABA through their health insurance plans. The legislation I’ve introduced seeks to cover all South Carolinians.

Currently, the State Health Plan and large group policies cover ABA but South Carolinians in the small group and individual health insurance market do not have the ability to obtain health insurance coverage for ABA. Yes, you read that right. The State of South Carolina says its employees are entitled to coverage for ABA but doesn’t think those outside of the large group market should have coverage.

Ten years ago, South Carolina passed Ryan’s Law. That law was a bold step in the right direction, but it’s time to strengthen Ryan’s Law. Providing coverage for ABA therapy under the State Health Plan, large group health insurance plans and the current Medicaid and PDD Waiver programs is not sufficient to cover all of South Carolina’s children. Following South Carolina’s lead, 45 states now require ABA coverage for the citizens of their state. It’s time South Carolina finishes the job it started ten years ago.

ABA is covered for all state employees, including members of the legislature. This is a benefit all 170 members of the General Assembly receive. If it is important enough for us, it is important enough for hard-working South Carolina families, many of whom cannot afford life-changing therapy for their children without it.

The cost to extend health insurance coverage for ABA is approximately fifty cents per member per month. That’s a whopping six dollars a year to extend a benefit that directly impacts the quality of life when caring for a child with Autism. It has been found that there is relatively no fiscal impact to the State of South Carolina by extending this benefit to make sure all South Carolinians are covered.

Quite frankly, extending coverage for ABA to make sure all South Carolinians can be covered is just common sense.

 

Representative Nathan Ballentine has served Richland and Lexington Counties in the House of Representatives since his election in 2004.