During his 2008 presidential campaign, President Obama promised to mandate insurance coverage of autism treatment. Where does Obama's promise stand today?
Sabrina Corlette, a research professor at Georgetown University's Health Policy Institute, told us that although Obama had made progress on autism coverage through the Affordable Care Act, or ACA, it's not completely mandated.
"The bottom line would be that Obama partially fulfilled his campaign progress -- coverage is a lot better today than it was pre-ACA, but varies state to state and depends on the kind of plan you have," she told us.
First, the Affordable Care Act's benefit rules only affect individual and small group markets. Large employers have greater flexibility to design plans. The result is that they may not cover autism treatment at all.
Second, the reason that autism coverage varies between states goes back to the Obama Administration's implementation of the essential health benefits provision of the Affordable Care Act.
"The administration declined to prescribe a national standard for what specific services have to be covered within each category," Corlette told us. "Instead they deferred to the states. ... Each state was tasked with coming up with a 'benchmark' plan that included the specific items and services insurers must cover within each category."
One important example would be the lack of a mandate to cover applied behavior analysis services. These services are designed to improve behavior in children with autism, and are seen a an integral part of autism treatment by health experts and autism awareness advocates.
However, because states can decide on their "benchmark" plans, not every state currently mandates coverage of applied behavior analysis. According to Autism Speaks, an autism awareness advocacy organization, 44 states currently require state-regulated insurance to cover autism treatment, including applied behavior analysis.
Lorri Unumb, vice president of state government affairs at Autism Speaks, said that although leaving autism insurance mandates to the states was necessary, further action could be taken at the federal level to make coverage more widely available for those on the autism spectrum.
One potential option would focus on mandating self-funded plans used by large companies to cover autism treatment. This approach would require amending the Employee Retirement Income Security Act of 1974, which has only been done a handful of times. Other approaches include shoring up coverage of applied behavior analysis for groups such as Medicaid-eligible children.
Marjorie Connolly, the press secretary of Health and Human Services, pointed to coverage of patients with pre-existing conditions as a major boon for those with autism.
"The Affordable Care Act prohibits companies from denying health insurance because of pre-existing conditions such as autism, and the law's essential health benefit rules require insurers to cover habilitative services, such as occupational therapy, physical therapy, and speech therapy," she said.
The bottom line is that autism coverage has been greatly expanded under the Affordable Care Act, but coverage still varies between states and between health care plans. Because autism coverage hasn't yet been mandated across the whole country and for all plans, we rate this promise as Compromise.