Well-Intentioned Autism Bill Also Carries Negative Consequences

Gov. Jay Nixon’s desk no doubt holds many bills with supporters eager to see them passed, although one of them will raise the cost of health insurance in Missouri when it is signed. The Autism Spectrum Disorder Coverage bill, H.B. 1311, requires state-regulated private health insurance companies — those that cover small and medium-sized businesses — to cover up to $40,000 annually for screenings and therapy for children with autism spectrum disorders. Although well-intentioned, this mandate will necessarily raise the cost of premiums for Missourians, making it more difficult for individuals and small businesses to keep their health insurance plans.

Autism is a problem in Missouri, and it is easy to be swept up by the heart-wrenching stories of families with autistic children. But there are many disorders and diseases that afflict people — children and adults alike — and mandated coverage of all or even most of these problems would make insurance prohibitively expensive for everyone, especially for those who have diseases that are not given state protection.

A mandate of any amount increases health insurance costs, and this bill’s substantial commitment would assuredly have a noticeable effect. Small businesses are particularly cost-sensitive, and the autism bill will increase the cost of doing business in Missouri — although estimates of how much costs would increase vary, depending on who is doing the calculation. This bill would exempt small businesses if the provisions demonstrably raised their premiums by more than 2.5 percent, but any increase would likely price some marginal number of businesses out of the insurance market, forcing them either to cut coverage or reduce hiring. At the same time, these costs bring only a relatively small gain for Missouri families; an independent report estimated that the bill would only help up to 350 families.

The bill also raises the cost of autism therapy by increasing licensing requirements. It establishes a board to certify applied behavior analysts, the professionals who administer the type of expensive therapy that the bill covers. This regulation will add an extra barrier to entry in becoming an analyst, reducing competition in the field. For families not covered under the mandate, this will raise their therapy costs.

State mandates raise health insurance costs across the board, and decrease people’s access to affordable coverage. In the long run, the most effective solution for families with autistic children — or any other disorder — is for officials to open the insurance market to further competition, giving providers a practical economic incentive to cater to niche health care markets. Despite the good intentions of those aiming to help some families with autistic children by supporting this insurance mandate, it will simultaneously hurt other Missourians who could face significant cost increases or even the potential loss of their own health insurance coverage.

Caitlin Hartsell is a research assistant with the Show-Me Institute and a graduate student in public health at Washington University.