Generosity of Insurance Mandates
The Politics of Autism includes an extensive discussion of insurance and explains the limits of insurance mandates:
There are no exact figures available, but suppose that we take the total number of autistic people and subtract the following:
• Those in states without mandates;
• Those who live in states with mandates but are under exempt, self-funded plans;
• Those with individual and small group policies to which post-2011 mandates do not apply, and
• Those who have already gone over the various limits and caps.
The remainder surely makes up a minority of the autistic population.
At PLOS ONE, Timothy Callaghan and Steven Sylvester have an article titled "Autism Spectrum Disorder, Politics, and the Generosity of Insurance Mandates in the United States." The abstract:
The study of Autism Spectrum Disorder (ASD) in the United States has identified a growing prevalence of the disorder across the country, a high economic burden for necessary treatment, and important gaps in insurance for individuals with autism. Confronting these facts, states have moved quickly in recent years to introduce mandates that insurers provide coverage for autism care. This study analyzes these autism insurance mandates and demonstrates that while states have moved swiftly to introduce them, the generosity of the benefits they mandate insurers provide varies dramatically across states. Furthermore, our research finds that controlling for policy need, interest group activity, economic circumstances, the insurance environment, and other factors, the passage of these mandates and differences in their generosity are driven by the ideology of state residents and politicians–with more generous benefits in states with more liberal citizens and increased Democratic control of state government. We conclude by discussing the implications of these findings for the study of health policy, politics, and autism in America.
From the article:
Even as forty-six states took action from 2001–2017 to enact an insurance mandate, the scope of these benefits varies dramatically. A select number of states have mandated generous benefits, but we show that this is far from the norm. Instead, most states limit benefits by either restricting eligibility to individuals under a certain age or by capping the amount that insurance companies must spend to pay for needed behavioral treatments. Thus, our findings suggest that even as states have moved quickly to reform their policies, the number of individuals who are eligible for generous benefits varies dramatically.
