This month marked a defining moment for many individuals and families as Texas and 19 other states went to federal court in an effort to end health care protections for millions of people, including 4.9 million Texans living with pre-existing conditions. If this lawsuit succeeds it could have a massive impact on eliminating health coverage under the Affordable Care Act (ACA) for millions of Texans and their families.
One of the most significant protections at risk under the ACA is health coverage for pre-existing conditions. Since the passing of the ACA, insurance companies have been prevented from denying services or charging more for people who have pre-existing conditions. However, this could all change if this protection is rescinded, leaving millions of people without coverage and unable to afford treatment or medications.
The diagnosis of Autism Spectrum Disorder (ASD) is on the list of pre-existing conditions, and prior to the ACA, insurers were able to exclude or deny coverage for its treatment. According to the Center for Disease Control and Prevention (CDC), 1 in 59 children are diagnosed with autism in the United States; an estimated 399,915 people diagnosed with autism live in Texas, including 130,316 children.
This population is steadily growing as people are becoming more aware of the early signs of autism, as well as recognizing the need for diagnosis and treatment. The increased prevalence only further reinforces the significant need for more support, resources and intervention services to help those living with autism.
If these protections are eliminated, this population would be unable to obtain benefits through their insurance coverage for behavioral health treatment, habilitation services, prescription drugs and health care services. They would also risk losing insurance that allows young adults with autism to stay on their parents’ policies until they turn 26 years old.
Evidenced-based research proves that early intervention for children with autism helps improve their social and intellectual abilities and reduces autism symptoms years after originally receiving treatment. However, with lack of insurance, limited support and financial struggles, obtaining these interventions for loved ones with autism is difficult.
Children and adults with autism need therapy and support services to succeed, learn and thrive in life. Obtaining treatment services for these families on the spectrum without health insurance coverage can be nearly impossible because of unaffordable premiums, deductibles and out of pocket-expenses. If the ACA is repealed, currently covered therapies for people living with autism might no longer be covered.
Conditions that are often accompanied with autism must also be considered. The CDC indicates that children with autism have a higher rate of developing a broader range of medical conditions such as epilepsy, attention deficit hyperactivity disorder, social anxiety disorder and sensory processing disorder. With these coexisting conditions that are often associated with autism, the need for medication and treatment is critical to their development.
Although health coverage for families with pre-existing conditions is needed, this is not the only protection at risk. Others include the ban on annual and lifetime coverage limits, the limit on out-of-pocket costs, tax credits that help people pay for health insurance and possible elimination of Medicaid expansion covering over 12 million people (in other states). This does not include the 180 million people who get insurance through employers or purchase individual plans on their own who could also lose these important protections.
Overall, millions of people with pre-existing conditions living in Texas could be affected by this lawsuit. There is no doubt that the ACA has played a vital role in helping families living with autism and has allowed many people to gain access to therapy, medical treatment and intervention services. However, if this lawsuit succeeds, it will have a negative impact on health care for millions of families. Without the ACA, those living with autism and other pre-existing conditions will be denied coverage and will have little to no access to the health care treatment and therapy that they greatly need.