How The American Health Care Act Can Affect Autism Coverage

How The American Health Care Act Can Affect Autism Coverage
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How with the GOP’s American Health Care Act (and similarly proposed legislation) affect Autism Service Coverage.

How with the GOP’s American Health Care Act (and similarly proposed legislation) affect Autism Service Coverage.

Autism Services Under the AHCA and Similar Proposed Legislation

For individuals and families who are affected by autism spectrum disorder, quality health care has always been a top priority. Coverage for autism services has come a long way in the past two decades, aided by the Affordable Care Act and state mandates for coverage of autism services. However, as the political atmosphere changes, so do our laws.

President Trump has been in office just under two months, and a lot has already changed in the world of health care. His fierce promise dismantle and replace Obamacare was a central piece of his campaign, and his administration is working hard to follow through. House Republicans revealed a proposal this week to do just that, which they call the American Health Care Act (AHCA). The ACHA is undoubtedly complicated like its predecessor, the Affordable Care Act, but it is a very different piece of legislation. While nothing is set in stone, republicans are determined to pass some version of this new health care bill. It is important to stay updated on revised legislation, but for now, we have a pretty good idea of the direction our health care system is headed.

So, exactly how does this most recent replacement plan affect those with ASD?

Let’s start by understanding a little more about the bill.

As promised, the ACHA would longer penalize those who chose to opt out of an insurance plan. It’s a little more complicated than it seems because it adds a significant penalty for those who lapse in coverage and then re-enter the market. A person re-entering after a lapse could pay as much as a 30 percent surcharge on their premium for a full year before going back to a standard rate.

This provision could have some far reaching effects. Experts predict that more young, healthy people will opt out of insurance plans if they feel they can’t afford them. It would also discourage people who lapsed from re-entering the market if they are still healthy, for fear of the penalty. This would result in rising costs for everyone who does not or cannot opt out. People in need of constant care, like those seeking treatment and therapies for ASD would be left with unaffordable health care.

Another key point is the new system for tax credits on premiums. Obamacare also has a tax credit system, that like the proposed AHCA, is based on age and income. This revision plays a big role in the proposed budget cut, that experts estimate will reduce the national deficit by $300 billion over the next 10 years. However, with a significantly reduced tax credit system, it would also result in 24 million people losing their insurance in that same time period. This is because the tax credits would not be proportional to the increased cost of premiums that comes with getting older.

Additionally, anyone earning under $75,000 a year can be included in the bracket with the largest tax credit, which means that higher-earning Americans would get the same help as low-income folks. The plan would cut out the employer mandate, as well, so that employers could drop coverage. Likely those with employees who are sick and/or older would be first to drop their plans. In short this proposed plan only offers savings to healthy, wealthy people, leaving the poor, sick, and elderly with coverage that is too expensive and offering subsidies that are inadequate.

The AHCA would rely on major cuts to Medicaid to reduce the deficit. It would keep Medicaid expansion as is until 2020, when enrollment will then stop. Republicans explain that once enrollment stops, people will slowly start opting out as their income increases. Medicaid funding would change from total coverage for all medical bills of enrollees to a per capita lump sum for each enrollee. For people who are in constant need of expensive care, like rehabilitative and habilitative therapies, that lump sum may not be enough to cover costs.

The expansion of Medicaid brought millions of Americans health insurance who were previously without, many of whom need coverage for autism services. This serious cut to the program would have serious consequences for low-income Americans, leaving many without coverage.

Here’s the good news.

Some key parts of the Affordable Care Act made it into the new bill and will continue to find their way into revised legislation. As most families affected by autism know, the “essential health benefits” laid out by the ACA ensure that plans will cover the necessary services for a patient with ASD. These benefits include behavioral treatment, habilitative services, screening, and prescription drugs.

Additionally kids will be able to continue to stay on their parents insurance until they are 26, and Obamacare’s ban on annual and lifetime limits will also remain in the law. Perhaps most importantly, insurance companies will not be able to discriminate based on a pre-existing condition like Autism Spectrum Disorder.

This may come as a relief to some families who are affected by ASD, and as the provisions continue to change, there is plenty of room for improvement. However, there are other concerns when it comes to autism services under a Trump administration. Trump’s vocal concern for the long-debunked connection between vaccines and ASD can have harmful effects on health care. Policy-makers, researchers, and advocates for services may end up focusing on yet another outdated debate, while losing valuable time and resources that may otherwise have been allocated on research, and fighting cuts to coverage.

The important thing is to stay informed and stay vocal. It is likely that the proposed legislation will not be passed. We have the power to direct the conversation to the things that matter: maintaining adequate coverage for quality health care no matter who you are or how much you make. Health care is a human right. If you want to see a better plan, call your senators and let them know what their voters believe in.



For more information on Autism services in Illinois contact Lauren Rabin at or visit the Autism Family Center website.

Article Researched and Written by Madeline Rabin: Madeline Rabin is a freelance writer and a friend of Autism Family Center. To work with Madeline as a writer and activist, contact her through the Autism Family Center website.

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