Virginia, Autism, and Health Reform

AUTISM'S MEDICAL COSTS

The Autism Society estimates that the lifetime cost of caring for a child with Autism Spectrum Disorder
diagnosis (Autism) ranges from $3.5 to $5 million, and that the United States is facing almost $90 billion
annually in costs for Autism. 1 The estimate includes the research, insurance, and non-covered expenses;
Medicaid waivers for Autism; educational spending; housing; transportation; and employment. The
estimate also includes related therapeutic services and caregiver costs.
Additionally, individuals with Autism have average medical expenditures that exceed those without Autism
by $4,110 to $6,200 per year. 2
VIRGINIA AND AUTISM 3
In 2008, over 330,000 Cumulative Growth of Number of Cases of Autism Since 2000 5
Americans ages 3-21 had
300% 294.6%
Autism.
239.1%
In Virginia alone, almost 9,000 250%
individuals ages 3-21 had 187.0%
Autism. This contributed to 200%
Virginia having the 12th highest 152.8% 175.9%
150%
Autism rate in the nation among 138.4%
112.8%
eight year olds enrolled in 104.8%
100% 77.3%
public schools. Virginia
49.4% 74.8%
United States
Moreover, in a recent report by 50% 21.2% 47.0%
the Fairfax County Public 0% 22.6%
Schools, "1 in 83 enrolled 0% 0%
students are now diagnosed 2000 2001 2002 2003 2004 2005 2006 2007 2008
with some form of Autism, an
846% growth since 1997."4 From 2000-2006, Virginia had a greater cumulative increase in Autism
cases than the average rate increase in the United States.

RECENT STATE AND FEDERAL LAWS AND INITIATICES RELATED TO AUTSIM 6

Employment for This law, enacted April 9, 2010, established specific goals for programs to assist
Individuals with individuals with Autism to obtain and sustain employment. The program goal include,
Autism 7 - Virginia skills training, behavioral support, and education.
The Patient ACA establishes a Cures Acceleration Network (CAN) and appropriates $500 million to
Protection and CAN for fiscal year 2010.
Affordable Care The goals of CAN are to:
Act (ACA) 8 -
Federal 1. Promote innovation in technologies to support the advanced research and
development and production of High Need Cures; 9

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National Coalition on Health Care July 2010
 2. Accelerate the development of High Need Cures utilizing medical products,
behavior therapies, or biomarkers, and;
3. Assist recipients of CAN awards with establishing protocols that comply with the
Food and Drug Administration standards throughout all stages of the
development of a medical product.
Additionally, ACA establishes new requirements for private health insurers in order to
make health care plans more accessible to the public. The following provisions are
related to individuals with Autism:
1. Plans must cover certain preventive health services, such as vaccines and
screenings, without a co-pay.
2. Insurers will not be allowed to drop any insured person because he/she gets sick
or develops a chronic health condition. In addition, ACA allows individuals to renew
health insurance coverage regardless of their health status.
3. Insurers cannot exclude people from coverage if they have a pre-existing
condition such as Autism.
4. Annual and lifetime benefit caps are prohibited.
5. Mental health services are covered.

1
AUTISM SOCIETY, ABOUT AUTISM, available at www.autism-society.org/site/PageServer?pagename=about_home (last accessed June
2010).
2
SHIMABUKURO TT, GROSSE SD, RICE C, Medical expenditures for children with an autism spectrum disorder in a privately insured
population, J. OF AUTISM DEVELOPMENTAL DISORDERS (2007), available at www.ncbi.nlm.nih.gov/pubmed/17690969 (last accessed June
2010).
3
Unless otherwise cited: INDIVIDUALS WITH DISABILITIES EDUCATION ACT DATA (2008), available at www.ideadata.org/PartBChildCount.asp (last
accessed June 2010).
4
Derek Kravitz, Fairfax: Autism, not 'baby boomers,' biggest future health challenge, THE WASH. POST, (May 18, 2010), available at
voices.washingtonpost.com/virginiapolitics/2010/05/fairfax_autism_not_baby_boomer.html (last accessed June 2010).
5
INDIVIDUALS WITH DISABILITIES EDUCATION ACT DATA (2008), available at www.ideadata.org/PartBChildCount.asp (last accessed June 2010).
Ages 3-21. U.S data unavailable after 2006.
6
Brian Chellgren & Michelle Coughlin, THE CURES ACCELERATION NETWORK: A HIDDEN GEM WITHIN THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT, ABA. Vo. 6, No. 9 (May 2010), available at www.abanet.org/health/esource/Volume6/09/Chellgren.html#_ftn3 (last accessed June
2010).
7
V.A. Chap. 0307 (2010), available at http://leg1.state.va.us/cgi-bin/legp504.exe?101+ful+CHAP0307 (last accessed Aug. 2010).
8
Pub. L. No. 111-148, 124 Stat. 119 (2010).
9
High Need Cures are a drug, biological product, or device that, in the determination of the Director of NIH—(A) is a priority to
diagnose, mitigate, prevent, or treat harm from any disease or condition; and (B) for which the incentives of the commercial market
are unlikely to result in its adequate or timely development. Ibid.

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National Coalition on Health Care July 2010