In fact, the $70,000 a year pricetag is almost always quoted in connection with the cost of 40 hours a week of 1:1 Applied Behavior Analysis provided by a trained professional in a public school, home, or private setting. Added to that cost may also be the price of occupational, physical and speech therapy - but those latter costs are relatively tiny compared to the overwhelming pricetag for ABA.
There's no doubt that ABA is a tried-and-true technique for teaching skills to children (and adults) with autism. But are the costs really reasonable and appropriate? Here's the issue as it's laid out in a recent article in the LA Times:
The state [of California] spent $320 million last year, up from $50 million a decade earlier. Nationwide, the tab is $90 billion annually, a figure expected to double in a decade.Is there any way to manage these costs? It seems to me that there must be options available that have yet to be explored. Insurance doesn't cover the full cost of any medical procedure; instead they negotiate a standard fee that's well under the cost that an individual would pay without that insurance. Yet the cost of ABA seems to be figured at approximately $35/hour per child (assuming a $70,000 pricetag and 40 solid hours of 1:1 ABA per week for 52 weeks a year per child - surely an absolute ceiling relative to treatment).
Parents, in growing numbers, say insurers aren't doing their part. Proposed class-action lawsuits -- including one filed in April by Arce against Kaiser and another filed late last month against Anthem Blue Cross -- allege that California's largest health plans are shirking their duties to autistic members.
Health plans say they cover medically necessary care. The problem, they say, is that parents ask for treatment that insurers deem experimental, or for basic skills training that has long been provided by state-funded regional centers and schools.
"What we're concerned about is we're seeing a shift of the state's responsibilities over to the health plans," said Chris Ohman, president of the California Assn. of Health Plans. "To just say 'We need to have health plans cover all treatments' could have unintended consequences."
But Kristin Jacobson of Autism Speaks California contends that the healthcare industry has "washed its hands of autism entirely." Parents of children who don't qualify for public programs "bear the full burden of the treatment costs and pay their premiums," she said. "They aren't asking for a free ride. They are paying premiums."
Even the good folks at the New York State Health Department suggest that 25 hours a week of therapy may be sufficient for some children. And even school districts and agencies that provide ABA on a regular basis provide fewer than 52 weeks per year of solid therapy. After all, even children with autism have to get a little exercise... eat meals... go on vacation... and generally engage in some activities other than behavioral therapy.
What's more - 1:1 ABA therapy may be overseen by a Ph.D. professional - but it is almost always administered day-by-day by a therapist with relatively minimal training and experience. Does it really make sense that that individual should make something like $70,000 per year to work with an individual child - or that that therapist should work with that child 40 hours a week, 52 weeks a year? Even dedicated parents who have taken on the job of fulltime therapist to their child take occasional days and hours off - or choose to engage with their children in non-therapeutic ways from time to time.
In short, it seems to me that something is very wrong with the way we're figuring costs, managing resources, and negotiating fees for autism treatment. What are your thoughts?