Friday, September 14, 2007

New Jersey Supreme Court Tells Insurer to Cover Autism Therapy

The New Jersey Supreme Court has done what Canada's Supreme Court would not do, it has ordered a health insurance plan for state workers to cover the cost of therapy for a 5 year old autistic boy. As reported in the Star-Ledger online the therapy cost the boy's family about $35,000 per year. The NJSC upheld two earlier appellate rulings:

The Supreme Court upheld two appellate rulings that came down in January and May 2007. The January decision said the commission could not deny treatment for "a class of dependents, notably afflicted children, based on the nature of their mental illness."

In Canada we can sometimes be smug about our "universal" health care coverage believing our system of health care coverage to be superior to that of our American friends. But in Auton the Supreme Court of Canada ruled that governments which provide our primary health care coverage in Canada were not required to provide coverage for ABA treatment for autistic children. For autistic children in Canada, and their families, Auton meant in effect that little, if any, reliance could be placed on Section 15 of the Canadian Charter of Rights and Freedoms.
15.(1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

The New Jersey Supreme Court ordered the state health benefits commission to pay the Micheletti family's bills in two weeks with 30 days to pay future bills. In Canada, by contrast, the families involved came away from the precedent setting Auton decision with something much less substantial - the sympathy of the Court - as expressed by Chief Justice Beverley McLachlin:

One sympathizes with the petitioners, and with the decisions below ordering the public health system to pay for their therapy. However, the issue before us is not what the public health system should provide, which is a matter for Parliament and the legislature. The issue is rather whether the British Columbia Government’s failure to fund these services under the health plan amounted to an unequal and discriminatory denial of benefits under that plan, contrary to s. 15 of the Charter. Despite their forceful argument, the petitioners fail to establish that the denial of benefits violated the Charter.


Suzanne said...

There is a subtle but important difference denying people and denying the coverage of a given therapy.

I don't think any insurer should be forced to pay for any therapy. That's their stock and trade. But I do agree that autistic people shouldn't be denied based on their condition.

So if an insurer doesn't want to pay for ABA, I don't have a problem with that. But if the insurance won't cover a claim for speech therapy that would be covered for non-autistic people, that's wrong.

Anonymous said...

Would a "smoking cessation" program or a "weight loss" program based on the principles of ABA be covered for non-autistic people? Some insurers do cover such intervention costs so by extension of this logic should not ABA for autisitcs also be covered?