Rep. Joe Sestak, D-Pa.
Member, House Armed Services Committee
In the United States, 1 in 150 children suffer from autism spectrum disorders and 67 new cases are diagnosed each day. As the fastest growing serious developmental disability, more children will be diagnosed with autism this year than with diabetes and cancer combined.
Tragically, autism research nationally receives only $80 million, or .28 percent of the National Institute of Health’s research funding, compared to the $130 million in private funding alone that is allocated to juvenile diabetes and the $310 million for leukemia, both of which I strongly support.
With approximately one percent of the nation’s total autistic population, military families are acutely aware of the funding and coverage limitations provided for autism.
Like others in the medical research and care community, the Department of Defense’s healthcare system has failed to adequately provide autism therapy services to families.
Master Sgt. Buck Doyle’s daughter Kate is an example.
After incurring $250,000 in legal fees and therapy costs trying to compel their local school district to provide basic autistic therapy, the Doyle family turned to TRICARE’s Extended Care Health Option (ECHO).
They waited seven months for Kate’s coverage to be authorized and then received only a fraction of the therapy costs.
I would like to say that the Doyle family’s story is the exception; sadly, it is not. Military families wait as long as two years for their coverage to be authorized and ECHO’s current coverage limit of $2,500 provides only one hour of therapy per day.
The American Academy of Pediatrics and National Academy of Sciences recommends a weekly minimum of 25 hours of Applied Behavior Analysis (ABA) and optimal results are seen with 35-40 hours a week.
With diagnoses of this disorder increasing 10-17 percent nationally each year, TRICARE and Congress should set a standard for healthcare nationwide, ensuring that autistic children have the opportunity to reach their potential and become productive members of society.
Toward this goal, I sponsored amendments that were included in the Fiscal Year 2009 National Defense Authorization Act, which passed the House of Representatives and laid the ground work for a model that could be used across the country.
First, my amendment provides autistic children from military families enrolled in ECHO with a minimum of $5,000 per month for therapy services, a 100 percent increase from the current level.
Sen. Dianne Feinstein, D-Calif., recently announced plans to introduce a companion amendment in the Senate.
Second, I call on the secretary of defense to make certain that the process of determining eligibility for these services is conducted in an expeditious manner, to prevent the Doyle family’s experience from becoming the norm.
Finally, I have mandated a study to research the costs and benefits of covering these treatments under TRICARE’s basic plan rather than under a supplementary program. If this transition occurs, autistic children will finally receive the recommended amount of therapy as an entitlement under TRICARE.
Just as autism is categorized by the military as a segregated disability that is only covered under TRICARE’s ECHO program, most insurance companies exclude it from basic coverage.
Finding a way to cover autism treatment under TRICARE will set a precedent for legislative efforts to require private insurance companies to provide coverage of Applied Behavioral Analysis and other structured behavioral treatments.
Three states – South Carolina, Texas and Indiana – have passed laws that mandate coverage and Autism Speaks, the nation’s largest autism advocacy organization, has established a multi-state initiative to promote similar provisions nationwide.
After 31 years in the United States Navy, I entered politics primarily to improve healthcare in this country.
Having served in the armed forces, I was given access to the military’s healthcare system and the exceptional coverage I received allowed my family to overcome our most difficult personal challenge.
I believe that we have an obligation to provide the same affordable, quality and accessible care that I received, to the many military and civilian children who suffer from autism every day.
As the Senate begins consideration of this legislation, I hope that my colleagues will do what is in the best interest of our nation’s heroes and set an example for state legislatures, so that autistic children benefit from the best possible care and have the ability to provide for themselves as adults.