The real issues in autism are threats to
funding, services, say experts
Johns Hopkins Bloomberg School
of Public Health
With so much focus in recent months on the
scientifically discredited notion that childhood vaccines cause autism, the
real threats to health care and services for people with autism and other
disabilities aren't being given enough attention, argue two leading health
policy experts.
"President Donald Trump's apparent openness to a
long-debunked link between vaccines and autism risks encouraging Americans to
stop vaccinating their children, posing a serious public health threat,"
the researchers write in the March 9 issue of the New England Journal of
Medicine.
"Meanwhile, renewed attention to disproven theories about autism may be distracting us from growing threats to essential policies that support the health and well-being of people with autism or other disabilities."
"Meanwhile, renewed attention to disproven theories about autism may be distracting us from growing threats to essential policies that support the health and well-being of people with autism or other disabilities."
The piece is authored by Colleen L. Barry, PhD, MPP, Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, and David S. Mandell, ScD, Professor and Director of the Center for Mental Health Policy and Services at the University of Pennsylvania.
If advocates and policymakers are focused on defending
long-settled science, Barry says, they may not have the bandwidth to consider
the potential consequences of efforts to roll back key protections in the
Affordable Care Act (ACA) and the Individuals with Disabilities Education Act
(IDEA) for people with autism and other disabilities.
The Affordable Care Act, which lawmakers in Washington
have vowed to repeal, has broadened access to health insurance for low-income
people living in 31 states and the District of Columbia through expansions of
the Medicaid program.
Medicaid is the largest health care payer for people with autism and developmental disabilities, providing access to needed services that many could not otherwise afford.
Congress is also considering proposals to transform Medicaid to a state block grant program, and Barry and Mandell caution that this change would likely reduce states' funding to pay for services and allow them to opt not to cover critical services for autism.
Medicaid is the largest health care payer for people with autism and developmental disabilities, providing access to needed services that many could not otherwise afford.
Congress is also considering proposals to transform Medicaid to a state block grant program, and Barry and Mandell caution that this change would likely reduce states' funding to pay for services and allow them to opt not to cover critical services for autism.
"These rollbacks could be devastating for children
and adults with autism and other disabilities," Barry says. "It is
important not to let the controversy over the de-bunked link between vaccines
and autism distract from what is at stake in terms of the potential loss of
critical benefits this vulnerable group relies on."
The ACA also requires Marketplace health plans to cover
ten 'essential health benefit' categories including services important to
people with autism and other disabilities such as therapies to improve skills
of daily living, speech and language therapy, and mental health treatment.
The authors also flag concerns about the future of the
Individuals with Disabilities Education Act (IDEA), which guarantees a free and
appropriate education for all children with disabilities. Children with autism
rely heavily on school-based services from minor accommodations and speech and
language therapy to separate classroom instruction through IDEA.
The new Secretary of Education, Betsy DeVos, and the new Attorney General, Jeff Sessions, have publicly questioned the value of IDEA, with DeVos suggesting states should be able to decide whether to enforce IDEA.
The new Secretary of Education, Betsy DeVos, and the new Attorney General, Jeff Sessions, have publicly questioned the value of IDEA, with DeVos suggesting states should be able to decide whether to enforce IDEA.
"People who care about preserving and expanding
services for children and adults with autism need to pay attention to the
conversations in Washington around the ACA repeal and threats to IDEA to make
sure important protections and guarantees are not lost," Barry says.
"The risk of getting drawn into an outdated debate
about vaccines and autism is that advocates and policymakers will spend their
time and resources fighting on that flank, and could miss the window to respond
on proposed cuts to critical services for those with autism coming from the
other direction."