Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

In Health Affairs, Colleen Barry and colleagues, including Andrew Epstein, Steven Marcus and David Mandell, examine whether state mandates requiring commercial insurers to cover treatment for children with autism spectrum disorder (ASD) altered service use or spending among commercially insured children with ASD. To date, 46 states and the District of Columbia have enacted such mandates.

The authors compared children age 21 or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. They found that mandates were associated with large increases in both the likelihood of using health care services and average spending on these services among children with ASD. Mandates were associated with a 3.4 percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.