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Heated testimony on bill to expand ABA coverage beyond autism; advocates and opponents clash
Summary
A contentious hearing on HB 2023 examined whether insurers should be required to cover ABA therapy for people with intellectual and developmental disabilities beyond autism, with families and clinicians testifying for expansion and disability advocates and some clinicians warning of harms.
The committee heard sharply divided testimony on House Bill 2023, which would require insurers to cover applied behavior analysis (ABA) services for people with intellectual and developmental disabilities (IDD) beyond autism spectrum disorder (ASD).
Supporters, including parents and licensed behavior analysts, described ABA as an evidence-based, individualized, data-driven therapy that can teach life skills, reduce dangerous behaviors and increase independence. Several witnesses related personal stories in which ABA improved communication, feeding and daily living skills. Proponents urged the committee to let medical necessity — not diagnostic label — determine coverage.
Opponents included disability-rights advocates and some former ABA workers who described abusive practices in some ABA programs and highlighted ethical concerns. Opponents said certain aversive techniques have been used historically, sometimes under private-equity-run clinics, and that there are reports of traumatic experiences by autistic adults exposed to intensive ABA. Insurers and behavioral-health leaders urged caution: insurers said the evidence base for ABA outside autism is limited and warned that broad mandatory coverage would strain a workforce already stretched for autism services and could divert scarce capacity.
Representatives from the Oregon Association for Applied Behavior Analysis and licensed clinicians said ABA practice has evolved with ethical codes emphasizing consent, assent, and trauma-informed approaches; they asked the committee to expand coverage while addressing parity and mental-health parity concerns, including provider caps. The committee heard competing proposals: proponents favored medically necessary coverage for clinically indicated cases; opponents suggested further study or pilots and safeguards.
Why it matters The bill touches a long-standing policy question: whether insurance coverage linked to a diagnostic label should expand to therapies that some families and clinicians say are beneficial across diagnoses. The hearing mixed family stories, clinical testimony and civil-rights concerns about the field’s history; committee members asked for additional technical work and deliberation.
