A few years ago, I shared a statistic showing that it costs almost $200,000 to raise a child, from birth to age eighteen. If that weren’t enough of a financial burden, consider that one out of 88 children are now diagnosed with autism, according to the Centers for Disease Control and Prevention (source, pdf).

Regardless of whether this significant, 78 percent increase in occurrence since the last study is attributed to broader diagnosis, more families are paying for the services a diagnosis of autism requires. Insurance will not cover all costs for therapies associated with autism or autism spectrum disorders. Families will need to pay out-of-pocket for many medical expenses. While the cost of raising a child to age 18 might average around $200,000, dealing with autism could add another $25,000 a year in medical costs.

The expenses don’t end with therapy and doctor’s visits. Beyond medical expenses, parents with children with autism often need to pay for special education, day care, and a home for an autistic adult who can no longer live with his or her parents.

The emotional burden placed on parents of autistic children adds to the financial burden. Parents of children with autism earn significantly less than parents of children who do not have this condition, presumably because the parents have extra responsibilities in competition with the attention they give to their careers. Mothers of autistic children average earnings that are 56% lower than other mothers. Dealing with autism from a financial perspective is doubly difficult due to the increased cost of care and the parents’ lowered income potential.

As a result of the increased financial burden, many parents of children with autism need to resort to going into debt to cover their costs. Today’s expenses may crush any dreams about retirement, and with a second or third mortgage, the costs of paying for housing may last until death.

It’s all very good for financial gurus, bloggers, and authors of books about money management to extol the virtues of saving money, cutting back expenses, and earning more, but sometimes, some families are faced with realities that place them beyond the sphere of accepting mainstream financial advice to improve their financial conditions. Everyone should be out of debt, but an average family earning average salaries with extraordinary needs like those that arise out of autism can’t be addressed by mainstream financial advice.

Experts write about making sacrifices, like forgoing the $6 daily latte and saving $1,500 or so a year. Experts talk about negotiating a raise from your employer. They argue about the best method for getting out of debt. For families dealing with tough financial issues, these discussions are irrelevant. They need support groups, financial assistance, and specialized advice for making the most out of a difficult situation.

And when the biggest issue a family faces is related to health, financial issues become just a secondary concern.

Have you ever dealt with autism or another health issue in your family that required expensive care? Please feel free to share your experiences, particularly with the effect they had on your finances or your philosophy of money.

CNN

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The Amish community is exempt from the health insurance mandate that is now federal law. Members of this community rely on each other for taking care of their health, rather than relying on insurance companies. It’s an interesting approach to healthcare, and it is effective for communities where people rarely leave or enter.

I visited Lancaster County this weekend and spent some time on a touristy, but respectful, tour of one of the local Amish communities.

Amish children don’t receive education beyond the eighth grade, and as a result, there are no doctors or lawyers within the community. In some respects, they do rely on outsiders despite being as self-sufficient a community as possible with that level of education. “English” — that is, non-Amish — doctors cater to the Amish community, and when a member of the community visits the doctor’s office or a hospital, they pay for these services in cash.

Once a young Amish adult decides to officially join the community, he or she begins paying a fee to the church. From what I understand from the tours I’ve participated in, this fee could be $100 per month. The fee does is not for the benefit of the church or its leaders; these payments are collected and resolve to care for members of the community in personal times of need. When a member of the community needs to cover health expenses, he or she is responsible for the first $2,000 of expenses — similar to a deductible in a traditional health insurance plan — but beyond that amount, the church will cover the remainder of the cost.

Religious grounds helped the Amish community win exemption from the law that will require all citizens to have a private or state-based plan from a regulated insurance company. Amish, who don’t collect Social Security payments or other forms of government assistance, are also exempt from Social Security taxes, after winning one court battle. A recent appeal seems to indicate that this exemption would apply only to self-employed Amish community members, but many individuals in the community are self-employed.

The concept of church-based health insurance may not be as effective in other communities. The reason this works well with Amish churches is that the member families have little migration. The same families have been part of the same congregations for generations. Although Amish community members can ride in cars, they don’t drive. Transportation is mostly by horse-and-buggy and scooter. This keeps the communities tightly-knit. Without much change of membership in each congregation and with a community where everyone is known, communities don’t need to worry about people taking advantage of the system.

Beyond the Amish community, where there is more geographical mobility, insurance coverage based on local churches may not be practical. Putting aside the idea that receiving exemption from the health insurance mandate is difficult, even on religious grounds, it might be hard for churches to collect this kind of payment when members believe they may not remain members long enough to benefit. Commercial health insurance is different as the pools are much wider, and can extend benefits to a new member even if he or she has not yet paid a premium (although companies often try to avoid this situation by charging higher premiums or denying coverage for people with pre-existing conditions).

Would you prefer a church or community based approach to health insurance?

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