S.5481.A/A.2898.A – Dyslexia 05-19-24

This legislation, S.5481-A/A.2898-A, would mandate coverage of neuropsychological examinations for the purposes of diagnosing dyslexia.  While we are sympathetic to the challenges facing families of children with dyslexia, the New York Health Plan Association (HPA) is opposed to the bill for two reasons.  First, dyslexia is categorized as a learning disorder and is not a medical condition.  The bill would mandate coverage of educational services that are not health related, blurring the distinction between health services covered by insurance and services that are educational in nature and should be provided by a school.  Second, mandating coverage of specific services increases premiums and disproportionately affects small and medium-sized employers.

Dyslexia is a Learning Disorder

Dyslexia is not characterized as a medical problem and is not tested by doctors because they don’t have training on reading, writing and spelling testing.  Instead, dyslexia is treated using specific educational approaches and techniques, and include evaluations of a child’s reading and other academic skills with the goal of improving an individual’s reading skills.  The International Dyslexia Association defines dyslexia as:

“a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

This term, specific learning disability, tends to be used more frequently in educational settings.

In the medical field, per the American Psychiatric Association (APA), dyslexia falls under the category of specific learning disorder. Per the APA, “Specific learning disorders are neurodevelopmental disorders that are typically diagnosed in early school-aged children, although may not be recognized until adulthood. They are characterized by a persistent impairment in at least one of three major areas: reading, written expression, and/or math.”

Coverage for testing of suspected dyslexia should not be required by health plans as it is not resulting in treatment of a medical condition.

Disproportionate Impact on Small Businesses

This legislation would force employers to include benefits they and their workforce may not want or need exacerbates the challenge they face to find affordable health care options.  Further, S.5481-A/A.2898-A creates the potential to shift educational services provided by the schools onto small and medium-sized businesses through the cost of coverage.

Mandated benefit bills pertain only to fully-insured policies, which are generally those purchased either by individuals who buy coverage on their own or receive it through a small or medium-sized business.  Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers. They are governed by the Federal Employee Retirement Income Security Act (ERISA) and are not subject to state mandated benefits. Included in ERISA is a provision preventing states from deeming employee health benefit plans to be in the business of insurance for the purpose of state oversight, which preempts states from regulating these plans.

Controlling rising health care costs is a critical issue facing employers, as increases in the cost of health care stymies their ability to create jobs, invest in their companies and improve the state’s economy.  At a time when New York employers are grappling with the high cost of health care, adopting new benefit mandates will make it more difficult for them in finding affordable coverage options and does nothing to address underlying health care costs.

For all these reasons, we urge you to reject S.5481-A/A.2898-A.