The Boom in Autism Therapy Is Medicaid’s Fastest-Growing Jackpot

Some companies have found lucrative opportunities to capitalize on a growing need, billing long hours and extracting payments as high as $800 an hour

By Christopher Weaver, Tom McGinty and Anna Wilde Mathews of The WSJ. Excerpts:

"In 2023, the state [Indiana] paid [Meghann] Mitchell’s company, Piece by Piece Autism Centers, $29 million to provide therapy to just 84 patients" 

"That amount [$340,000 a child] surpassed what Indiana Medicaid typically spends in a year treating a newly diagnosed lung-cancer patient or covering a year of nursing-home care."

"reimbursements as high as $640 an hour for routine therapy that can be administered by workers with little more than a high-school diploma."

"“I don’t think Indiana really had any oversight, or not much,” said Mitchell"

"The number of companies offering such therapy"

"almost doubled between 2019 and 2023. Direct payments from state Medicaid programs to autism therapy providers grew to $2.2 billion in 2023, from $660 million just four years"

"Federal taxpayers financed about 70% of Medicaid spending during that period. Entrepreneurs and investors, including some private-equity firms, have piled into the business."

"The office [inspector general inspector general] has so far found widespread flaws in Maine, Wisconsin, Indiana and Colorado" and "errors in every case, including billing for therapy while patients napped or watched videos"

"Many providers nationwide billed a high number of hours of therapy for nearly every patient"

some "billed an average of 30 or more hours of weekly therapy per child in 2023"

"Evidence-based, broadly accepted guidelines do not exist for autism care" 

one firm "paid bonuses for working more hours of “treatment delivery” services, starting at 30 hours per week"

"Medicaid [in Indiana] spending on autism surged—from $21 million in 2017 to $611 million in 2023"

"No one monitored providers’ billing practices during those years"

one company "company threw Christmas parties with an open bar at local country clubs and a downtown Indianapolis karaoke bar"

one firm "In October 2023 . . . boosted its therapy prices again, raising them to $1,600 an hour" 

Washington State’s Income Tax Con

Democrats design a new ‘millionaire tax’ so it will inevitably capture the middle class

WSJ editorial. Excerpt:

"Once the state’s constitutional guardrails come off, middle-class Washingtonians know tax-and-spend Democrats will be coming for them next. That’s what happens in every state that has introduced an income tax. Spending soars with the new revenue, and politicians demand even higher taxes. The rate starts low, or at a high level of income, but the rate inevitably gets higher and the income threshold lower. It’s a slow form of fiscal suicide.

The taxing Democrats are already at this. The House this week struck from the bill an annual inflation adjustment to the $1 million tax threshold. Instead it will adjust only every other year, capturing only the prior 12 months of inflation. The House also replaced its traditional Seattle consumer price index with a slower-growing national CPI."

Keeping Up With the Jones Act

Trump may suspend the 1920 law that hurts the U.S. in war and peace

WSJ editorial. Excerpt:

"The law requires goods shipped between American ports to be transported on vessels that are U.S.-built, -flagged and -owned. Congress intended to boost the U.S. ship industry, but the protectionism has helped to ruin it instead. There are few Jones Act-compliant oil tankers, and they command higher shipping prices than foreign vessels.

America’s shale fracking bounty means the U.S. isn’t hurt as much by oil supply disruptions in the Strait of Hormuz as are Asia and Europe, which depend on the Middle East. Nonetheless, the Northeast and California import much of their oil. California imports about 15% of its refined fuel and 60% of its crude. About 30% of the latter comes from the Middle East."

What’s Driving the Spike in College Students with Disabilities

Universities from Harvard to Hampshire have admitted significantly more students with disabilities over the last decade, as diagnoses for A.D.H.D. and anxiety increase

By Mark Arsenault and Steven Rich of The New York Times. Excerpts:

"The number of college students reporting disabilities rose more than 50 percent over the last decade"

this "meant an increase in the number of students requiring accommodations, such as more time to take tests"

"it has raised worries that some could be gaming the system"

"The proliferation in accommodation plans, known as 504 plans after a section of federal law that prohibits discrimination based on disability, has made even the most academically rigorous universities more welcoming to students with disabilities."

"What is causing the increase is not entirely clear, but experts named a number of factors, including a rise in A.D.H.D. and autism diagnoses, as well as an uptick in diagnoses of severe anxiety, particularly since the Covid pandemic."

"Many of the college students arrive on campus after having a 504 designation in their high school years; data shows those accommodations are offered more liberally in affluent areas."

"Macalester College, a private liberal arts school in St. Paul, Minn., reported that 29 percent of students in 2024 had a disability, up from 5 percent a decade ago."

"Harvard recently established a centralized testing facility for students requiring accommodations during exams, so that professors do not have to scramble to find rooms for students who need them, said Steven Pinker, a Harvard professor of psychology.

Dr. Pinker added that as more people cite disabilities, the label “is being stretched into meaninglessness.”"

"“Everyone benefits from more time and fewer distractions, though to varying degrees along a continuum,” Dr. Pinker said" 

Elizabeth Warren’s Housing Coup

The GOP Senate is about to pass a bill that is great for progressives

WSJ editorial. Excerpts:

"Companies like Amherst and Invitation Homes that buy and then rent single-family homes have become a popular scapegoat for high housing prices. The real leading culprit is the Federal Reserve’s pandemic-era monetary policy. Historically low mortgage rates followed by inflation fueled price appreciation and resulted in a lock-in effect for owners that is constricting the supply of homes for sale."

"They account for less than 1% of the single-family housing stock, and the number of rental homes has declined on net by 900,000 since 2017. They manage fewer homes in pricy markets like Los Angeles (0.3%), Boston (0.02%) and Washington, D.C. (0.07%)."

"Most tenants are lower-income. The Senate bill could force many of them out of their homes."

"If investors are forced to unload properties, where will their tenants go? Amherst estimates that roughly 85% of its tenants wouldn’t qualify for a mortgage because of credit constraints or other underwriting restrictions."

Seniors Paid Billions in Extra Premiums Due to Alleged Medicare Overpayments

A congressional committee finds that controversial practices like adding diagnoses in Medicare Advantage triggered higher bills

By Christopher Weaver and Anna Wilde Mathews of The WSJ. Excerpts:

"The average American senior’s Medicare premiums last year were about 10% higher, or more than $200 annually, because of alleged overpayments to private Medicare Advantage plans, congressional investigators found.

Medicare Part B premiums that most seniors pay were partly pushed up by controversial health-insurer practices such as adding diagnoses to trigger higher payments"

"Overpayments to Medicare Advantage insurers increased Part B premiums by $13.4 billion in 2025"

"Medicare Advantage costs the federal government more than traditional Medicare, partly because of insurers’ billing practices. The insurers are paid more to cover enrollees who have more health conditions, and they can boost their reimbursement by recording more diagnoses."

"in 2025 Medicare Advantage cost roughly 20% more than traditional Medicare."

"insurer practices contribute to potential overpayments. For instance, insurers sent nurses to patients’ homes, where they documented diagnoses that trigger more payments."

"Medicare officials nevertheless moved in January to remove some of the tools insurers use to increase their payments, such as certain behind-the-scenes reviews of medical charts that can lead to extra diagnoses." 

America’s Strategic Oil Exports

Thanks to Paul Ryan’s 2015 deal, U.S. crude is helping the world

WSJ editorial. Excerpt:

"In recent years, however, the outfit has become a mouthpiece for the anti-fossil-fuel crowd. Progressives have cited IEA projections of waning global oil and gas demand to push policies to limit U.S. production. Fortunately, they haven’t succeeded in stranding U.S. oil exports, which are now also mitigating supply disruptions for allies.

Europe and Asia can thank former House Speaker Paul Ryan, who in 2015 drove legislation to overturn the U.S. embargo on oil exports that was imposed in 1975. Mr. Ryan cut a deal with Barack Obama to lift the ban in return for extending renewable subsidies. This spurred more shale fracking without crimping U.S. supply since Gulf Coast refineries aren’t well-suited to process lighter shale blends.

As a result, the U.S. is now a net exporter of oil. Since 2015, U.S. crude exports have increased nearly 10-fold to four million barrels a day, about 1.8 million of which supply refineries in Europe and 1.5 million in Asia and Australia. (See the nearby chart.) U.S. exports have reduced allies’ reliance on Russia and the Middle East."