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In the last decade, autism has become one of the most hotly contested health policy issues in North America and beyond. From debates about the role of vaccines to the efficacy of therapeutic interventions, a range of civil society actors has been advocating for policy and societal change in the field, with mixed success. In Canada, this culminated in 2004 with a much-publicized Supreme Court decision—Auton v. British Columbia—that pitted parents of autistic children against the BC government, which was unwilling to cover the costs of behavioural treatment for autistic children. In contrast to parent-led advocacy groups, there has been a flurry of civil society activity waged by autistic self-advocates who decry the focus on curing autistic people and press instead for the recognition of neurological difference. Drawing on interviews with advocates in Canada and the US, this article highlights these contending perspectives and argues that both pose fundamental challenges to how we view the redistributive aims of the welfare state in Canada and beyond. [ABSTRACT FROM PUBLISHER]