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A Fair Deal for the Mentally Ill

June 21, 1998

Brain research has made it increasingly clear that severe mental illnesses like autism and schizophrenia are as biologically hard-wired and resistant to human willpower as heart disease and diabetes. Most health care plans in California, however, either don't cover mental illness at all or cover it at levels far below those for other physical ailments. In recent years, 19 states, recognizing the new science, have enacted "parity" laws requiring insurers to cover severe mental illnesses just as they cover other disease.

Now, it's California's turn. AB 1100, a parity bill passed earlier this month by the state Legislature, is now on its way to Gov. Pete Wilson, who should sign it into law.

Wilson has threatened to veto what his spokesman, Sean Walsh, describes as a "blanket, undefined remedy that has no cost controls." In fact, AB 1100 covers fewer mental illnesses and offers more leeway to managed care cost cutters than most of the other state bills. Requiring parity for only severe, biologically based forms of seven mental illnesses, the bill preserves managed care's authority over specific coverage decisions and includes two recent amendments that explicitly say insurers are free to limit care through "case management, managed care, or utilization review." These systems may be unpopular, but they are legitimate tools for keeping health care affordable.

A recent poll by the state Chamber of Commerce of small business leaders in California found 65% of them approving of "legislation that would mandate that mental health coverage be included in your insurance plan," even if that mandate were to raise their insurance premiums by 5%. The cost of AB 1100's mandate would be far lower--one federal study found that more sweeping state mental health parity bills did not increase overall costs at all, because of tight case management.

In recent years, Gov. Wilson has rightly rejected bills mandating levels of health coverage for specific body parts and procedures. Such legislation, playing to voters' frustration with managed care, puts legislators in the awkward role of practicing medicine.

The governor should see AB 1100 as different. In no way would it prevent physicians from treating patients as they saw fit. Rather, it would bring health insurance in line with modern science. Society no longer regards the mentally ill as "feebleminded." Nor should managed care.

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