Poised for Parity

Lawmakers seem likely to pass a mental-health requirement for insurance providers.

Eight years after it was first introduced in the Legislature, mental health insurance parity is on track to make its way to the governor's desk for signature. "We're looking good, but we aren't there yet," says Randy Revelle, chairman of the Washington Coalition for Insurance Parity, the bill's longtime advocates. "If this isn't the year, I don't know what the hell we do."

The bill would require most health insurance coverage offered by employers to include equalized coverage for mental-health conditions. It passed the House on Jan. 28, 67-25. It is scheduled for a hearing before the state Senate's Health and Long-term Care Committee on Monday, Feb. 21. Co-sponsors include four Republican senators, including influential Linda Evans Parlette, R-Wenatchee. The bill is expected to be approved by the full Senate and forwarded to Gov. Christine Gregoire. During her gubernatorial campaign, she said she supported the legislation.

That's a far cry from last year, when the parity bill cleared the House but was spiked in the then-Republican-dominated Senate, at the behest of then-Gov. Gary Locke, according to Senate Republicans. They were convinced that it would boost health care premiums radically. Democrats, who now control both houses of the Legislature, have long thought otherwise—that treating mental illness aggressively makes more sense than hardly treating it at all, when you consider lost productivity and sick days.

Under Washington's present laws, health insurance plans such as Premera Blue Cross, Regence Blue Shield, and Group Health Cooperative do not have to offer coverage comparable to that of physical ailments for people with depression, bipolar disorder, or schizophrenia, among other mental afflictions. That's created a clinical environment in which patients are severely limited in the number of visits they can make to their doctor or therapist each year. (How many cancer patients are limited to six doctor visits a year?) Many also are charged more in co-payments, sometimes double the amount they'd pay to see a physician for a broken bone. Mental-health advocates like Revelle have long called such treatment discrimination and a disincentive for people to seek care.

Thirty-eight states over the past decade have passed parity legislation. Business groups and health care companies predicted that equalizing coverage for the mentally ill would explode health insurance costs. But that hasn't been the experience in those states, says Ron Bachman, a principal with PriceWaterhouse Coopers, one of the nation's largest accounting firms. Bachman has studied the effects of parity legislation and says, "It's not even a cost issue." Most increases in premiums, he says, run to about 1 percent.

An actuarial analysis he performed on the Washington insurance market for the parity coalition estimates that premium increases here would be less than 1 percent.

Health insurance and business trade groups see things differently. "It's another mandated cost and will further aggravate costs," says Sydney Smith Zvara, executive director of the Association of Washington Health Care Plans. She says that adding mental-health coverage would increase some premiums as much as 5 percent. The Association of Washington Business offered similar testimony during hearings in the House.

"Show me the report, show me the data," says Bachman, who will testify on behalf of the bill in its lone Senate hearing. He says that businesses and insurers, some of which are his clients in other insurance work, have been making the same claim for years but haven't been able to muster proof. Bachman says that Blue Cross of California officials say that parity in that state created no cost problems.

It's a measure of just how weak the cost argument is that no Republican state senator would speak to Seattle Weekly in opposition to the bill. Even some conservatives in Olympia acknowledge that the bill is popular and they'd look mean-spirited to actively oppose it.

"How can you stand up for treating mental illnesses differently than other illnesses?" says Lisa Brown, D-Spokane, majority leader of the Senate. "The benefits are just overwhelming in terms of getting treatment."

The bill exempts businesses with 50 or fewer employees, self-insured companies like Microsoft and Boeing, as well as insurance plans offered to individuals. If passed, it would become law on July 1. Several of its provisions, including protections against patients incurring catastrophic costs, would be phased in over five years.

Revelle admits that to get the bill this far has required more compromises than he would have liked, but that they were necessary to get the legislation passed. Co-payments for doctor visits and pharmacy benefits would be the first provisions equalized under the proposed new law.


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