Bill supports equal time for mental health: Five Republicans join Oregon Senate Democrats to require insurers to end limits on visits for mental illness and drug abuse

SALEM -- The Oregon Senate approved a bill Monday requiring insurers to cover mental illness and drug abuse "at the same level as" physical ailments such as diabetes or broken bones.

Backers hailed the 23-6 vote as a bipartisan blow to mental illness as a stigma and a step toward equity in health coverage. They said the cost would be more than offset by improved health and reduced absenteeism.

"It is time to end discrimination against the mentally ill," said Sen. Avel Gordly, D-Portland, in support of the parity bill. Her son has schizophrenia.

Opponents called parity a feel-good slogan for shifting health costs to the private sector. They said it could have the perverse effect of forcing some employers and insurers to cut back on covered benefits in order to pay for additional mental health coverage.

All 18 Democrats, plus five of the Senate's 12 Republicans, voted for the parity bill. No previous bill calling for mental health parity had ever passed either house of the Legislature. Prospects for the bill remain uncertain in the Republican-controlled House.

Senate President Peter Courtney, D-Salem, called parity "as important as any issue we'll take up this session." He noted that one in five Americans has a severe mental illness at some point.

The parity law would take effect in 2007. It would require private group health insurance policies to cover treatment for mental health and drug or alcohol abuse at a level equivalent to other medical conditions.

In all, 34 states require some form of parity between mental health and physical health coverage. Details vary widely from state to state.

Washington joined the list this month, when Gov. Christine Gregoire signed a measure that will phase in mental health parity by mid-2010. The Washington law does not apply to businesses with 50 or fewer employees.

The Oregon bill, Senate Bill 1, would not affect state employees, who have had full mental health coverage since 2003, or the Oregon Health Plan, which covers mental health for about 375,000 low-income Oregonians.

In Oregon, private health insurance plans already are required to include mental treatment. But to control costs, they can limit coverage -- capping the number of therapy sessions allowed, for example -- in ways that don't apply to physical ailments.

"We don't do this for diabetes," said Sen. Laurie Monnes Anderson, D-Gresham. "We don't do this for high blood pressure. Why should we be doing this for mental illness?" She described limits on mental health treatment as "open and legal insurance discrimination."

Regence BlueCross BlueShield of Oregon, the largest insurer in the state, covers about 325,000 Oregonians in employer-based group plans. Of those who use its mental health and drug-dependency benefits, more than 97 percent complete their course of treatment before using up their mandated coverage, said Pam Lally, manager of legislative affairs.

That means the parity bill would help fewer than 3 percent of Regence members, Lally said. But she warned it would raise premiums for all by generating an estimated $20 million a year in additional claims.

Beneficiaries already can make as many as 34 therapy visits in two years for severe depression, she said. For drug abuse or alcohol treatment, the limit is 36 visits for children and 25 visits for adults every two years, she said.

Gov. Ted Kulongoski expressed strong support for the parity bill.

"Those who oppose SB 1 argue that the cost of parity is something Oregon cannot afford," Kulongoski wrote in a letter Monday to Courtney. "On the contrary, I believe that the costs to individuals, to employers and to the state resulting from our current lack of parity are unsustainable.

"When individuals with mental illness and chemical dependency receive adequate treatment, symptoms are reduced, children learn and thrive, and adults are able to work and participate as productive members of society."

The National Federation of Independent Business opposes parity, saying it would raise premiums and force some small employers to drop health benefits altogether, rather than offer the added mental health coverage.

"This takes us in the wrong direction," said Sen. Jeff Kruse, R-Roseburg. He called SB 1 "form over substance." Proposals by Kruse and other Republicans -- one to kill the bill and another to delay consideration by referring it to the Joint Ways and Means Committee -- were easily defeated Monday.

Sen. Ben Westlund, R-Bend, one of five Republicans voting for the parity bill, alluded to his treatment for lung cancer the past two years.

The suffering of a family facing severe and chronic mental illness is "a more insidious 'cancer' than anything I and my family went through with the actual disease of cancer," he said.

Sen. Ted Ferrioli, R-John Day, voted against the parity bill, saying it would shift costs to the private sector, raise premiums and force insurers to cut back on other kinds of coverage. He said it was irresponsible for the Senate to vote on such a bill without first determining its fiscal impact.

If mental health parity becomes law in Oregon, that won't be the end of the controversy, said Gina Firman, executive director of the Association of Oregon Community Mental Health Programs, which backs parity. Insurers will have to decide what equivalent coverage means in practical terms.

"There will be big debates," she said, "about what is 'usual and customary' in mental health care."