Mental-health bill will hike insurance costs

Rocky Mountain News Editorial

4/5/07

      The cost of health care insurance keeps rising faster than the rate of inflation. Is that because, at least in some part, lawmakers require that more and more conditions be covered instead of letting consumers choose?

      You bet. And mandates are coming our way again in Senate Bill 36, which is scheduled for action this morning in the Senate Appropriations Committee.

It would require that insurers provide coverage for numerous mental disorders "that is no less extensive than the coverage provided for a physical illness."

The mental health industry has long chafed under the fact that some of the problems they treat are regarded with suspicion by the public at large and thus aren't covered as extensively as physical ailments. Psychiatrists and their allies are constantly trying to achieve parity.

In recent years the legislature has mandated group health insurance coverage for alcoholism and for six so-called "biologically based mental illnesses," including schizophrenia, bipolar affective disorder, obsessive-compulsive disorder and panic disorder.

The current bill would extend that coverage to most of the mental disorders included in the International Classification of Diseases (ICD), with a few exceptions, like tobacco use, infant autism and mild mental retardation.

One problem not exempted is eating disorders, which has attracted clinics happy to charge you $900 or more a day in order to cajole you into eating. You want your health insurance premium raised to cover something like that?

"This bill requires full parity for the treatment of narcissism," notes Sen. Steve Johnson, R-Fort Collins. "Wouldn't that require all of the senators to excuse themselves under Rule 17(c)?" That's the rule that requires legislators to exempt themselves on bills where they have a conflict of interest.

More seriously, Johnson pointed out that the bill covers diseases include masochism, bestiality, fetishism, exhibitionism and "inhibited sexual excitement."

We're not saying that mental health problems aren't real. But every mandate piled on will drive up the cost of health insurance for all but the smallest companies, which would be exempted. And the higher the cost of health insurance, the more employers are likely to stop offering it.

If we had our druthers, not only would these mandates not be added, but some others would be eliminated, too. Customers should be allowed to choose from more limited health plans.

Given today's political climate, this bill is unlikely to die. The best we may be able to hope for is a compromise. Kaiser Permanente is offering one. Instead of adding the entire ICD (minus a few exceptions) to mandated coverage, it would expand the coverage to only four additional diseases: post-traumatic stress disorder, social phobia, agoraphobia with panic disorder and chemical dependency. Adding these four would encompass 95 percent of mental health conditions, says Kaiser spokeswoman Susan Cox.

It's difficult to predict how much premiums would rise if the bill were adopted as is. But the cost of health care is such that the legislature should try to reduce, not expand, the list of mandates.