Senate to tackle mental health bill

A state Senate committee vote puts the legislature closer to improving insurance coverage, but the House's version differs

Workers in North Carolina are as close as they have ever been to benefitting from mental health insurance coverage required in most other states.

Insurance companies would treat people with major depression and other mental illnesses the same as they do patients with heart disease and other physical ailments under a proposal that cleared an important hurdle Wednesday in the state legislature. A Senate committee unanimously endorsed a bill that would require equal treatment from insurance companies for mental and physical illnesses. The bill now goes to the full Senate.

Legislators have talked for years about a law that would require equal insurance coverage for mental and physical illnesses. The Senate approved a version of the mental health insurance requirement 10 years ago, but the House all but ignored the issue until this year.

Insurance companies in the past have objected to expanding coverage because they said it would cost too much. But Blue Cross and Blue Shield of North Carolina, the state's largest private health insurer, worked on the measure this year and suggested the version of the bill that the Senate Health Care Committee approved.

Most of the arguments about increased costs now come from business lobbyists who say that expanded coverage would lead small businesses to drop health insurance plans.

Other states have found that few companies drop coverage and that cost increases are minimal. For example, a 2003 study of the mental heath coverage law in Vermont found that less than 1 percent of companies dropped coverage, and spending by Blue Cross and Blue Shield of Vermont increased 19 cents per month for each person enrolled.

Currently, few private insurance policies for North Carolina workers cover mental illnesses for more than short periods, and they often impose a lifetime cap that can be reached with just one hospitalization. Supporters say that expanding private insurance coverage would help working people and their families receive proper treatment.

The state ends up paying to treat or hospitalize workers with inadequate mental health insurance when they lose their jobs because of their illnesses or when their policies stop covering costs, say those who support expanded private coverage.

The talk of expanding private insurance comes as the public mental health system, which relies on private contractors to provide most treatment, is faltering.

The measure approved by the Senate committee is substantially different from the version the state House approved overwhelmingly in May. Neither proposal would cover drug or alcohol treatment, and under the House version, businesses with 25 or fewer employees would not have to comply.

The Senate committee took the recommendation of Blue Cross and Blue Shield of North Carolina and limited to nine the mental illnesses placed on equal footing with physical ailments. Insurers of patients with illnesses not among the nine would be required to pay only for 30 doctor visits and 30 days of hospital treatment each year. The House bill had no such restrictions.

Blue Cross lobbyist Kenneth Wright said that most of its customers hospitalized for mental illnesses have one of the nine specified ailments. "You take care of the bulk of the problem ... by using those nine," he said.

Advocates for the mentally ill said they prefer the Senate proposal. John Tote, executive director of the Mental Health Association in North Carolina, said the Senate proposal triples the number of people covered.

"For mental health, it moves us way down the road," he said.