In a hard-won, if limited, victory for mental health advocates, the state House on Wednesday passed a bill that would assure insurance coverage for South Carolinians suffering from depression and other mental illnesses.

The proposal did not go as far as mental health advocates had hoped. Yet if the legislation passes in the Senate and wins Gov. Mark Sanford's signature, it would put South Carolina on par with 34 other states that require some companies to provide some level of mental health coverage to their employees.

Where it comes up short, according to those advocates, is that it does not require employers to provide coverage for psychological ailments at the same level as physical maladies, an approach known as mental health parity.

Scaled back from a wider bill approved last month in the Senate, the House version requires companies to buy insurance plans that provide mental health treatment for a minimum of 105 days a year.

Nevertheless, advocates said it's a good start for the estimated 170,000 South Carolinians suffering from serious mental illness. They said it will give more people early access to treatment key to keeping psychological problems from becoming serious.

"It is a good health insurance bill for people with mental illnesses," said Dave Almeida, executive director of the state chapter of the National Alliance for the Mentally Ill. "It gives someone who is just experiencing the first symptoms of an illness an opportunity to get immediate treatment. That's something not afforded them previously because of limits on health insurance."

The bill passed the House on a voice vote, and after a third reading today, will head over to the Senate, which can agree with the House version or send the bill to a conference committee of both bodies for further debate.

Other states tackling the issue include Oregon, Ohio and Iowa. Legislators in Idaho recently rejected a parity bill.

Mental health advocates for years have pushed for equal coverage of psychological problems. They argue that many people can't afford proper treatment because insurers won't pay for it. As a result, their problems worsen, and they frequently end up on Medicaid. This year, advocates were armed with figures from a two-year experiment by the state health plan, which provides coverage to government employees, showing that added mental health coverage led to only a modest increase in premiums. While the overall cost of health care per enrollee in the state health plan rose nearly 22 percent between 2001 and 2003, just 1.1 percent of that growth was attributed to parity.

Even so, the insurance industry and business groups argued that mandated coverage would lead to higher costs that ultimately would be passed on to employers and their workers. As a result, the bill approved in the Senate last month was limited, having been crafted in an earlier compromise reached in March between insurers and mental health advocates.

The bill requires health plans to cover nine mental problems: bipolar disorder, major depression, obsessive-compulsive disorder, paranoid and other psychotic disorders, schizoaffective disorder, schizophrenia, anxiety disorder, post-traumatic stress disorder and childhood depression.

The proposal exempts small businesses with fewer than 50 workers, which typically struggle to pay for health coverage. According to federal statistics, 650,000 of the state's 1.5 million workers are employed in such businesses.

Larger employers, meanwhile, typically self-insure. Such plans already are exempt from state mandates by federal law.

That means the bill likely would affect only mid-sized employers. According to federal statistics, 435,000 South Carolinians work for companies with between 50 and 250 employees, the employers that most likely will feel the mandate.

The House added another restriction before Wednesday's vote, allowing insurers to restrict inpatient coverage to 45 days a year and outpatient coverage to 60 days a year. "I don't think we would call this a parity bill," Almeida said. "It's progress, but it's not parity."

Critics weren't happy either, believing mandated coverage still would add costs in a system that barely can tolerate more increases.

State Rep. Wallace Scarborough, R-Charleston, believes that because of the added costs, more young people who make less money will drop health coverage altogether. That will leave the system with older, sicker workers, which in turn will drive costs higher, forcing yet more companies to drop coverage, he said.

Scarborough also believes companies should have a right to choose a plan with mental health coverage.

"I think it's a bad precedent," the lawmaker said. "When you start mandating what people can and cannot do, that's not capitalism. That's socialism. It's like telling (Kmart) that they can't have a blue-light special, they have to have a red-light special. When does it end?"

Others complained about what the bill does not mandate. One provision cut from the original bill would have provided coverage for alcohol and drug abuse.

"We don't refuse treatment for obese people, and half the nation is obese and we have resulting health care costs because of it," said Sharon Fratepietro of Charleston, president of South Carolinians for Drug Law Reform, a group that believes the state should shift the focus of the drug war from enforcement to treatment.