Mental illness patients may get more aid from insurance

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But if the diagnosis is bipolar disorder, chances are you're stuck with the bills yourself.

It's now up to the state General Assembly to decide whether to change that in South Carolina by passing a bill that would require health plans to cover serious mental illness much the way they do arthritis, cancer and other physical diseases.

The bill, S-49, would mandate coverage for schizophrenia, bipolar disorder, major depression, obsessive compulsive disorder, paranoid or psychotic disorders, anxiety disorders, post traumatic stress disorder, and depression in children and adolescents.

Serious mental illness strikes between 5 percent and 7 percent of the population, said Dave Almeida, executive director of the South Carolina chapter of the National Alliance for the Mentally Ill. The State Budget and Control Board estimates that the bill would apply to approximately 930,000 South Carolinians.

"With modern medicine, mental illness is a treatable disease," said Sen. Robert W. Hayes Jr., R-Rock Hill, the bill's primary sponsor and chairman of a House-Senate conference committee expected to meet about the bill on Wednesday. "It ought to be treated like any other disease."

The bill wouldn't cover addiction services, and it would limit inpatient stays to a total of 45 days a year and outpatient visits to 60 a year. Businesses with 50 or fewer employees would be exempt.

Rep. Bob Leach, R-Greenville, said the measure is long overdue.

"Mental illness is like any other illness," he said. "And this bill says that insurance companies with 50 or more employees must put that coverage in their policies."

Almeida said, "This bill is designed to help people who get the most disabling illnesses. And let's call them what they are — diseases of the brain."

But Rep. Dan Tripp opposes the bill, saying that providing insurance parity for mental illness will raise premiums.

"It's a mandate that is going to cause insurance premiums to go up," the Greenville Republican said. "The Legislature a couple years ago put a moratorium on health care mandates specifically for that reason. That ended earlier this year, and already they're passing a mandate."

Hayes said coverage for mental illness permitted in the state health plan to determine the impact on rates had little effect. The State Budget and Control Board set that cost increase at 0.87 percent. And Almeida said increases in other states that have passed similar bills have been "negligible."

But Tripp said there hasn't been enough time to determine whether state health plan rates will increase, and that experiences in other states can't be compared to South Carolina because the mandates differ.

"You can't look at a year or two period and know whether that's the true cost," he said.

Furthermore, he said, the market should dictate coverage, not mandates from the Legislature.

Larry Akey, spokesman for the trade group America's Health Insurance Plans, said the industry opposes mandates because they result in higher premiums that force some employers to discontinue coverage. Instead, he said, employers should work with employees to determine what they want covered.

"As the Legislature adds mandates, it makes the policy more expensive," he said. "Each one may not be the straw that breaks the camel's back. But taken together, mandates can represent 25 percent of cost of insurance."

Nonetheless, Akey said many companies already provide the level of coverage for mental illness proposed in Hayes' bill. And as mandates go, he said, this "isn't a particularly egregious one" because of the treatment caps.

Leach said that while adding the coverage might increase premiums over time, failing to provide it will cost society much more in the long run because many mentally ill people wind up on Medicaid and other taxpayer-funded programs.

"This allows people to protect themselves," he said. "It might raise premiums, but mental illness can affect anybody."

Like Hayes, Leach is opposed to the caps.

"I don't think we should restrict treatment from anyone with mental illness problems," Leach said, "no more than you would for heart problems."

Clemson University athletic director Terry Don Phillips didn't give mental illness much thought until his son, John, developed schizophrenia, a serious, chronic condition marked by psychotic thinking, delusions and hallucinations.

"Mental illness is not a flaw in character. My son is a good person. There is nothing he could have done to prevent it. It's something that happened to him, no different from someone who has cancer or diabetes," said Phillips, 57. "But until people have lived it, it's hard to understand. It's like wrestling smoke."

Phillips, then living in another state, had a policy that covered mental illness when his son, then 20, was diagnosed. But treatment was capped, and in just six weeks, he reached the limit his policy would cover.

"I found out very quick that if someone suffers from mental illness they don't have the same benefits and coverage that you have with physical illnesses," he said. "It's a lifelong illness. It's treatable, but it comes with a cost. You could run up a $100,000 bill in a hurry, like you could if you're taking cancer treatment."

Tripp said that historically one of the reasons mental illness hasn't had the same coverage is because it isn't as clearly delineated a disease as a broken leg, for example. Therefore it is difficult to measure risks and set premiums, he said. Another reason, he said, is that it's an area ripe for abuse and fraud.

Almeida said it is because of the stigma.

"Mental illnesses are real diseases and should be covered like any other disease," he said. "This legislation measures how ready South Carolina is to accept mental illnesses as the real diseases we know them to be."