Mental-health bill requires equality

In 1977, Randy Revelle says, he almost killed his two young children with a fireplace poker during a psychotic hallucination brought on by untreated bipolar disorder. But at the time, his health insurer didn't cover psychiatric treatments and his family couldn't get him hospitalized.

Revelle's father, a King County Superior Court judge, resorted to a desperate tactic: He ordered a Group Health Cooperative doctor to admit his son or risk jail. The doctor finally complied — but only by claiming that Revelle needed to be treated for back pain.

"In order to get admitted, we had to threaten the doctor with jail and lie about the diagnosis," said Revelle. He responded quickly to lithium, which he still takes today, and went on to become King County executive from 1981 to 1985.

Three decades later, Revelle may finally achieve a longtime goal by seeing a law passed that would prevent what happened to him from happening to others — by mandating some of the nation's best coverage for most mental illnesses.

The so-called "mental-health parity bill" is the second half of a state law signed in 2005 that banned large employers from offering health plans that provide coverage for psychiatric treatment that is inferior to coverage for other health problems. Two identical measures in the state House and Senate this year would extend that equality requirement to insurance sold to individuals and to those offered by small businesses with 50 or fewer employees.

Self-insured employers, such as Boeing and Microsoft, are exempt from state parity laws.

Though the 2005 law took seven years to pass, even opponents concede that the current measures stand good chances of becoming law. The Senate version will get its first hearing Thursday.

"Now it's time to finish the job," said Revelle, now senior vice president of policy and public affairs for the Washington State Hospital Association.

If the bills become law, health plans would be required starting next January to apply the same copayments and out-of-pocket spending caps for mental-health services that they do for other medical and surgical procedures.

After July 2010, insurers won't be allowed to charge separate deductibles for mental-health services. They also must lift all restrictions on mental-health treatments, such as limits on the number of psychotherapy sessions or hospitalization days, unless those limits apply to all medical services equally.

Perhaps most visibly, the bills would make some coverage for mental-health services mandatory for any insurance plans sold or renewed starting next Jan. 1. Most small-business health plans include some mental-health coverage, but it is not included in any individual health plans sold in Washington.

The bills would affect about 540,000 Washington residents.

Business groups again oppose the measures, saying the cost of beefing up mental-health benefits would add to the financial pressures employers already face in providing health coverage.

That squeeze would hit the smallest companies hardest, said Mellani Hughes McAleenan of the Association of Washington Business.

Instead, McAleenan said, the association favors leaving mental-health benefits optional and allowing buyers to tailor coverage according to their needs. Expanded mental-health coverage is good, but "there is a tradeoff," she said.

Even so, McAleenan acknowledges that there is "real possibility" that lawmakers will pass the bills.

An analysis of the measures funded by supporters estimated that they would mean about 0.5 percent to 0.9 percent more in premiums for small-group plans and up to 1.5 percent for individual policies.

But most important, Revelle said, parity would not only improve patients' mental health, but their physical health and productivity.

"All those benefits will overwhelm the premium increases," Revelle said.

Kyung Song: 206-464-2423 or ksong@seattletimes.com