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California Assembly bills expand health coverage requirements for private insurance policies in sta

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POSTED January 26, 2012 8:50 p.m.


 

SACRAMENTO. (AP) — The state Assembly on Thursday passed a set of bills intended to broaden the mental health and health care services covered by private insurance plans.

Lawmakers approved AB154, which would require insurers to cover the diagnosis and treatment of mental illnesses, and AB171 for coverage of developmental disorders such as autism. They also approved legislation to cover oral chemotherapy treatments and mammograms regardless of age.

The bills now move to the Senate ahead of a Tuesday deadline to pass legislation that was introduced last year.

Supporters say many people with mental illness and substance abuse problems are unable to obtain treatment and end up in public health care programs, emergency rooms and state and county jails.

"The bill is a cost-effective way to help people who are paying for health insurance actually to get (the) full-scope health insurance they need," said Assemblyman Jim Beall, a San Jose Democrat who authored the mental health and autism bills. "Mental health and substance abuses are treatable, and treatment reduces incarceration, homelessness, and most importantly human suffering."

Getting people treated earlier also will save taxpayer money, he said.

Republican lawmakers said the legislation will drive up insurance costs, particularly as government broadens the definition of mental illness. They worry more people would use mental illness to access drugs like medical marijuana.

"Our insurance rates will increase because of this clandestine broadening of the coverage," said Assemblyman Jim Nielsen, R-Gerber. "And I think you're further legitimizing drug abuse and encouraging it even more."

Beall estimated it would add between 6 cents to 61 cents per month to insurance premiums.

Supporters say the bill would provide new coverage benefits for non-severe mental illness for 4.5 million people and substance abuse treatment for 6.3 million people.

They say people struggling with mental illnesses can quickly reach coverage limits on their private insurance plans and have no choice but to turn to public health programs. Supporters say that's discriminatory because health plans should cover both the mind and body.

Under current law, California requires health care plans to cover treatment for some serious mental illnesses, such as schizophrenia, autism and anorexia. Beall's bill would expand coverage to other mental illnesses such as depression and anxiety.

The mental health bill expands on new federal health care requirements that require group health plans with more than 50 employees to offer equal medical and mental health benefits.

Opponents say it's premature for the state to act because California risks going beyond federal health care exchange guidelines, which are still being worked out. Such a move could end up costing the state money in the long run.

"With AB 154 mandating coverage for almost every mental health condition on the books, almost 400 conditions, this is a sizeable mandate that should be put in the context of the full benefit package that federal dollars are contingent upon," said Patrick Johnson, president of the California Association of Health Plans.

Although the state already requires health plans to cover autism and other developmental disorders, Beall said his bill was necessary because some insurers continue to deny claims.

The mental health bill passed on a 47-18 vote while the autism bill passed 45-13.

The Assembly also approved AB137, which would require insurance plans to cover mammograms based on medical need, regardless of the patient's age. It was passed 67-0.

Lawmakers passed AB1000 requiring insurance companies to cover oral chemotherapy treatments at the same rate they cover intravenous chemotherapy. The bill passed 51-15.

Henry Perea, D-Fresno, said he was inspired to change the law after meeting other patients as he accompanied his mother to intravenous chemotherapy treatments. He said many of them had to travel long distances from rural areas to medical centers, even though there are pill forms of chemotherapy drugs available for 57 types of cancer.

For some patients, co-payments for the pill form of treatment ran as high as $10,000 a month, but they paid only an office-visit co-pay for an intravenous treatment, Perea said.

Assemblyman Dan Logue, R-Linda, said the bill would "increase the price and premiums for the people of California," and said the legislation was premature. Perea's office said 13 other states and the District of Columbia already have adopted similar laws.

Also, a bill to create a government-run health care system in California fell short of the votes it needed in the state Senate, and Senate President Pro Tem Darrell Steinberg predicted it won't succeed this year.

Author Sen. Mark Leno, D-San Francisco, argued that California should take the lead in creating a single-payer universal health care system, despite the new federal health care law taking effect in 2014.

But Republican lawmakers objected to creating what they said would be a huge, expensive new bureaucracy. The bill failed on a 19-15 roll call, two votes short of the majority it needed, after several Democrats also declined to vote for the measure.

Previous similar measures were vetoed by former Gov. Arnold Schwarzenegger.

 

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