Open This Door Slowly

Last month, state Assemblyman Don Perata (D-Alameda) spoke poignantly in Sacramento about the trauma his family suffered on discovering that his sister’s health insurance would not cover treatment for her debilitating bout with schizophrenia. The reason, said the insurer, was that schizophrenia was a “mental and nervous disorder,” not a medical illness.

The distinction between “medical” and “mental” is common in health insurance policies today. It is also somewhat arbitrary, for research is making it increasingly clear that mental illnesses have a physical component.

Today, the Assembly Appropriations Committee is scheduled to take up a bill to level some of those distinctions. AB 1100, introduced by Perata with Assemblywoman Helen Thomson (D-Davis), would require all health insurance issued or amended after this year to offer the same level of benefits for “severe mental illnesses” as for “other medical conditions.”

Relative to some of the similar bills enacted in eight other states, the Perata-Thomson measure is moderate, preserving the freedom of health plans to set payment rates and of doctors to decide in most cases what is medically necessary. And clearly, reform is needed. Few physicians would dispute that schizophrenia can be as debilitating and biologically hard-wired as Parkinson’s disease; recent research shows that both stem from the brain’s inability to produce and regulate normal amounts of a chemical called dopamine. To allow only several thousand dollars over a lifetime for one but hundreds of thousands for the other is unconscionable.

Nevertheless, the Legislature should be wary of jumping on the mental health parity bandwagon. In its current form, AB 1100 specifies a broad range of conditions that must be considered “biologically based,” employing definitions that are not grounded in medical consensus. For instance, it lists “bipolar disorder,” popularly known as manic depression, but is unclear whether this includes both bipolar I (a debilitating biological disease) and bipolar II (a milder, more controversial disorder).

Any coverage mandated by the Legislature must reflect the most solid science possible. This is a door that should be opened slowly.