As the mental health crisis in the state continues to unfold, lawmakers and advocates say existing laws have failed to ensure Californians with mental health and substance abuse disorders are covered by health insurance companies.
“Unfortunately, there are gaps in the law that have allowed insurance companies to deny what is clearly medically necessary coverage for people experiencing mental health and addiction challenges,” state Sen. Scott Wiener, who represents San Francisco, said at a virtual press conference earlier this month.
SB855, which aims at expanding mental health services covered by health insurance companies, passed the state legislature’s Assembly Health Committee last week. It is now making its way through the Assembly Appropriations Committee.
“It’s a real fight. The health care industry in the country is so powerful,” said Sal Rosselli, president of the National Union of Healthcare Workers, whose members have been pressing state lawmakers to pass SB 855.
The bill would require health insurance companies to cover mental health and substance use treatment deemed by a patient’s doctor as “medically necessary” under the same terms and conditions applied to physical illnesses.
Wiener said the bill would require health insurance companies to cover a wider range of mental illnesses. Current parity laws do not mandate coverage of mental health disorders such as post traumatic stress disorder and generalized anxiety disorder, he said, nor substance use disorders such as opioid, alcohol and stimulant use disorders.
Officials at the trade group California Association of Health Plans contended otherwise. “We believe that this bill is based on a false premise that health plan enrollees are not receiving mental health care services at parity with other medical care,” said Mary Ellen Grant, a spokesperson of the California Association of Health Plans.
Grant said the federal Affordable Care Act and the California Mental Health Parity Act already mandate health care plans cover substance use disorder at parity with other medical conditions.
Instead, what needs to be addressed to tackle the mental health crisis is the shortage of mental health care providers, a problem which SB855 fails to address, Grant said.
She also pointed to an analysis of the bill by the California Health Benefits Review Program, which assesses proposed bills mandating health insurance benefits. The report detailed that 99.8 percent of enrollees in state-regulated health insurance would not “experience a change in benefit coverage” and they currently have coverage for mental health and substance use disorder services at parity with other medical conditions. That includes post traumatic stress disorder, generalized anxiety disorder and substance use disorders, according to Grant.
The report also showed that 0.2 percent of 13.4 million people with insurance subject to SB855 — people with grandfathered health care plans — do not have coverage for mental health and substance use disorders at parity. And they would gain extra coverage under SB855.
Proponents say the bill is crucial to ensuring Californians suffering substance abuse and mental health conditions receive proper medical care. According to Christine Stoner-Mertz, chief executive officer of California Alliance of Child and Family Services, mental health conditions are the most common reasons children in California are hospitalized. She said during the press conference there was a 34 percent increase in suicide among Californian youth between the ages of 15 and 19 in the last three years, a significantly higher rate than the national increase of 25 percent.
In addition, the coronavirus pandemic has exacerbated the mental health crisis, which supporters of the bill say highlights the need for comprehensive mental health care coverage.
“People who have not had diagnoses before are now getting diagnosed because of the stress and the trauma and the anxiety [of] the pandemic,” Wiener said. “People who have never had substance use problems before are now developing substance use problems. And people who have been sober for years are now lapsing. And yet, we’re not providing adequate coverage.”