Florida legislator pushes for mental health insurance parity

From Tampa Bay Online:

TALLAHASSEE, Fla. -- The economy is in recession and the budget outlook is bleak. Could 2009 turn out to be state Rep. Ed Homan's lucky year anyway?

The Tampa Republican (pictured) is trying for a third year to force insurers to cover mental health treatment at the same level that they cover other health services. Florida law sets minimum requirements for mental health benefits, but does not require parity; as a result, insurers typically offer less coverage of those illnesses.

It's a personal cause for Homan, a physician whose adult son has bipolar disorder. This year, the lawmaker may get his chance at success, as the new chairman of the House Health and Family Services Policy Council. It is the chamber's most powerful health policy panel, to which smaller committees will send bills for approval.

"Finally," Homan said, smiling. "The bill ought to get heard this year."

Homan may have another advantage as well: no more Marco Rubio.

In 2007, the exasperated Tampa lawmaker lashed out at Rubio, his chamber's former speaker, for refusing to let the mental health parity bill come to a vote despite its 91 co-sponsors and approval by two committees. Homan suggested that Rubio's brother, then a Blue Cross Blue Shield lobbyist, was using his influence to block the bill. Speaker Rubio - no fan of business regulation in general - denied that his brother had anything to do with it.

In 2008, Rubio's last year as speaker, the House passed Homan's bill in such a watered-down form that he said it was hardly worth approving. The toothless bill, which Homan said was rewritten by insurance lobbyists, never came to a vote in the Senate.

Homan filed the original version of his bill again Dec. 18. Victor Crist, R-Tampa, who sponsored the bill in the Senate last year, has filed it again this year as well.

Insurers consistently fight mental health parity, arguing that requiring those benefits could dramatically raise their business costs. Last spring, House analysts cited studies by the U.S. Substance Abuse and Mental Health Services Administration showing that full mental health parity would increase premiums up to 8.7 percent.

"That's our primary reason for taking a hard look at mandates," said Gary Landry, vice president of the Florida Insurance Council. "Companies try to tailor policies for individual policyholders as best they can; their goal is to make an insurance product as available and affordable for as wide a group of policyholders as possible."

Higher costs mean that fewer people will have coverage, the insurers warn. Homan says they have yet to offer proof.

"The argument always heard is, if the cost goes up 1 percent, then 1 percent of the public becomes uninsured," he said. "Well, they pack on another 10 to 11 percent every year, and they don't lose 10 to 11 percent of their insured. It's an empty argument."

Homan continues to argue that covering mental illness treatment increases worker productivity and reduces absenteeism, offsetting any increase in insurance costs for employers. "We just can't get the insurance companies to listen to that."

Those arguments held sway on Capitol Hill, however. Last summer, Congress attached a national mental health parity requirement to an economic stimulus bill that President George W. Bush signed into law in October.

But the federal bill limits the coverage mandate to employers of 50 people or more - leaving out 80 percent of the work force, said Homan, whose bill would drop the threshold to 10 employees.

What's more, the mandate only applies to insurers who choose to offer mental health coverage. That provision, Homan argued, may allow insurers to drop the benefit rather than comply with the mandate.

"That would be like saying, 'If you don't want to provide hypertension coverage, then you don't have to,'" he said. "The only disease more common than mental health problems is hypertension; how can we not cover the second most common disorder that we have?"

Homan's version offers no such "out" for insurers who, under his bill, would have to offer mental health benefits equal to the physical health coverage they provide. If it passes, the tougher state mandate would supersede the more modest federal requirement.

That's still a big "if," however. Don Gaetz, who presides over the Senate Health Regulation committee, said this is "probably a brutally tough year" for pushing an insurance mandate.

"In general, I think we've shortchanged mental health treatment in this state," said Gaetz, R-Niceville.

Nonetheless, he said, "the problem with any insurance mandate right now is that it will, at least in the short term, have a direct effect on the cost of insurance for employers and employees. And when you have employers sitting at the board table every week, trying to decide how do we cut costs and who do we let go ... it's difficult in that environment to come forward with even a very well-intentioned and well-crafted mandate of this scope."

Homan said he knows the challenges remain formidable. "I'm not making any promises - but we're going to try."