Zarelli Kills Mental Health Bill:
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Mentality Challenged
An ignorant GOP state senator kills a popular bill that would have required
insurers to cover mental-health treatment and counseling.
By Philip Dawdy
March 3, 2004
WHEN IT COMES to health insurance for mental health in Washington, there's
only one name you need to know: Joe Zarelli. He doesn't head an insurance
company. He's a security consultant and Republican state senator from Ridgefield,
in Clark County near Vancouver, and he's chair of the powerful Ways and Means
Committee. On Monday, Zarelli killed a well-supported bill requiring that
insurance coverage for mental-health treatment be at parity with medical services.
Over the past decade, 38 states—including progressive leading lights like Arkansas
and Alabama—have enacted similar insurance parity laws.
HB 1828 passed the Democrat-controlled state House on Feb. 13 by a 64-33 vote,
with 13 Republicans in support, but it never got a hearing in the Republican-
controlled Senate. Monday, March 1, was the final day that bills could be reported
out of legislative committees. Zarelli, the first-session Ways and Means chair, told
Seattle Weekly that he didn't find the matter a pressing responsibility, conceding,
however, that he had not examined it. By not ordering a hearing for HB 1828 in
his committee, Zarelli prevented the bill from reaching the Senate floor, where it
would have passed, according to members of both the Republican and Democratic
Senate caucuses. Gov. Gary Locke has quietly advocated for the bill and would
have signed it, his office said.
How could one man quash a bill that would have helped tens of thousands of
Washingtonians, including, perhaps, members of the state Senate, and maybe
saved a few lives as well? "I don't know the issue," Zarelli said Monday. "It's a
hot potato in a lot of people's minds."
Strangely, the Washington Coalition for Insurance Parity isn't particularly upset.
"The farther you get, the better you are," says Randy Revelle of the coalition,
noting that an earlier version of the parity bill had never cleared even the House.
Revelle is a former Seattle City Council member and former King County
executive. "As long as you make that progress, you are in great shape."
UNDER WASHINGTON law, it is legal for insurers to provide two-tiered
coverage—one for treatment of the body, another for mental health. Under this
system, visits to a doctor or therapist can be limited to as few as six per year. With
conventional wisdom being that regular meetings with a therapist are crucial to any
mental-health treatment, such a limitation doesn't make sense. Moreover, it's not
uncommon for co-payments of upward of $50 per office visit for mental-health
care, compared with $10 for standard medical treatment. Mental-health consumers
also face lesser insurance benefits for prescription coverage and no protection
against catastrophic expenses—the so-called stop-loss provisions enjoyed by other
patients. The current law is devastating for those who can't afford treatment and
for those who are acutely ill, but it also greatly affects people who are not as
impaired—who are fully functional but do best with regular doctor or therapist
visits and ongoing use of medication.
The consensus of scientific opinion in the U.S. is that mental illnesses are, in fact,
physical ones. In 2002, a federal court judge in Washington, D.C., ruled that
bipolar disorder—the second most common mental illness behind depression—
meets the legal definition of a physical illness. Besides being unfair and illogical,
unequal coverage creates disincentives for the mentally ill to get treatment, and
when the mentally ill go untreated, society as a whole suffers, or pays, in one way
or another. HB 1828 states "that the costs of leaving mental disorders untreated or
under-treated are significant, and often include: decreased job productivity, loss of
employment, increased disability costs, deteriorating school performance,
increased use of other health services, treatment delays leading to more costly
treatments, suicide, family breakdown and impoverishment, and
institutionalization, whether in hospitals, juvenile detention, jails, or prisons."
BEGINNING IN THE early 1990s, parity bills were first introduced around the
country. They faced intense opposition from insurance companies and business
associations, who argued that expanded coverage for the mentally ill would raise
health insurance costs and force businesses to offer their employees no health
insurance whatsoever. As it turns out, they were wrong on both counts.
The experience of states with parity laws and of the federal government, which
has insurance parity for federal employees, is that costs barely increase and that
employers don't yank insurance plans, according to the American Psychological
Association. A study of the parity system in Vermont by an insurance actuary
shows that premium costs went down, despite the fact that the mental-health
system was being used by more people. In testimony before the Colorado
Legislature, an official with PacifiCare, a large insurer in Washington, stated that
parity in that state increased costs by $1 to $4 per person per month.
Zarelli didn't know any of this. In an interview, he admitted that he had no idea
how many suicides—the most extreme measure of mental-health care needs—
there were in his district, which covers portions of Clark and Cowlitz counties. In
2002, there were 66, a 38 percent increase over 2001. Nor did Zarelli know that
nationally there has been a more than 30 percent decrease in the teen suicide rate
since the mid-1990s, largely a result of teens' willingness to own up to—and get
treatment for—problems that adults often refuse to grapple with, or can't afford
to. Even former U.S. House Speaker Newt Gingrich, a pre-eminent conservative,
supports mental-health insurance parity.
ZARELLI HAS BEEN a state senator since 1995. The parity bill has been
introduced in the Washington Legislature each year since 1997. His claim not to
know the issue is particularly odd in light of the fact that he voted on a previous
parity bill, on the Senate floor in 2001. He voted "no." If Zarelli didn't make an
informed decision now, presumably he cast an informed vote then.
In 2001, there was organized opposition to the bill from insurance companies and
business groups. Their principal gripes were feared costs and the idea that the new
coverage would be "mandated"—something insurers and business groups can't
stand.
This year, however, there was no organized opposition to HB 1828. Even large
insurers like Group Health Cooperative and Premera Blue Cross were silent,
according to spokespeople for the two companies. Mysteriously, though, there
was silent opposition in the Senate. Take Sen. Linda Evans Parlette, R-
Wenatchee, who is vice chair of the Ways and Means Committee. She also sits on
the Senate's Health and Long-Term Care Committee, which last week forwarded
the parity bill to Zarelli's committee. In 2003, she raised $15,000 in campaign
contributions, $10,875 of that coming from the health care industry. Asked her
thoughts on the bill, Parlette said, "I want to know whether insurance carriers
were involved when the bill was drafted." She added that she was very nervous at
the prospect of the parity bill being heard before Ways and Means without
insurance industry representatives present.
In that kind of environment, it was easy for Zarelli to spike the bill, even though
Parlette and state Sen. Lisa Brown, D-Spokane, both said that there were enough
votes in the Senate to pass the measure.
IN OTHER WORDS, this bill should have passed. The coalition backing mental-
health insurance parity can afford to be sanguine—they've made huge progress,
after all, and expect to get the bill through both houses next year. But each year,
about 800 people kill themselves in Washington. The state's suicide rate was 26
percent above the national average in 2002. There are people who simply do not
have another year to wait.
"It's really disappointing to me that it was held up by political machinations than
by any genuine policy reason," says Brown, who promises to reintroduce the bill
next year. "I don't believe that mental health should be seen as a mandate. It's
more an issue of continuing to discriminate against people." Says Revelle: "It's the
right thing to do—no one argues against that. No one who opposes it has produced
one document or study that disagrees with what we say."
Yet, like others in the coalition, Revelle won't criticize the lack of movement in the
Senate this year. They don't want to poison the bill next year—particularly if
Zarelli still chairs Ways and Means.
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Jon T. Haugen for Senate, 18th District (D)