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A few months ago, the nation's largest state was on track to enact a bill that would have guaranteed its citizens the same insurance coverage for their mental disorders as they now receive for their physical illnesses. With a stroke of his veto pen, however, the governor derailed the work that legislators and advocates for the mentally ill had spent years constructing.
Governor Pete Wilson (R) vetoed the bill on September 28 and was immediately condemned by the bill's many supporters for caving in to the insurance industry, which had lobbied vigorously against the parity legislation (Psychiatric News, August 7).
The bill mandated insurance parity for seven "biologically based" mental illnesses-schizophrenia, schizoaffective disorder, bipolar disorder, major depression, panic disorder, obsessive-compulsive disorder, and pervasive developmental disorder or autism. The legislation imposed parity on annual and lifetime dollar caps, physician visits, and prescription costs.
With a statewide survey having indicated that 90 percent of Californians support the concept of parity for mental illness coverage and strong backing from lawmakers and advocacy groups, supporters were enthusiastic that this major step in ending discrimination against people with mental illnesses was on its way to becoming reality. Psychiatrists and other parity advocates were also banking on the prospect that a California law would, as is the case with so many incipient trends, spread its antistigma message throughout the country. Only 19 states have some form of parity legislation, most of them quite limited.
Wilson justified his veto by insisting, "While such mandates may be desirable when reviewed individually, their collective costs are substantial and contribute to the rising costs of health insurance coverage."
He maintained that any increase in insurance costs would soon lead to even more Californians choosing or being forced to go without health care coverage. He cited a study by Californians for Affordable Health Reform concluding that "for every 1 percent increase in insurance premium costs, up to 40,000 Californians will lose health care coverage."
He also dismissed as a misrepresentation of "the facts" the claim by the bill's authors that mental health parity would add only $1 a year to health insurance premiums. "Change of this magnitude should be made incrementally," Wilson said, "as we learn more about the impact of this type of legislation on the number of uninsured."
After Wilson's veto, Laurie Flynn, executive director of the National Alliance on Mental Illness, expressed the views of supporters who had dared to get their hopes up. "The only thing greater than our anger over Governor Wilson's veto is our immense sadness," she said. "With the stroke of a pen, he has allowed insurance policies to continue blocking access to lifesaving treatment for thousands of Californians with mental illnesses. Our loved ones will continue suffering as a result of the governor's cozy relationship with the well-healed executives of the insurance industry."
One of the bill's authors, Assembly member Helen Thomson, accused Wilson of choosing "the low road." Noting how often she and the bill's other sponsors compromised its language to accommodate the governor's objections, she angrily concluded that Wilson decided to believe "industry gobbledygook over medical science and sound independent economic analysis."
Thomson pointed out that contrary to Wilson's conclusion that parity mandates would increase the rolls of the uninsured, her bill would in fact "increase access to affordable, comprehensive coverage for severe mental illnesses, which is unavailable now in California."
Instead of a system that allows insurers to charge whatever they want for their limited mental health coverage, Thomson stressed that the California parity bill "would make all insurers and HMOs carry the risk, which would reduce the cost, allowing greater access to more comprehensive coverage" for the mental illnesses covered by the bill.
Another of the bill's supporters, Assembly member Jack Scott of Pasadena, said after Wilson's veto that he was sure "that people will look back on the 20th century and see. . .our failure to recognize mental illness and to treat mental illness as we should."
One of the strongest condemnation's of the governor's action came from the San Jose Mercury News. An editorial in the October 1 issue charged that Wilson's veto reflected "a medieval mind-set" and called his decision "prejudiced, shortsighted, and cruel."
Thomson, who is married to psychiatrist Captane Thomson, M.D., vowed to reintroduce a parity bill next year and promised that it would be "even stronger."
The final version of the bill Wilson vetoed, along with related discussions and amendments, can be found at the state senate's Web site,