A mental health gap
Even before the pandemic swept through California, a person needing help with depression or a recurring addiction could face a glaring loophole with insurance coverage. Insurers would only cover a few sessions, obliging patients to switch to statepaid MediCal to find care.
Put another way, taxpayers were stuck with the bill when private plans balked. Those looking for help were left scrambling for a new doctor or professional in the switchover. The paper chase and additional worries compounded the stress.
That situation was unconscionable six months ago, but it’s worse now as people agonize over job losses, handle family pressures brought on by school closures, and fret about a precarious future.
Small wonder that 44% of California adults are reporting anxiety and signs of depression, a sharp uptick from past levels. Another study from the federal Centers for Disease Control and Prevention found that a COVIDdarkened future was leading to increased thoughts of suicide among young people, health care and essential workers.
In January, state Sen. Scott Wiener, DSan Francisco, authored a bill, SB855, that would oblige insurers to cover mental health and substance abuse more fully for the 13.4 million people enrolled in stateregulated plans. It was a good idea then, and it’s even a better one now.
The measure so far has progressed through the Legislature by lopsided margins, a sign that lawmakers recognize the problem. It will be up to Gov. Gavin Newsom to sign it into law.
The present rules generally offer coverage when a patient first seeks help or reaches the far gone point described as acute. Under SB855, a doctor could decide that earlier treatment is medically necessary to forestall a crisis, obliging insurers to pay the bill all along the process.
While many plans cover mental health and addiction treatment adequately, the measure goes after a slice of the population who are vulnerable to haphazard coverage. One analysis estimated an extra cost of $3.1 million in the proposed expansion. That’s a fair price for improved care at a critical time.