Mental Health Bill’s High Stakes--in Purses, Politics

As her son was hospitalized again and again, trapped in the grip of a severe mental illness, Sharon Fountain of Buena Park found herself caught too--with $145,000 in medical bills.

Four years ago, Fountain lost her home of 30 years and a rental property to lenders. Then she declared bankruptcy. “I was left homeless and penniless,” said Fountain, 58, who blames her insurance company, which would not cover treatment for her son’s illness.

In the wake of the state Senate’s June 11 passage of legislation requiring health insurance companies to cover severe mental illnesses, those most affected by the lack of coverage hailed it as perhaps the most significant piece of health legislation ever approved.

While it is too late to help Fountain, she said it could save others from sharing her misery. Mental illness affects one in four Orange County families, and experts estimate that up to 64,000 residents here suffer from some mental disability, although many often go undiagnosed.

County mental health advocates estimate that at least 60% of the clients they serve are not covered by insurance. Instead, the public pays for treatment, often after patients and their families have faced financial disaster, say those who support the bill.

However, its fate remains uncertain because Gov. Pete Wilson objects to provisions he contends could create a hardship for employers and insurers, such as the bill’s requirement that insurers provide unlimited hospitalization coverage.

Proponents are attempting to hammer out a compromise, but both sides disagree on many points. Opponents of the bill, including some business and insurance groups, say the measure could raise insurance premiums as much as 11%, while supporters say it is likely to cause only a 1% increase.

Mental health advocates further argue that the bill could ultimately save money, and get people the medical treatment they need.

“First, people have to lose everything they have, and then the public pays not only for mental health treatment but sometimes housing, rehabilitation and all sorts of other costs,” said Chad Costello, director of programs for the county’s Mental Health Assn.

Fountain says there’s a double standard for the mentally ill. Alzheimer’s and Parkinson’s diseases, for example, are covered by many insurance policies and are considered biological diseases, similar to many mental illnesses. “Yet we are discriminated against in our coverage,” Fountain said.

Under the new bill, seven disorders would be covered, including schizophrenia and severe depression.

In 1994, Fountain said, her insurance plan allowed 20 therapy sessions a year and limited hospitalization. She said her son required more lengthy hospital stays than covered by insurance and was repeatedly released early, while still ill.

She said she had no choice but to declare him indigent so he could become eligible to receive mental health care through the county.

“It’s a painful thing . . . to declare that this person has nobody who cares about him,” Fountain said. “But I didn’t have the money, and I was going to get him help one way or another.”

The California Chamber of Commerce is against the bill, but does not take a position on whether insurance should cover the mentally ill. The chamber opposes any state mandate rigidly dictating what employers must do, said Fred Main, senior vice president of the organization.

Many large employers already provide mental health coverage, said Main, who predicted that a mandate will increase costs so much that fewer employers will be able to offer such coverage, and fewer employees will be able to purchase it.

Many insurers are also opposed to the bill, although they note that if they are pushed to provide coverage, the cost will be passed on to employers.

“It’s a burden on employers and individuals,” said Maureen O’Haren of the California Assn. of Health Plans, which represents insurance companies in the state. “It’s not our economic burden because we just basically pass it on to employers.”

While opponents say it is the middle-class workers who are likely to suffer, supporters say such employees are already suffering.

Mary Fosnight, a staff member at the Mental Health Assn.’s Garden Grove facility, puts herself in this category. Like Fountain, Fosnight’s bout with manic depression eventually wiped out her assets.

“I had tried to kill myself, and I overdosed and ended up in the hospital,” said Fosnight, who did not have insurance to cover her medical costs. “I was there for three days and the bill came to $8,000.”

She was forced to sell her three-bedroom Huntington Beach home to pay her bills. She now lives in Costa Mesa, and the county pays for most of her medication. But recently, her doctor prescribed a medication that costs $7 a pill and is not covered by the county.

This new medication has had a remarkable impact: Within weeks, signs of creeping anxiety have dissipated. She is smiling, more at ease. But there is still concern.

“My doctor gave me some samples, but I don’t have $210 a month to pay for these pills,” she said. “I don’t know what I’ll do when they run out.”