Providing more mental health care will be costly. The bill for health care reform is expected to be in the hundreds of billions of dollars. Premiums could rise 1 percent to 3 percent for everyone if basic mental health benefits were mandated, and more for fuller coverage, according to the Council for Affordable Health Insurance, which represents small insurance companies.
"You'll probably run into people like the guy at Joe's Auto Body who makes $9 an hour and can't afford that," said J.P. Wieske, the council's director of state affairs. "That's the rub. You increase the comprehensiveness, and you probably make it unaffordable."
But there are costs now, advocates say. Mental health disorders and addiction cost U.S. businesses $171 billion a year in lost productivity, according to estimates from the Campaign for Mental Health Reform, an umbrella group for mental health advocates. That doesn't count costs to the criminal justice system, nonprofit groups and other public providers - or costs to society, advocates say.
When problems are left to linger, they only get worse, according to Mental Health America, a mental health and education association. People with mental health problems typically die 25 years earlier than the general population because they often have other untreated conditions such as diabetes, heart disease or cancer. Half the people with a mental health diagnosis have problems by age 14 but do not get treatment for a decade, leaving them less able to study and work, the group says.
The goal for mental health advocates is to go beyond basic coverage for the uninsured and attain parity with medical coverage. Those with mental health insurance now typically pay higher deductibles, pay more for drugs and are allowed fewer services, such as days spent in the hospital, said Kirsten Beronio, Mental Health America's vice president of public policy and advocacy. That will change in the coming months for some, however, because a law passed last year requires insurers that offer mental health coverage now to provide benefits on par with their medical coverage.
"We've battled discrimination for so long," she said. "We want to build on our progress and not go backward."
The major House version of the health care overhaul bill would require behavioral and addiction coverage on par with medical coverage for just about everyone. On the Senate side, the two major bills exempt smaller employers from providing coverage and one exempts some larger employers, too.