Pro-corporate bias manifests in key mental health decision – The Ukiah Daily Journal
It is well established that the State Utilities Commission has a major league bias favoring the large companies it regulates over the consumers they serve.
Governor Gavin Newsom’s penchant is also evident in his refusal to seriously penalize companies like Pacific Gas & Electric even after they were repeatedly convicted of manslaughter – killing their own customers.
And the state legislature is so obviously in the pocket of big developers and real estate investors on Wall Street that it insists that cities help them build homes for which there are no assured buyers – accommodations that are often likely to remain vacant or become short-term or corporate rentals. .
But so far, the Ninth Circuit Court of Appeals, the federal court that often oversees California laws, seemed at least somewhat independent.
Yet his new decision in a case involving health insurance companies’ mental health coverage seriously challenges that assumption of integrity.
This case ultimately stems from a 1999 state law called the Mental Health Parity Act, which requires health insurers to cover medically necessary treatment for most mental illnesses, even when previously written insurance policies exclude explicitly such coverage.
This law is particularly critical now, as Newsom pushes a plan to let authorities force homeless mental patients into treatment even if it is against their will. Nobody knows exactly how this could be paid for or realized.
Enter the Ninth Circuit, causing extreme confusion over the matter. In a decision this spring, a panel overturned lower court rulings that forced a major insurer to reconsider its denials in tens of thousands of mental health, addiction and alcohol claims — exactly the kind of treatments that Newsom calls.
The lower court ruling, by Federal Magistrate Judge Joseph Spero of San Francisco, said United Behavioral Health, head of mental health services at giant United Healthcare, acted to “protect its results” via restrictive criteria it had set up to deny claims here and in several other states between 2011 and 2017.
He said company policies do not provide sufficient coverage for treatments that meet generally accepted standards of care.
But the baffling and confusing Ninth Circuit ruling said group plans need not conform to all generally accepted standards of care, but should not conflict with them. Eh?
The appeals court said United Behavioral Health’s policies meet that standard and it follows them in denying coverage for residential and outpatient treatment under plans written for self-insured individuals and employee groups fully insured.
The appeals court decision came despite unified support for the decision from the lower court of the American Medical Assn., the American Psychiatric Assn. and other medical groups.
They took the case because, they said, it could set a precedent for “all insurance companies that offer employer-sponsored health benefits.”
But no matter, the Ninth Circuit said as it appeared to reverse its own 2011 decision in a case where Blue Shield of California tried to suspend mental health coverage. The court then said that Blue Shield was required under state law to provide medically necessary health insurance for mental illnesses, just like treatment for physical conditions.
He cited state legislature findings that mental health coverage limitations “result in inadequate treatment” and cause “untold relapses and suffering” for people with treatable mental illness. .
The Ninth Circuit has now dismissed that earlier work, giving insurance companies apparent license to return to the bad old days of refusing to provide nearly any mental health coverage.
The court’s reasoning here leaves a lot of questions open about the kinds of mental health care companies must provide in California. Obviously, these will not be as extensive in the future as they have been for most of the past 20 years.
The fact that this comes at a time when Newsom’s intended cure for homelessness includes a strong mental health treatment component lends great irony to the image and implies particularly bad timing.
But that should hardly shock anyone, given how long and how much the political and legal apparatus of this state has favored corporations over their customers.
Email Thomas Elias at [email protected] His book, “The Burzynski Breakthrough, The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It” is now available in a fourth edition hardcover. For more Elias columns visit www.californiafocus.net