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Congressional Testimony
May 18, 2000, Thursday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 2947 words
HEADLINE:
TESTIMONY May 18, 2000 PAUL D. WELLSTONE SENATOR SENATE HEALTH,
EDUCATION, LABOR & PENSIONS MENTAL HEALTH PARITY
BODY:
Thursday, May 18, 2000 SENATOR PAUL D.
WELLSTONE TESTIMONY Senate Hearing on Mental Health Treatment
Parity Senate Committee on Health, Education,
Labor, and Pensions Mr. Chairman, I want to thank you for the opportunity to
speak to the committee this morning on an extremely critical
health issue facing millions of Americans -
parity for the treatment of mental illness.
Last April, along with Senator Domenici, I introduced legislation, the
Mental Health Equitable Treatment Act (MHETA, S. 796) that will
help ensure that private health insurance companies provide the
same level of coverage for mental illness as they do for other
diseases. This bill will be a major step toward ending the persistent
discrimination against people who suffer from mental illness.
Today, you will hear powerful testimony about how badly this treatment coverage
is needed, how mental illness has affected the lives of so many
Americans throughout our country, and how the costs for such treatment are very
low. For too long, mental illness has been stigmatized, or
viewed as a character flaw, rather than as the serious disease that it is. A
cloak of secrecy has surrounded this disease, and people with
mental illness are often ashamed and afraid to seek treatment,
for fear that they will be seen as admitting a weakness in character. We have
all seen portrayals of mentally ill people as somehow different, as dangerous,
or as frightening. Such stereotypes only reinforce the biases against people
with mental illness. Can you imagine this type of portrayal of
someone who has cancer, heart disease, or diabetes? Although mental
health research has made many advances in establishing the biological,
genetic, and behavioral components of many of the forms of serious
mental illness, the illness is still stigmatized as somehow
less important or serious than other illnesses. Too often, we try to push the
problem away, deny coverage, or blame those with the illness for having the
illness. We forget that someone with mental illness can look
just like the person who is sitting next to us on a plane or working with us in
our office. It can be our brother, our daughter, our father, our mother, our
friend. It can be ourselves. We have all known someone with a serious
mental illness, within our families or our circle of friends,
or in public life. Many people have courageously come forward to speak about
their personal experiences with their illness, to help us all understand better
the effects of this illness on a person's life, and I commend them for their
courage. The statistics concerning mental illness, and the
state of health care coverage for adults and children with this
disease are startling, and disturbing. The current estimate is that about 20
percent of the U.S. adult population are affected by mental
disorders during a given year, and although the research on children is not as
well-documented, the percentage of children affected by mental
or emotional disorders appears to be very similar, at 20 percent, with 9%
severely affected. One severe mental illness affecting millions
of Americans is major depression. The National Institute of Mental
Health, a NIH research institute within the U.S. Department of
Health and Human Services, describes serious depression as a
critical public health problem.. More than 18 million people in
the United States will suffer from a depressive illness this year, and many will
be unnecessarily incapacitated for weeks or months, because their illness goes
untreated. Depressive disorders are not the normal ups and downs everyone
experiences. They are not just "the blues." They are illnesses that affect mood,
body, behavior, and mind. Depressive disorders interfere with individual and
family functioning. Without treatment, the person with a depressive disorder is
often unable to fulfill the responsibilities of spouse or parent, worker or
employer, friend or neighbor. Without treatment, a person can die. Available
medications and psychological treatments, alone or in combination, can help 80
percent of those with depression. But without adequate treatment, future
episodes of depression may continue or worsen in severity. Yet, the steady
decline in the quality and breadth of health care coverage is
truly disturbing. We know from the recent Surgeon General's Report on
Mental Health that the costs of mental illness
in our country are very high. The direct costs of mental health
services (i.e., spending for treatment and rehabilitation) in the United States
in 1996 totaled $69.0 billion. This figure represents 7.3 percent of total
health spending. We know too that when economists calculate the
costs of an illness, they also strive to identify indirect costs, such as lost
productivity at the workplace, schooL and home due to premature death or
disability. The 1990 indirect costs of mental illness were
estimated in the Surgeon General's Report to be $78.6 billion. The suffering of
people with mental illness and their families because of broken
lives, broken dreams, and the financial devastation that can result is
immeasurable. The results of a major survey of employer-provided
health plans was published in 1998 by the Hay Group, an
independent benefits consulting firm. The Hay Report showed a major decline in
benefits in the last decade. Employer-provided mental health
benefits decreased 54% and the number of plans restricting hospitalization for
mental disorders increased by 20%. Descriptions of benefit
limits themselves are often misleading. Although some plans may say that they
allow 30 days for hospitalization, this is rarely approved. In 1996, the average
length of stay was 8 and V2days, down from 17 in 1991. In 1988, most insurance
plans allowed 50 therapy sessions per year. In 1997, the average number was 20.
Clearly, people with mental illness are having fewer and fewer
opportunities to receive appropriate medical care. Opponents of mental
health parity often mention cost. No one, of course, expects coverage
of any illness to cost nothing. But what we do know is that fears of spiraling
costs for mental health treatment are unfounded. Recent studies
from HHS that have examined the effects of mental health and
substance abuse treatment parity have shown that full
parity for these benefits would be just slightly higher than
current premiums. Most reports, like the one requested by Congress from the
National Advisory Mental Health Counsel, showed that when
mental health coverage is managed, either moderately or
tightly, premium increases can be as low as I%. These costs are so low. And the
cost of NOT treating is so high - - especially when one looks at the toll that
untreated mental illness takes on individuals, families,
employers, corporations, social service systems, and criminal justice systems. I
have seen firsthand in the juvenile corrections system what happens when
mental illness is criminalized, when youth with
mental illness are incarcerated for exhibiting symptoms of
their illness. To treat ill people as criminals is outrageous and immoral. We
must make treatment for this illness as available and as routine as treatment
for any other disease. The discrimination must stop. Our bill includes
parity for hospital day and outpatient visits for all
mental illnesses. Additionally, for many of the most severe
adult and child mental illnesses, the bill establishes full
parity, i.e., parity for copayments, deductibles, hospital day,
and outpatient visit benefits. I believed it was particularly important that for
the illnesses covered through this benefit that we include as many childhood
illnesses as we could. The bill also provides protection for non- physician
providers, and for states with stronger parity bills; includes
a small business exemption, and eliminates the sunset provision and the I%
exemption from the 1996 Mental Health Parity Act. Covered
services include inpatient treatment; non-hospital residential treatment;
outpatient treatment,, including screening and assessment, medication
management, individual, group and family counseling; and prevention services,
including health education and individual and group counseling
to encourage the reduction of risk factors for mental illness.
The Mental Health Equitable Treatment Act of 1999 provides for
major improvements in coverage for mental illness by private
health insurers. It does not require that mental
health benefits be part of a health benefits package,
but establishes a requirement for parity in coverage. for those
plans that offer mental health benefits. This bill goes a long
way toward our bipartisan goal: that mental illness be treated
like any other disease in health care coverage. We know from
the GAO study released today that this new law is absolutely necessary. The
study shows that employers freely acknowledge that they have taken many steps to
further restrict access to mental health treatment, either
through limitations on services or by increasing cost-sharing. The movement for
parity for treatment for mental illness is
growing. Over the past few years, the principle of parity in
insurance coverage for mental health treatment has received the
strong support of the White House and the Surgeon General, and many leading
figures in medicine, business, government, journalism, and entertainment who
have suffered from mental illness and have been successfully
treated. Federal employees will soon be entitled to fill mental
health and substance abuse treatment parity. The mental
health legislation on the Hill has frequently highlighted the recent
major advances in scientific information about the disease; the biological
causes or consequences of mental illness; the effectiveness and
low cost of treatment; and many painful, personal stories of people, including
children, who have been denied treatment. In addition to federal
parity legislation, 31 of our states have passed some form of
mental health or substance abuse treatment
parity. We do not discriminate against other illnesses where
the brain is affected; why do we continue to discriminate against
mental illness? It is time for the federal government to enact
legislation that will help move us toward full parity for
mental illness. The important thing to remember is that we
cannot wait any longer for mental health treatment
parity in our country. Mental illness is a
real illness, and to fail to provide treatment for those suffering from this
disease is costly and life-threatening. We need to do more to help. This hearing
today is an important step to making sure we change the laws, the attitudes, and
the practices in our society that lead to this discrimination. But it is only a
modest first step. The 1996 Mental Health Parity law was a
groundbreaking federal law that sent the message loud and clear that we will not
tolerate the exclusion of those with mental illness from our
health care system. A critical next step is enactment this year
of this new bill, the Mental Health Equitable Treatment Act of
1999, which is designed to take an even larger step toward ending the suffering
of those with mental illness who have been unfairly
discriminated against in their health coverage. I hope the
Senate will move forward quickly on this bill, and get it enacted into law
before the end of this Congress.
LOAD-DATE: May 26,
2000, Friday 
