NATIONAL MENTAL HEALTH PARITY ACT OF 1999 -- HON. FORTNEY PETE STARK
(Extensions of Remarks - July 22, 1999)
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HON. FORTNEY PETE STARK
OF CALIFORNIA
IN THE HOUSE OF REPRESENTATIVES
THURSDAY, JULY 22, 1999
- Mr. STARK. Mr. Speaker, I am proud to join with my colleagues to introduce
the National Mental Health Parity Act of 1999. The goal of this legislation is
to provide parity in insurance coverage of mental illness and improve mental
health services available to Medicare beneficiaries. This legislation will end
the systematic discrimination against those with mental illness and reflect
the many improvements in mental health treatment.
- My legislation would prohibit health plans from imposing treatment
limitations or financial requirements on coverage of mental illness, if they
do not have similar limitations or requirements for the coverage of other
health conditions. The bill also expands Medicare mental health and substance
abuse benefits to include a wider array of settings in which services may be
delivered. Specifically, the legislation would eliminate the current bias in
the law toward delivering services in general hospitals by allowing patients
to receive treatment in a variety of residential and community-based settings.
This transition saves money for the simple reason that community-based
services are far less expensive than hospital services. In addition,
community-based providers can better meet the patient's personal needs.
- Providing access to mental health treatment offers many benefits because
of the significant social costs resulting from mental health and substance
abuse disorders. Treatable mental and addictive disorders exact enormous
social and economic costs, individual suffering, breakup of families, suicide,
crime, violence, homelessness, impaired performance at work and partial or
total disability. Recent estimates indicate that mental and addictive
disorders cost the economy well over $300 billion annually. This includes
productivity losses of $150 billion, health care costs of $70 billion and
other costs (e.g. criminal justice) of $80 billion.
- Two to three percent of the population experience severe mental illness
disorders. As many as 25 percent suffer from milder forms of mental illness,
and approximately one out of ten Americans suffers from alcohol abuse. One out
of thirty Americans suffer from drug abuse.
- Alcohol and drug dependence is not the result of a weak will or a poor
character. In many cases, the dependence results from chemical abnormalities
in the person's brain that makes them prone to dependence. In other cases, the
dependence represents a reaction to unhealthy social and environmental
conditions that perpetuate abuse of alcohol and drugs. Regardless of the cause
of the abuse, alcohol and drug abuse can be treated and allow the person to
live a normal and productive life.
- Mental health disorders are like other health disorders. With appropriate
treatment, some mental health problems can be resolved. Other mental health
conditions, like physical health conditions can persist for decades. Indeed,
there are those who battle mental illness their entire life just as there are
those who suffer from diabetes, congenital birth defects, or long-term
conditions like multiple sclerosis. Whereas insurance policies cover the
chronic health problems, they do not offer the same support for mental health
conditions.
- During the last 104th Congressional session, parity in the treatment of
mental illness was a widely and hotly debated issue. Although parity
legislation was finally developed, insurance carriers found gaping loopholes
and created mental health insurance policies that provide less access to
mental health services. Furthermore, the current parity legislation includes
many exemptions in coverage requirements for small employers. if an employer
has at least 2 but not more than 50 employees, they can be exempt from the
coverage requirement. Finally, if a group health plan experiences an increase
in costs of at least 1 percent, they can be exempted in subsequent years. We
can and must do more for our constituents.
- My proposed legislation addresses two fundamental problems in both public
and private health care coverage of mental illness. First, despite the
prevalence and cost of untreated mental illness, we still lack full parity for
treatment. The availability of treatment, as well as the limits imposed, are
linked to coverage for all medical and surgical benefits. Whatever limitations
exist for those benefits will also apply to mental health benefits.
- Let us not forget the small employers either. If a company qualifies for
the small employer exemption, the insurance companies will be
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able to set different, lower limits on the
scope and duration of care for mental illness compared to other illnesses.
This means that people suffering from depression may get less care and
coverage than those suffering a heart attack. This disparity is
indefensible.
- Access to equitable mental health treatment is essential and can be
offered at a reasonable price. Recent estimates indicate that true parity for
mental health services will increase insurance rates by a mere one percent, a
trivial price to pay for the well being of all Americans.
- Second, the diagnoses and treatment of mental illness and substance abuse
has changed dramatically since the start of Medicare. Treatment options are no
longer limited to large public psychiatric hospitals. The great majority of
people receive treatment on an outpatient basis, recover quickly, and return
to productive lives. Even those who once would have been banished to the back
wards of large institutions can now live successfully in the community.
Unfortunately, the current Medicare benefit package does not reflect the many
changes that have occurred in mental health care. This bill would permit
Medicare to pay for a number of intensive community-based services. These
services are far less expensive than inpatient hospitalization.
- For those who cannot be treated while living in their own homes, this bill
would make several residential treatment alternatives available. These
alternatives include residential detoxification centers, crisis residential
programs, therapeutic family or group treatment homes and residential centers
for substance abuse. Clinicians will no longer be limited to sending their
patients to inpatient hospitals. Treatment can be provided in the specialized
setting best suited to addressing the person's specific problem.
- Currently there is a 190-day lifetime limit for psychiatric hospital
treatment. This limit was originally established primarily in order to contain
costs. in fact, CBO estimates that under modern treatment methods, only about
1.6% of Medicare enrollees hospitalized for mental disorders or substance
abuse used more than 190 days of service over a five year period.
- Under the provisions of this bill, beneficiaries who need inpatient
hospitalization would be admitted to the type of hospital that can best
provide treatment for his or her needs.
- Inpatient hospitalization would be covered for up to 60 days per year. The
average length of hospital stay for mental illness in 1995 for all populations
was 11.5 days. Adolescents averaged 12.2 days; 14.6 for children; 16.6 days
for older adolescents; 8.6 days for the aged and disabled; 9.9 days for
adults. A stay of 30 days or fewer is found in 93.5% of the cases. The 60-day
limit, therefore, would adequately cover inpatient hospitalization for the
vast majority of Medicare beneficiaries, while still providing some modest
cost containment. Restructuring the benefit in this manner will level the
playing field for psychiatric and general hospitals.
- In summary, my legislation is an important step toward providing
comprehensive coverage for mental health. Further leveling the health care
coverage playing field to include mental illness and timely treatment in
appropriate settings will lessen health care costs in the long run. These
provisions will also lessen the social costs of crime, welfare, and lost
productivity to society. This bill will assure that the mental health needs of
all Americans are no longer ignored. I urge my colleagues to join me in
support of this bill.
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