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U. S. Senate Committee Conducts Hearing on Parity; GAO
Reports on Employer Compliance with 1996 Federal Law
NAMI Member Dr. Ken Duckworth Testifies at the
Hearing | For Immediate
Release, May 19, 2000 Contact: Chris
Marshall 703-524-7600
On Thursday, May 18, 2000, the U.S. Senate Committee on Health,
Education, Labor, and Pensions (HELP) conducted a public hearing on
the Mental Health Parity Act of 1996. The 1996 act expires September
30, 2001, unless reauthorized by the Congress. Testifying at the
hearing was Ken Duckworth, M.D., NAMI member, NAMI volunteer, and a
past recipient of NAMI's exemplary psychiatrist award. Dr.
Duckworth, a community mental health psychiatrist and member of the
faculty at Harvard University, will shortly become the Deputy
Commissioner in the Massachusetts Department of Mental Health.
Convening the hearing was HELP Chair Senator James Jeffords
(R-VT). Testifying at the hearing and then staying for the remainder
of the forum was Senator Paul Wellstone (D-MN). Others attending the
hearing were Senators Chris Dodd (D-CT), Edward Kennedy (D-MA), and
Jack Reed (D-RI). Senator Pete Domenici (R-NM), scheduled to
testify, was ill and not available.
Senators Domenici and Wellstone are primary sponsors of S. 796,
the Mental Health Equitable Treatment Act. S. 796 would require full
insurance parity for schizophrenia, bipolar disorder (manic
depression), obsessive-complusive disorder, panic disorder,
post-traumatic stress disorder, autism, and other severe and
disabling illnesses such as anorexia nervosa and
attention-deficit/hyperactivity disorder. Further, no health plan
may use day and visit limits for mental illness which are different
than physical illnesses.
Attached at the end of this e-news is NAMI's press statement
handed out at the hearing. NAMI "supports S. 796, the Mental Health
Treatment Act, and recognizes the progress that today's hearing"
makes.
Though unable to attend the hearing, Senator Domenici's press
statement declared that "the Mental Health Parity Act of 1996 was a
good first start, but that law is not working as intended." Further,
"Senator Domenici welcomed the conclusions of a new General
Accounting Office (GAO) study released at the hearing confirming
that employer compliance with the 1996 law is not driving up
insurance costs."
GAO summarized the results from its May 2000 report, "Mental
Health Parity Act: Despite New Federal Standards, Mental Health
Benefits Remain Limited" (GAO/HEHS-00-95). Testifying on behalf of
GAO was Associate Director for Health Financing and Public Health
Issues Kathryn Allen. GAO's web site is www.gao.gov. GAO's findings
were:
1. Costs associated with the Mental Health Parity Act of 1996
were "negligible for most health plans" with only 3% of employers
reporting an increase in costs.
2. 14% of employers are not complying with the 1996 act. This
does not include small employers, 50 or fewer employees, that are
exempt from the 1996 law. Further, GAO did not find significant
differences in the rate of employer noncompliance based on
characteristics such as employer size, industry or geographic
region, or whether the plan was fully insured or self-funded.
3. 87% of employers complying with the 1996 act restrict mental
health benefits to a greater extent than medical and surgical
benefits.
4. Only 5 employers in the nation dropped mental health
coverage as a result of the 1996 act.
5. The Administration relies on complaints for monitoring
compliance. Though 24 states may not be fully implementing the
1996 act, 3 states are not complying at all. The GAO report
identifies the 24 states, but not the 3.
Also testifying at the hearing was Dr. Steven Hyman, Director,
National Institute of Mental Health. Dr. Hyman testified about the
science of diagnosis and treatment of mental illness, about the
impact of youth suicide, about the genetic basis of some illnesses,
and the direct medical and disability cost offsets associated with
treatment of depression. Dr. Hyman observed that there is no
scientific reason that a health plan should cover Parkinson's
disease but not schizophrenia, for both are chronic and not yet
curable diseases that affect dopamine systems in the brain.
Senators' questions to Dr. Hyman and Ms. Allen were the impact of
managed care, the restrictions used by employers, the Health Care
Financing Administration's slow rate of implementation,
reimbursement rates of professionals, motivations other than cost,
the problem faced by persons with co-occurring mental and addictive
disorders, early intervention techniques with children, the day in
the future when mental illnesses can be explained by biology and
neurology, the attitudes of employers, the definition of full
parity, the reliance on medication and relationship to behavioral
interventions, the importance of investing resources in the
treatment of mental illness, experience with state enacted parity,
characteristics of non-complying employers, the over-use of
medications in young children, the interface between special
education and parity, and school violence and environmental
influences.
The last witness panel testifying at the hearing were a
representative of Delta Airlines who emphasized why they have a
parity mental health benefit program, a representative of the Health
Insurance Association of America (HIAA) who opposed any parity
requirements, NAMI member Dr. Ken Duckworth, and Dr. Ken Libertoff,
Ph.D., Vermont Association for Mental Health. Dr. Libertoff
emphasized that he is a member of the National Mental Health
Association (NMHA) and that NMHA "shares the values and public
policy goals reflected in my statement." Dr. Libertoff emphasized
that "this is a fight for civil rights, not insurance" and that "a
comprehensive approach is the only approach." He declared that
"anything less than full parity (such as only serious mental illness
or brain disorders) continues partial discrimination." Laws that
focus only on serious mental illness or brain disorders are
"fundamental civil rights barriers." The Vermont parity law is full
parity for all persons seeking mental health and substance abuse
services.
Senator Jeffords asked "what is the most reasonable approach to
parity?" Dr. Libertoff replied that "partial parity is foolish" as
most of the costs of parity are for serious mental illnesses. Dr.
Duckworth replied that "though the Vermont comprehensive parity law
is laudable, the perfect is often the enemy of the good. There is
gross discrimination against catastrophic and severe mental
illness....The Domenici-Wellstone bill is a substantial step
forward."
The hearing ended with Senator Wellstone explaining that his
objective is to make an important step forward which has a realistic
chance of passage. Senator Wellstone stressed again that the
Domenici-Wellstone legislation (S. 796) would require full parity
for severe and disabling mental illnesses and prohibit the use of
day and visit limits for all mental illnesses. Senator Wellstone
asked Dr. Duckworth: "Is this (S. 796) an important step forward?"
NAMI member Dr. Duckworth replied "yes." Senator Wellstone then
asked Dr. Libertoff the same question. Dr. Libertoff, the NMHA
member, replied that "It would be a step side-ways." Senator
Wellstone replied to Dr. Libertoff: "so, if we can't make it 100%
perfect, all these people will have to do without any protection
because we failed politically. Persons with mental illnesses may not
accept this."
NAMI's press statement, which follows, declares NAMI "supports S.
796, the Mental Health Equitable Treatment Act, and recognizes the
progress that today's hearing" makes. Likewise, the NMHA press
statement stated that "Legislation from Senators Paul Wellstone
(D-MN) and Pete Domenici (R-NM), S. 796, is a step toward parity
between mental and physical health treatments. NMHA and its 340
affilates will actively campaign for its passage." NAMI's statement
follows.
NAMI Supports
Domenici-Wellstone Bill For Full Insurance Coverage For Severe
Mental Illnesses
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