[Congressional Record Volume 145, Number 90 (Wednesday, June 23, 1999)]
[House]
[Pages H4813-H4815]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             EQUAL ACCESS FOR CHEMICAL DEPENDENCY TREATMENT

  The SPEAKER pro tempore (Mr. Deal of Georgia). Under the Speaker's 
announced policy of January 6, 1999, the gentleman from Minnesota (Mr. 
Ramstad) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. RAMSTAD. Mr. Speaker, every day politicians talk about the goal 
of a drug-free America. Mr. Speaker, let us get real. We will never 
even come close to a drug-free America until we knock down the barriers 
to chemical dependency treatment for the 26 million Americans presently 
addicted to drugs and/or alcohol. That is right, Mr. Speaker. Twenty-
six million American alcoholics and addicts today.
  Mr. Speaker, 150,000 people in America died last year from drug and 
alcohol addiction. In economic terms, alcohol and drug addiction cost 
the American people $246 billion last year alone. That is with a B, 
$246 billion. American taxpayers paid over $150 billion for drug-
related criminal and medical costs alone. That is more than the 
American taxpayers spent on education, transportation, agriculture, 
energy, space, and foreign aid combined; more than in all of those 
areas combined the American taxpayers spent for drug-related criminal 
and medical costs.
  According to the Health Insurance Association of America, each 
delivery of a new baby that is complicated by chemical addiction 
results in an expenditure of $48,000 to $150,000 in maternity care, 
physician's fees, and hospital charges. We also know, Mr. Speaker, that 
65 percent of emergency room visits are alcohol or drug-related.
  The National Center on Addiction and Substance Abuse found that 80 
percent of the 1.7 million men and women in prisons today in this 
country are there because of alcohol and/or drug addiction.
  Another recent study showed, Mr. Speaker, that 85 percent of child 
abuse cases involve a parent who abuses drugs and/or alcohol; 85 
percent of child abuse cases are related to alcohol and drug abuse. 
Seventy percent of all people arrested in this country test positive 
for drugs; two-thirds of all homicides are drug-related.
  Mr. Speaker, I ask the question: how much evidence does Congress need 
that we have a national epidemic of addiction, an epidemic crying out 
for a solution that works; not more cheap political rhetoric, not more 
simplistic quick fixes that obviously are not working. Mr. Speaker, we 
must get to the route cause of addiction and treat it like any other 
disease.
  The American Medical Association in 1956 told Congress and the 
American people that alcoholism and drug addiction are a disease that 
requires treatment to recover. Yet, today in America, only 2 percent of 
the 16 million alcoholics and addicts covered by health plans are able 
to receive adequate treatment; only 2 percent of those with

[[Page H4814]]

insurance for chemical dependency treatment are able to get effective 
treatment.
  That is because of discriminatory caps, artificially high deductibles 
and copayments, limited treatment stays, as well as other restrictions 
on chemical dependency treatment that are not there for other diseases. 
If we are really serious about reducing illegal drug use in America, we 
must address the disease of addiction by putting chemical dependency 
treatment on par with treatment for other diseases. Providing equal 
access to chemical dependency treatment is not only the prescribed 
medical approach, it is also the cost-effective thing to do; it is also 
the cost-effective approach.
  We have all the empirical data, including actuarial studies, to prove 
that parity for chemical dependency treatment will save billions of 
dollars nationally, while not raising premiums more than one-half of 1 
percent in the worst case scenario. It is well documented that every 
dollar spent for chemical dependency treatment saves $7 in health care 
costs, criminal justice costs, and lost productivity from job 
absenteeism, injuries, and subpar work performance. A number of studies 
have shown that health care costs alone are 100 percent higher for 
untreated alcoholics and addicts than for people who have gone through 
treatment; 100 percent higher for those who go untreated.
  Mr. Speaker, as a recovering alcoholic myself, I know firsthand the 
value of treatment, and as a grateful recovering alcoholic for 18 
years, I am absolutely alarmed by the dwindling access to treatment for 
people who need it. In fact, over the last decade in America, 50 
percent of the treatment beds for adults are gone. Even more alarming, 
60 percent of the treatment beds for adolescents are gone.
  Mr. Speaker, we must act now to reverse this alarming trend. We must 
act now to provide greater access to chemical dependency treatment.
  That is why I have introduced the Harold Hughes, Bill Emerson 
Substance Abuse Treatment Parity Act named for two departed colleagues, 
one Democrat, one Republican, who did so much in this field of 
addiction; so much to raise public awareness, so much to help people in 
need, people who are suffering the ravages of drug and alcohol abuse. 
This is the same bill, Mr. Speaker, by the way, that last year had the 
broad bipartisan support of 95 House cosponsors.
  This legislation would provide access to treatment by prohibiting 
discrimination against the disease of addiction. The bill prohibits 
discriminatory caps, prohibits higher deductibles and copayments that 
exist for treatment of other diseases. It also prohibits limited 
treatment stays and other restrictions on chemical dependency treatment 
that are different from other diseases. All we are saying, Mr. Speaker, 
is treat chemical addiction like other diseases.
  Mr. Speaker, this is not another mandate. It does not require any 
health plan which does not already cover chemical dependency treatment 
to provide such coverage. It merely says that those which offer 
chemical dependency coverage cannot discriminate, cannot treat chemical 
dependency different from coverage for medical or surgical services for 
other diseases. In addition, the legislation waives the parity for 
substance abuse treatment if premiums increase by more than 1 percent, 
and it also exempts small businesses with 50 or fewer employees.
  Mr. Speaker, it is truly the time to knock down the barriers to 
chemical dependency treatment. It is time to end discrimination against 
people with addiction. It is time to provide access to treatment, to 
deal with America's number 1 public health and public safety problem.
  We can deal with this epidemic now or be forced to deal with it 
later. But, this problem, this epidemic will only get worse if we 
continue to allow discrimination against the disease of addiction.
  As last year's television documentary by Bill Moyers pointed out, 
medical experts and treatment professionals agree that providing access 
to chemical dependency treatment is the only way to combat addiction in 
America.
  We can build all the fences on our borders, we can build all of the 
prison cells that money can buy, we can hire thousands of new border 
guards, thousands of new drug enforcement officers, but simply dealing 
with the supply side of this problem will never solve it.
  That is because, Mr. Speaker, our Nation's supply-side emphasis does 
not adequately attack the underlying problem. The problem is more than 
illegal drugs coming into our Nation, coming across our borders. The 
problem is more than that. The problem is the addiction that causes 
people to crave and demand those drugs.

                              {time}  1915

  That is the problem, the addiction that causes people to crave drugs 
and to demand those drugs. So we need more than simply tough 
enforcement and interdiction. We need extensive education, and we need 
access to treatment.
  Drug czar Barry McCaffrey understands. He said recently, and I am 
quoting, ``Chemical dependency treatment is more effective than cancer 
treatment, and it is cheaper.'' General McCaffrey also said, ``We need 
to redouble our efforts to ensure that quality treatment is 
available.'' Mr. Speaker, the director of our National Office of Drug 
Policy is right. All the studies back him up. Treatment does work, and 
treatment is cost-effective.
  Last September the first national study of chemical dependency 
treatment results confirmed that illegal drug and alcohol use are 
substantially reduced following treatment. This study by the Substance 
Abuse and Mental Health Services Administration shows that treatment 
rebuilds lives, puts families back together, and restores substance 
abusers to productivity.
  According to Dr. Ronald Smith, United States Navy Captain in the 
Medical Corps, and also Dr. Smith was formerly vice chairman of 
psychiatry at the National Naval Medical Center at Bethesda, Dr. Smith 
says ``The U.S. Navy substance abuse program works. It has an overall 
recovery rate of 75 percent.''
  The Journal of the American Medical Association on April 15 of last 
year reported that a major review of more than 600 research articles 
and original data conclusively showed that addiction conforms to the 
common expectations for chronic illness, and addiction treatment has 
outcomes comparable to other chronic conditions, outcomes comparable to 
other chronic conditions.
  The same study by the American Medical Association said that 
``Relapse rates for treatment for drug and alcohol addiction are 40 
percent,'' relapse rates. That compares favorably with those for three 
other chronic disorders: adult onset diabetes, 50 percent; 
hypertension, 30 percent; and adult asthma, 30 percent.
  A March 1998 GAO report also surveyed the various studies on the 
effectiveness of chemical dependency treatment and concluded that 
treatment is effective and beneficial in the majority of cases. A 
number of State studies have also been done that showed treatment is 
cost-effective and good preventative medicine.
  A Minnesota study, a study in my home State, Mr. Speaker, extensively 
evaluated the effectiveness of its treatment programs and found that 
Minnesota saves $22 million in annual health care costs because of our 
treatment programs, $22 million in the State of Minnesota alone saved 
because of treatment programs. A California study reported a 17 percent 
improvement in other health conditions following treatment, and 
dramatic decreases in hospitalization.
  A New Jersey study by Rutgers University found that untreated 
alcoholics incur general health care costs 100 percent higher than 
those like me who have received treatment. So the cost savings and the 
effectiveness of chemical dependency treatment are well documented.
  But putting the huge cost savings aside for a minute, Mr. Speaker, 
what will treatment parity cost? That is a question that is asked by a 
number of people. First, there is no cost to the Federal budget. Parity 
does not apply to the Federal Employees Health Benefit Plan, does not 
apply to Medicare or Medicaid.
  According to a national research study that based projected costs on 
data from States which already have chemical dependency treatment 
parity, the average premium increase due to

[[Page H4815]]

full parity it would be two-tenths of 1 percent, that is from a 
Mathematica Policy Research study in March of 1998, a two-tenths of 1 
percent increase in premiums for policyholders.
  A recently published Rand study by the Rand Corporation found that 
removing an annual limit of $10,000 a year on substance abuse care will 
increase insurance payments by 6 cents per member per year, 6 cents per 
member per year. Removing a limit of $1,000 increases payments by only 
$3.40 a year, or 29 cents a month.
  The worst case scenario we could find, the study that showed the 
worst case scenario, estimated the cost would be five-tenths of 1 
percent increase in premiums per month, which translates to 66 cents a 
month per insured.
  So the bottom line, Mr. Speaker, for the cost of a cup of coffee per 
month we can treat 16 million Americans addicted to drugs and/or 
alcohol today, for the cost of a cup of coffee per month to the 113 
million Americans covered by health plans. At the same time, Mr. 
Speaker, the American people would realize $5.4 billion in cost savings 
from treatment parity, according to a recent California study.
  So we could treat these 16 million American alcoholics and addicts 
who are addicted today, who are hooked today on alcohol and/or drugs. 
For the price of a cup of coffee we can treat 16 million Americans, and 
we can save in the process $5.4 billion to the American taxpayers.
  United States companies that provide treatment have already achieved 
substantial savings. Chevron, for example, reports saving $10 for every 
$1 it spends on treatment. GPU saves $6 for every $1 spent. United 
Airlines reports a $17 return, a $17 return for every dollar spent on 
treatment by United Airlines.
  Mr. Speaker, no dollar value can quantify the impact that greater 
access to treatment will have on people who are addicted and their 
families. No dollar value can measure the impact on spouses, children, 
other family members who have been affected by the ravages of 
addiction. Broken families, shattered lives, broken dreams, ruined 
careers, messed up kids, children on Ritalin, divorces, I could go on 
and on with the human impact of the ravages of this epidemic that has 
swept our Nation. How can we put a dollar cost on those horrible 
factors, those horrible results of addiction?
  Mr. Speaker, this is not just another public policy issue. This is a 
life or death issue for 16 million Americans and their families, 16 
million Americans who are chemically dependent covered by health 
insurance but unable to access treatment.
  We know one thing for sure, Mr. Speaker. Treatment taught me that 
addiction, if not treated, is fatal. This is a fatal disease if not 
treated. Last year 95 House Members from both sides came together in a 
bipartisan way to support and cosponsor this substance abuse treatment 
parity legislation. This year let us knock down the barriers to 
treatment for 16 million Americans. This year let us do the right thing 
and the cost-effective thing and provide access to treatment. This year 
let us pass substance abuse treatment parity legislation to deal with 
the epidemic of addiction in America.
  Mr. Speaker, the American people cannot afford to wait any longer. I 
urge all Members to cosponsor H.R. 1977, the Substance Abuse Treatment 
Parity Act of 1999. I ask my fellow recovering alcoholics and addicts, 
all 2 million of them, to write their Members of Congress, their Member 
of the House, their United States Senators, and urge them to cosponsor 
this treatment parity bill, H.R. 1977, the Substance Abuse Treatment 
Parity Act. That is H.R. 1977.
  We need to mobilize the recovering community, we need to mobilize 
concerned people throughout America to pass this life and death 
legislation.
  Finally, Mr. Speaker, I ask the loved ones of those still suffering 
the ravages of addiction and chemically dependent people themselves who 
are unable to access treatment to contact their United States Senators 
tomorrow, contact their United States representatives tomorrow, and 
urge them to cosponsor H.R. 1977, 1977, the Substance Abuse Treatment 
Parity Act.
  Working together, Mr. Speaker, as Americans, as Members of Congress, 
working together we will knock down those barriers to treatment. We 
will provide access to treatment for those people suffering the ravages 
of addiction. We will, Mr. Speaker, get this done, but only only if the 
American people demand it. I hope and pray that the responses are there 
and that Congress wakes up to the need to deal with addiction, and this 
year passes the Substance Abuse Treatment Parity Act.

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