[Congressional Record Volume 146, Number 125 (Tuesday, October 10, 2000)]
[Extensions of Remarks]
[Pages E1733-E1734]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             MEDICARE MENTAL ILLNESS NON-DISCRIMINATION ACT

                                 ______
                                 

                           HON. MARGE ROUKEMA

                             of new jersey

                    in the house of representatives

                       Tuesday, October 10, 2000

  Mrs. ROUKEMA. Mr. Speaker, I am today introducing the Medicare Mental 
Illness Non-Discrimination Act, legislation to end the historic 
discrimination against Medicare beneficiaries seeking outpatient 
treatment for mental illness. Under the current Medicare statute, 
patients are required to pay a 20 percent copayment for Part B 
services. However, the 20 percent copayment is not the standard for 
outpatient psychotherapy services. For these services, Section 1833(c) 
of the Social Security Act requires patients to pay an effective 
discriminatory copayment of 50 percent.
  Let me say this again: If a Medicare patient has an office visit to 
an endocrinologist for treatment for diabetes, or an oncologist for 
cancer treatment, or a cardiologist for heart disease, or an internist 
for the flu, the copayment is 20 percent. But if a Medicare patient has 
an office visit to a psychiatrist or other physician for treatment for 
major depression, bipolar disorder, schizophrenia, or any other illness 
diagnosed as a mental illness, the copayment for the outpatient visit 
for treatment of the mental illness is 50 percent. The same 
discriminatory copayment is applied to qualified services by a clinical 
psychologist or clinical social worker. This is quite simply 
discrimination. It is time for Congress to say ``enough.''
  Last year, U.S. Surgeon General David Satcher, M.D., Ph.D. released a 
landmark study on mental illness in this country. The Surgeon General's 
report is an extraordinary document that details the depth and breadth 
of mental illness in this country. According to Dr. Satcher, ``mental 
disorders collectively account for more than 15 percent of the overall 
burden of disease from all causes and slightly more than the burden 
associated with all forms of cancer.'' The burden of mental illness on 
patients and their families is considerable. The World Health 
Organization report that mental illness including suicide ranks second 
only to heart disease in the burden of disease measured by ``disability 
adjusted life year.''
  The impact of mental illness on older adults is considerable. 
Prevalence in this population of mental disorders of all types is 
substantial. 8 to 20 percent of older adults in the community and up to 
37 percent in primary care settings experience symptoms of depression, 
while as many as one in two new residents of nursing facilities are at 
risk of depression. Older people have the highest rate of suicide in 
the country, and the risk of suicide increases with age. Americans age 
85 years and up have a suicide rate of 65 per 100,000. Older white 
males, for example, are six times more likely to commit suicide than 
the rest of the population. There is a clear correlation of major 
depression and suicide: 60 to 75 percent of suicides of patients 75 and 
older have diagnosable depression. Put another way, untreated 
depression among the elderly substantially increases the risk of death 
by suicide.
  Mental disorders of the aging are not, of course, limited to major 
depression with risk of suicide. The elderly suffer from a wide range 
of disorders including declines in cognitive functioning, Alzheimer's 
disease (affecting 8 to 15 percent of those over 65) and other 
dementias, anxiety disorders (affecting 11.4 percent of adults over 
55), schizophrenia, bipolar disorder, and alcohol and substance use 
disorders. Some 3 to 9 percent of older adults can be characterized as 
heavy drinkers (12 to 21 drinks per week). While illicit drug use among 
this population is relatively low, there is substantial increased risk 
of improper use of prescription medication and side effects of 
polypharmacy.
  While we tend to think of Medicare as a ``senior citizen's health 
insurance program,'' there are substantial numbers of disabled 
individuals who qualify for Medicare by virtue of their long-term 
disability. Of those, the National Alliance for the Mentally Ill 
reports that some 400,000 non-elderly disabled Medicare beneficiaries 
become eligible by virtue of mental disorders. These are typically 
individuals with the severe and persistent mental illnesses, such as 
schizophrenia.
  Regadless of the age of the patient and the specific mental disorder 
diagnosed, it is absolutely clear that mental illness in the Medicare 
population causes substantial hardships, both economically and in terms 
of the consequences of the illness itself. As Dr. Satcher puts it, 
``mental illnesses exact a staggering toll on millions of individuals, 
as well as on their families and communities and our Nation as a 
whole.''
  Yet there is abundant good news in our ability to effectively and 
accurately diagnose and treat mental illnesses. The majority of people 
with mental illness can return to productive lives if their mental 
illness is treated. That is the good news: Mental illness treatment 
works. Unfortunately, today, a majority of those who need treatment for 
mental illness do not seek it. Much of this is due to stigma, rooted in 
fear and ignorance, and an outmoded view that mental illnesses are 
character flaws, or a sign of individual weakness, or the result of 
indulgent parenting. This is most emphatically not true. Left 
untreated, mental illnesses are as real and as substantial in their 
impact as any other illnesses we can now identify and treat.
  Mr. Speaker, Medicare's elderly and disabled mentally ill population 
faces a double burden. Not only must they overcome stigma against their 
illness, but once they seek treatment the Federal Government via the 
Medicare program forces them to pay half the cost of their care out of 
their own pockets. Congress would be outraged and rightly so if we 
compelled a Medicare cancer patient to pay half the cost of his or her 
outpatient treatment, or a diabetic 50 cents of every dollar charged by 
his or her endocrinologist. So why is it reasonable to tell the 75-
year-old that she must pay half the cost of treatment for major 
depression? Why should the chronic schizophrenic incur a 20 percent 
copayment for visiting his internist, but be forced to pay a 50 percent 
copayment for visiting a psychiatrist for the treatment of his 
schizophrenia?
  It is most emphatically not reasonable. It is blatant discrimination, 
plain and simple, and we should not tolerate it any longer. That is why 
I am introducing the Medicare Mental Illness Non-Discrimination Act. It 
is time we acknowledged what Dr. Satcher and millions of patients and 
physicians and health professionals and researchers have been telling 
us: Mental illnesses are real, they can be accurately diagnosed, and 
they can be as effectively treated as any other illnesses affecting the 
Medicare population. We can best do that by eliminating the statutory 
50 percent copayment discrimination against Medicare beneficiaries who, 
through no fault of their own, suffer from mental illness.
  My legislation is extremely simple. It repeals Section 1833(c) of the 
Social Security Act, thereby eliminating the discriminatory 50 percent 
copayment requirement. Once enacted, patients seeking outpatient 
treatment for mental illness would pay the same 20 percent copayment we 
require of Medicare patients seeking treatment for any other illnesses. 
My bill is a straightforward solution to this last

[[Page E1734]]

bastion of Federal health care discrimination. Via Executive Order we 
have at last initiated parity coverage of treatment for mental illness 
for our federal employees and their families. Can we now do any less 
for our Medicare beneficiaries? I urge my colleagues to join with me in 
righting this wrong.

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