[Congressional Record Volume 147, Number 20 (Tuesday, February 13, 2001)]
[Extensions of Remarks]
[Pages E156-E157]
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, February 13, 2001

  Mrs. ROUKEMA. Mr. Speaker, today I am reintroducing the Medicare 
Mental Illness Non-Discrimination Act, legislation to end the historic 
discrimination against Medicare beneficiaries seeking outpatient 
treatment for mental illness. I first introduced this bill in the 106th 
Congress, and I am pleased to again sponsor anti-discrimination 
legislation in the 107th Congress.
  Medicare law now requires patients 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 explain this another way: 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.''
  U.S. Surgeon General David Satcher, M.D., Ph.D. recently released a 
landmark study on mental illness. 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 
reports that mental illness including suicide ranks second only to 
heart disease in the burden of disease measured by ``disability 
adjusted life year.''

[[Page E157]]

  The impact of mental illness on older adults is considerable. 
Prevalence in this population of mental disorders of all types is 
substantial. Eight 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 from 
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 issnesses, such as 
schizophrenia.
  Regardless 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 other health professionals and researchers have been 
telling us: Mental illnesses are real, they can be accurately 
diagnosed, and they can be just 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 bastion of Federal 
health care discrimination.
  Last year, via Executive Order we at last initiated parity coverage 
of treatment for mental illness for our federal employees and their 
families. Members of Congress and their staff, who are covered under 
FEHPB, have parity for treatment of mental illnesses. If parity is good 
enough for federal employees and for Members of Congress and their 
staff, can we now do any less for our Medicare beneficiaries? I urge my 
colleagues to join with me in righting this wrong.
  Mr. Speaker, I ask that a letter in support of this legislation from 
Dr. Daniel B. Borenstein, President of the American Psychiatric 
Assocaiton, be included in the Record.

                             American Psychiatric Association,

                                  Washington, DC, January 5, 2001.
     Hon. Marge Roukema,
     House of Representatives, Rayburn House Office Building, 
         Washington DC.
       Dear Congresswoman Roukema: The American Psychiatric 
     Association (APA) a medical specialty society representing 
     over 40,000 psychiatric physician nationwide, is deeply 
     concerned about the crisis surrounding children's mental 
     health. We welcome the opportunity to work with the 107th 
     Congress as it presents America with the opportunity to 
     dedicate itself to the well being of our children and 
     families.
       According to the ``National Action Agenda on Children's 
     Mental Health'' released by the Surgeon General earlier this 
     week; the United States is facing a disastrous state of 
     health care for children. In the U.S., 1 in 10 children and 
     adolescents suffer from mental illness severe enough to cause 
     impairment. Yet, in any given year, it is estimated that 
     fewer than 1 in 5 of these children receives needed 
     treatment. The long-term consequences of untreated childhood 
     disorders are costly, both in human and fiscal terms.
       It is a national crisis that millions of Americans continue 
     to struggle with mental illness. Children and families are 
     suffering because of missed opportunities for prevention and 
     early identification, low priorities for research and 
     resources and fragmented services. Overriding all of this is 
     the issue of stigma, which continues to surround mental 
     illness.
       The American Psychiatric Association and our members are 
     pleased to offer our medical expertise and experience 
     expertise to you and your staff on the critical issues 
     outlined in the Surgeon General's Report. We place particular 
     emphasis on the Report's call for the need to: develop and 
     disseminate scientifically-proven prevention, diagnostic and 
     treatment services in the field of children's mental health; 
     eliminating the ethnic and socioeconomic disparities in 
     access to mental health care; and increasing access to and 
     coordination of quality mental health care services. If the 
     APA can be of further assistance, have your staff contact our 
     Division of Government Relations at 202/682-6060.
           Sincerely,
                                       Daniel B. Borenstein, M.D.,
                                                        President.

     

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