[Congressional Record Volume 147, Number 62 (Tuesday, May 8, 2001)]
[Senate]
[Pages S4510-S4511]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself and Mr. Kerry):
  S. 841. A bill to amend title XVIII of the Social Security Act to 
eliminate discriminatory copayment rates for outpatient psychiatric 
services under the Medicare Program; to the Committee on Finance.
  Ms. SNOWE. Mr. President, I rise today to introduce the Medicare 
Mental Illness Non-Discrimination Act with my colleague on the Finance 
Committee, Senator John Kerry.
  In brief, my bill would a correct a serious disparity in payment for 
treatment of mental disorders under Medicare law. Medicare 
beneficiaries typically pay 20 percent coinsurance for most outpatient 
services, including doctor's visits. Medicare pays the remaining 80 
percent. But for treatment of mental disorders, Medicare law requires 
patients pay 50-percent coinsurance. Under my bill, patients seeking 
outpatient treatment for mental illness would pay the same 20 percent 
coinsurance required of Medicare patients seeking treatment for any 
other illnesses.
  Let's look at this issue in another way. If a Medicare patient has an 
office visit for treatment for cancer or heart disease, the patient is 
responsible for 20 percent of the doctor's fee. But if a Medicare 
patient has an office visit with a psychiatrist, psychologist, social 
worker, or other professional for treatment for depression, 
schizophrenia, or any other condition diagnosed as a mental illness, 
the co-insurance for the outpatient visit for treatment of the mental 
illness is 50 percent. What sense does this make?
  Indeed, my bill has a larger purpose, to help end an outdated 
distinction between physical and mental disorders, and ensure that 
Medicare beneficiaries have equal access to treatment for all 
conditions.
  Perhaps this disparity would matter less if mental disorders were not 
so prevalent. But the Surgeon General has told us otherwise. The 
importance of access to treatment for mental disorders is emphasized in 
a landmark report on mental health released by the Surgeon General in 
1999. The Surgeon General reported mental illness was second only to 
cardiovascular diseases in years of healthy life lost to either 
premature death or disability. And the occurrence of mental illness 
among older adults is widespread. Upwards of 20 percent of older adults 
in the community and an even higher percentage in primary care settings 
experience symptoms of depression. Older Americans have the highest 
rate of suicide in the country, and the risk of suicide increases will 
age. Untreated depression among the elderly substantially increases the 
risk of death by suicide.
  There is another sad irony. While Medicare is often viewed as health 
insurance for people over age 65, Medicare also provides health 
insurance coverage for people with severe disabilities. The single most 
frequent cause of disability for Social Security and Medicare benefits 
is mental disorders--affecting almost 1.4 million of 6 million 
Americans who receive Social Security disability benefits. Yet, at the 
same time, Medicare pays less for critical mental health services 
needed by these beneficiaries than if they had a non-mental disorder.
  But there is also the very good news that there are increasingly 
effective treatments for mental illnesses. With proper treatment, the 
majority of people with a mental illness can lead productive lives. Yet 
because of fears of stigma and a lack of understanding of mental 
disorders, too often mental disorders go untreated. Our payment 
policies should not provide another barrier to access to care.
  I urge my colleagues to join with me to bring Medicare payment policy 
for mental disorders into the 21st century.
  Mr. KERRY. Mr. President, I am pleased to join my colleague Senator

[[Page S4511]]

Snowe in introducing the Medicare Mental Illness Non-Discrimination 
Act. This legislation will establish mental health care parity in the 
Medicare program.
  Medicare currently requires patients to pay a 20 percent co-payment 
for all Part B services except mental health care services, for which 
patients are assessed a 50 percent co-payment. Thus, under the current 
system, if a Medicare patient sees an endocrinologist for diabetes 
treatment, an oncologist for cancer treatment, a cardiologist for heart 
disease treatment or an internist for treatment of the flu, the co-
payment is 20 percent of the cost of the visit. If, however, a Medicare 
patient visits a psychiatrist for treatment of mental illness, the co-
payment is 50 percent of the cost of the visit. This disparity in 
outpatient co-payment represents blatant discrimination against 
Medicare beneficiaries with mental illness.
  The prevalence of mental illness in older adults is considerable. 
According to the U.S. Surgeon General, 20 percent of older adults in 
the community and 40 percent of older adults in primary care settings 
experience symptoms of depression, while as many as one out of every 
two residents in nursing homes are at risk of depression. The elderly 
have the highest rate of suicide in the United States, and there is a 
clear correlation between major depression and suicide: 60 to 70 
percent of suicides among patients 75 and older have diagnosable 
depression. In addition to our seniors, 400,000 non-elderly disabled 
Medicare beneficiaries become Medicare-eligible by virtue of severe and 
persistent mental disorders. To subject the mentally disabled to 
discriminatory costs in coverage for the very conditions for which they 
became Medicare eligible is illogical and unfair.
  There is ample evidence that mental illness can be treated. 
Unfortunately, among the general population, those in need for 
treatment often do not seek it because they are ashamed of their 
condition. Among our Medicare population, the mentally ill face a 
double burden: not only must they overcome the stigma about their 
illness, but once they seek treatment they must pay one-half of the 
cost of care out of their own pocket. The Medicare Mental Illness Non-
Discrimination Act will eliminate the 50 percent co-payment for mental 
health care services. By applying the same 20 percent co-payment rate 
to mental health services to which all other outpatient services are 
subjected, the Medicare Mental Illness Non-Discrimination Act will 
bring parity to the Medicare program and improve access to care for our 
senior and disabled beneficiaries who are living with mental illness.
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