[Congressional Record Volume 148, Number 8 (Wednesday, February 6, 2002)]
[Senate]
[Pages S423-S424]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MENTAL HEALTH
Mr. DURBIN. Madam President, I submit for the Record an article that
ran in The Washington Post yesterday about the discrimination that
individuals with a history of mental illness face in our current health
insurance market. The story documents the dilemma of Michelle Witte who
was denied health insurance coverage because she was successfully
treated for depression during her adolescence. In fact, more than 50
million Americans each year suffer from mental illness. About 19
percent of the Nation's adults and 21 percent of the youths aged 9 to
17 have a mental disorder at some time during a one-year period.
Last Congress I introduced legislation to address the barriers faced
by Michelle Witte and thousands like her who have been treated for a
mental condition. I plan to reintroduce this legislation this spring,
and I urge my colleagues to join me in this effort.
The Mental Health Patients' Rights Act limits the ability of health
plans
[[Page S424]]
to redline individuals with a preexisting mental health condition. I
undertook this initiative when I learned that some of my constituents
were being turned away from health plans in the private non-group
market due solely to a past history of treatment for mental conditions.
Unfortunately, under the current system of care in the United States,
individuals who are undergoing treatment or have a history of treatment
for mental illness may find it difficult to obtain private health
insurance, especially if they must purchase it on their own and do not
have an employer-sponsored group plan available to them. In part this
is because while the Health Insurance Portability and Accountability
Act, HIPAA, protects millions of Americans in the group health
insurance market, it affords few protections for individuals who apply
for private non-group insurance. While the majority of Americans under
age 65 have employer-sponsored group coverage, a significant minority,
approximately 12.6 million individuals, rely on private, individual
health insurance.
The Mental Health Patients' Rights Act closes this loophole by
limiting any preexisting condition exclusion relating to a mental
health condition to not more than 12 months and reducing this exclusion
period by the total amount of previous continuous coverage. It
prohibits any health insurer that offers health coverage in the
individual insurance market from imposing a preexisting condition
exclusion relating to a mental health condition unless a diagnosis,
medical advice or treatment was recommended or received within the 6
months prior to the enrollment date. And it prohibits health plans in
the individual market from charging higher premiums to individuals
based solely on the determination that the individual has had a
preexisting mental health condition. These provisions apply to all
health plans in the individual market, regardless of whether a state
has enacted an alternative mechanism, such as a risk pool, to cover
individuals with preexisting health conditions.
The Mental Health Patients' Rights Act complements ongoing efforts to
enhance parity between mental health services and other health
benefits. This is because parity alone will not help individuals who do
not have access to any affordable health insurance due to preexisting
mental illness discrimination. The Patients' Rights Act does not
mandate that insurers provide mental health services if they are not
already offering such coverage. It simply prohibits plans in the
private non-group market from redlining individuals who apply for
general health insurance based solely on a past history of treatment
for a mental condition.
I have also asked the General Accounting Office to examine the types
of mental health conditions for which individual health insurers
typically underwrite; the degree to which there is an actuarial basis
for these carrier practices; the prevalence of medical underwriting for
mental health conditions that results in denying coverage or raising
premiums; and the extent of state laws that prevent or constrain
insurers from denying coverage or raising premiums due to a history of
mental health conditions, including consumer protections such as
appeals procedures and access to information. This report is due out
next month.
It simply does not make sense that a person is rendered uninsurable
for all health needs simply because he or she seeks treatment for
mental illness. I invite my colleagues to enlist in this important
initiative to ensure that such individuals are not discriminated
against when applying for health insurance coverage.
I ask unanimous consent that the article be printed in the Record.
There being no objection, the article was ordered to be printed in
the Record, as follows:
[From the Washington Post, Feb. 5, 2002]
Second Opinion: The Perils of Doing Right
(By Abigail Trafford)
Michelle Witte did everything right. She graduated from the
University of Maryland last June with a degree in English.
She got a job she loves with a Washington communications firm
that is too small to qualify for a group health plan. But her
employer will pay for an an individual policy, so she applied
to CareFirst BlueCross BlueShield. In answer to questions on
the form, she stated that she has chronic asthma and had been
prescribed antidepressant medication for a short period when
she was in high school.
The health plan rejected her.
``Upon review of the Individual Health Evaluation
Questionnaire, you have documented that you have been or are
currently being treated for depressive disorder,'' stated the
letter from the health plan. ``Based upon our medical
underwriting criteria, we are unable to approve this coverage
for you.''
``I just think it's shocking,'' said Witte, 23. CareFirst
has refused to comment on the case. But in its official reply
to her application, the plan expressed no concern over her
ongoing problem of asthma. It was one episode of successfully
treated depression in adolescence that turned Witte into a
health plan pariah. ``It didn't occur to me that it could be
such a liability,'' she said.
This is how discrimination works against people with mental
diseases. For all the rhetoric about removing the stigma of
mental illness and treating disorders of the brain the same
way as disorders of the body, the bias persists. A physical
disease like asthma is okay; a mental disorder like
depression is not.
If anything, Witte ought to be a prized health plan client.
She has demonstrated that she knows how to take care of
herself. Six years ago, when she was in high school, she
developed anorexia, an eating disorder. Her parents promptly
took her to a psychiatrist at Children's National Medical
Center who diagnosed depression and prescribed a six-month
course of the antidepressant Zoloft. Witte responded well.
She overcame her eating problems. She has had no problems
with depression since that time.
How many teenage girls try to keep their destructive eating
habits secret? How many go for years without proper
treatment? They can end up needing hospitalization and may
suffer long-term complications. In the end, that is much more
expensive to a health plan than covering outpatient
psychotherapy and medications for six months.
In short, Witte and her parents--her father works for the
federal government, her mother for a health maintenance
organization--did everything right in getting prompt
treatment. ``It was a success story,'' said Witte. ``I'm a
proponent of drugs when they're used properly. They can
really help.''
Why should she be penalized for being a success story?
It's legal for health insurers to consider a person's
health status when they offer individual policies. Otherwise
some people might not buy insurance until they were diagnosed
with a major medical problem and needed coverage to get care.
But this is obviously not the case with Witte, a healthy
young woman who runs regularly and likes to take day-long
hikes. As a health insurance reject, she is eligible for
programs designed for high-risk individuals, but the costs of
coverage are generally higher and the benefits more limited
compared to a regular plan. That's a steep price to pay for
having had a six-month prescription for Zoloft.
In many parts of the country, the infrastructure of mental
health services is unraveling. Headlines have rightly focused
on the collapse of public programs for people who need
government-funded treatment.
But a much larger population with mental disorders remains
in the private sector. They are holding jobs and raising
families. They rely on private insurance and private
therapists for treatment. Support for them is eroding, too,
as insurance agencies stint on payment for mental health
services, managed care plans place limits on benefits, and
the burden of co-payments and other out-of-pocket expenses
continues to increase.
Even people with good jobs and supposedly good health
coverage are hurting. One man who works for the federal
government has been treated for major depression since his
first episode at age 38. He has seen the same psychiatrist,
who monitors his medications and provides psychotherapy,
every week for 15 years.
This year his insurance plan has eliminated the more
generous high-option policy that covered 50 visits to the
doctor. His current plan, with a premium that is a few
dollars cheaper every month, covers only 25 sessions. His
psychiatrist charges $165 an hour; the plan now covers about
half the hourly fee, and only half the time. Bottom line: His
doctor bills come to $8,250 a year. His plan pays $1,800; he
pays the rest.
``It's not fair,'' he said, ``it has to cost us so much
money when there's supposed to be parity'' in coverage of
mental and physical illnesses. ``Parity keeps slipping
away.''
The president last week came out in favor of patients'
rights. That ought to include the millions of Americans with
mental illness.
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