[Congressional Record Volume 148, Number 50 (Monday, April 29, 2002)]
[Senate]
[Pages S3510-S3512]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Kennedy, Mr. Wellstone, and Mr. 
        Corzine):
  S. 2393. A bill to amend the Public Health Service Act to provide 
protections for individuals who need mental health services, and for 
other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. DURBIN. Mr. President, I rise tonight to introduce the Mental 
Health Patient Rights Act. This legislation will break down one of the 
barriers faced by thousands of Americans who face discrimination in the 
individual health insurance market because they have been treated at 
some time in their life for a mental condition. Senators Kennedy, 
Wellstone, and Corzine have joined me in this effort.
  Each year some 18 million Americans suffer from depression, and fully 
a quarter of the country's adult population is faced with some form of 
mental illness. Many of them are not part of group coverage provided by 
employers and must rely on individual policies that they purchased 
themselves. Without coverage, many who are dealing with mental disease 
do not seek treatment. Indeed, repeated surveys have shown that 
concerns about the cost of mental care is one of the most common 
reasons that individuals decline to seek care. The Mental Health 
Patient Rights Act limits the ability of health care plans to redline 
individuals with a preexisting mental health condition.

[[Page S3511]]

  I undertook this initiative when I read a letter from one of my 
Illinois constituents who was turned away from health care plans in the 
private nongroup market, due solely to a past history of treatment for 
a mental condition. This constituent, whom I will call Mary, suffered 
severe depression over 10 years ago and received treatment, which was 
successful. It allowed her to return to work.
  At that time Mary had employer-sponsored health insurance through her 
husband's employment. But in the fall of 1998, Mary and her husband 
lost this employer-based insurance coverage when Mary's husband lost 
his job.
  Mary applied for a comprehensive health insurance plan offered to 
individuals. Her application was declined because, as per the insurance 
company notice, due to her medical history of depression, she did not 
meet the company's underwriting requirements.

  Mary wrote:

       As I see it, we are being punished for accessing health 
     care. In 1987, when I became clinically depressed, I could 
     have chosen to avoid proper medical care, become unemployed 
     and received Social Security disability. I did not. I 
     obtained the help I needed and continued to support myself, 
     my family and contribute positively to society. Depression is 
     a treatable medical illness. Insurance companies must stop 
     their indiscriminate denial of coverage.

  The Washington Post recently ran a column that documented a similar 
story about the discrimination that individuals with a history of 
mental illness face in our current health insurance market.
  The column conveys the dilemma of Michelle Witte who was denied 
health insurance coverage because she was successfully treated for 
depression during her adolescence.
  Unfortunately, Mary and Michelle are not alone. 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.
  Underwriting in the individual health insurance market is fierce.
  Just last week The Wall-Street Journal reported that a Wisconsin-
based insurer, American Medical Security Group, Inc., is actually re-
underwriting individual policies on an annual basis. At each annual 
renewal, this company reviews the individuals claims filed in the 
previous year and increases premiums to policyholders whose claims 
exceed the standard. 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 particularly 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.
  That is why I have introduced this legislation. 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 high 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.
  The legislation is backed by more than compelling anecdotal stories. 
I asked for a study from the GAO and last month they told me the new 
study documents that individuals with mental disorders, past or 
present, face restrictions in purchasing health insurance in the 
individual market that exceed restrictions for physical health 
preexisting conditions in the same cost category.
  GAO interviewed insurance carriers that sell individual market 
insurance and sell insurance in most of the 34 states in which carriers 
are permitted to medically underwrite.
  Collectively, these insurers cover more than one million individuals 
representing more than 10 percent of all individual market enrollees. 
Researchers found that carriers denied coverage for applicants with 
selected mental disorders more than half of the time, while denying 
coverage for applicants with other selected chronic conditions just 30 
percent of the time.
  Even in states which have established subsidized insurance options as 
a coverage option for applicants rejected in the individual insurance 
market, sometimes called high-risk pools, these options have higher 
premium rates.
  High-risk pools also may include more restrictions on mental health 
benefits than other benefits and many have waiting lists due to budget 
constraints.
  In the seven states without high-risk pools and without guaranteed 
issue requirements, applicants with a history of mental illness are 
likely to find themselves without any viable health insurance coverage 
option.
  In other words, it is not about money. If the insurance company wants 
to ask you if you have a history in your family of cancer, heart 
disease, diabetes, things that might have some impact on the cost of 
health insurance, it is understood that is part of underwriting. But 
now they are including mental illness as part of this inquiry, and 
regardless of the fact that it doesn't seem to be, or prove out to be 
as expensive to the insurance companies, they are just discriminating 
against people who have this history of mental illness.
  That is why I am introducing this legislation.
  It does not make sense that a person is rendered uninsurable for all 
health needs simply because he or she seeks treatment for mental 
illness. Mental illness is a disease just as cancer or asthma or the 
flu is a disease.
  Yet it is clear that when it comes to mental health millions of 
Americans must battle not only with their disease, but for their access 
to adequate insurance coverage.
  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.
  More than 80 organizations representing consumers, family members, 
health professionals and providers have endorsed the Mental Health 
Patient Rights Act. I urge you to do the same.
  Some of us who saw the movie, ``A Beautiful Mind,'' are reminded that 
there are people who have suffered from mental illness who have 
recovered and made great contributions to America, as John Nash has at 
Princeton, and as those who have been involved in so many other walks 
of life. It is unfair in America for us to discriminate against a 
person because of a history of mental illness. Yet it is a fact of 
life.
  I salute my colleagues, Senators Wellstone and Domenici, for their 
leadership on this issue. I join them in their effort and hope this 
bill will complement what they are doing to not only make mental 
illness subject to coverage by health insurance but also to end this 
discrimination against those who have a history of that illness. We 
should be working to break down the stigma of mental illness, not to 
maintain it.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

[[Page S3512]]

                                S. 2393

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Mental Health Patients' 
     Rights Act''.

     SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

       Subpart 1 of part B of the Public Health Service Act (42 
     U.S.C. 300gg-41 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 2745. LIMITATION ON PREEXISTING CONDITION EXCLUSION 
                   PERIOD AND PREMIUMS WITH RESPECT TO MENTAL 
                   HEALTH.

       ``(a) Limitation on Preexisting Condition Exclusion 
     Period.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, a health insurance issuer that offers health insurance 
     coverage in the individual market in a State may, with 
     respect to an individual or dependent of such individual, 
     impose a preexisting condition exclusion relating to a 
     preexisting mental health condition only if--
       ``(A) such exclusion relates to a mental health condition, 
     regardless of the cause of the condition, for which medical 
     advice, diagnosis, care, or treatment was recommended or 
     received within the 6-month period ending on the enrollment 
     date;
       ``(B) such exclusion extends for a period of not more than 
     12 months after the enrollment date; and
       ``(C) the period of any such preexisting condition 
     exclusion is reduced by the aggregate of the periods of 
     creditable coverage (if any, as defined in paragraph (3)(A)) 
     applicable to the individual or dependent of such individual 
     as of the enrollment date.
       ``(2) Definitions.--In this section:
       ``(A) Preexisting mental health condition.--The term 
     `preexisting mental health condition' means, with respect to 
     coverage, a mental health condition, including all categories 
     of mental health conditions listed in the Diagnostic and 
     Statistical Manual of Mental Disorders, Fourth Edition (DSM 
     IV-TR), or the most recent edition if different than the 
     Fourth Edition, that was present before the date of 
     enrollment of such coverage, whether or not any medical 
     advice, diagnosis, care, or treatment was recommended or 
     received before such date.
       ``(B) Other terms.--The terms `preexisting condition 
     exclusion', `enrollment date', and `late enrollee' shall have 
     the meanings given such terms in section 2701 as relating to 
     individual health insurance coverage.
       ``(3) Crediting previous coverage.--For purposes of 
     subsection (a), the term `creditable coverage' has the 
     meaning given such term in section 2701(c) and includes 
     coverage of the individual under any of the following:
       ``(A) A college-sponsored health plan, or a plan under 
     which health benefits are offered by or through an 
     institution of higher education (as defined in section 481(a) 
     of the Higher Education Act of 1965 (20 U.S.C. 1088(a)) in 
     relation to students at the institution (not including 
     benefits offered to such a student as a participant or 
     beneficiary in a group health plan).
       ``(B) Title XXI of the Social Security Act.
       ``(C) A State or local employee health plan.
       ``(b) Prohibition on Increased Premiums Based on 
     Preexisting Mental Health Condition.--A health insurance 
     issuer that offers health insurance coverage in the 
     individual market in a State may not, with respect to an 
     individual or dependent of such individual, require any 
     individual (as a condition of enrollment or continued 
     enrollment) with a preexisting mental health condition to pay 
     a premium or contribution which is greater than a premium or 
     contribution for an individual without a preexisting mental 
     health condition based solely on the determination that such 
     individual has a preexisting mental health condition, as such 
     term is defined in subsection (a)(2)(A).
       ``(c) Nonapplicability of Acceptable Alternative 
     Mechanisms.--The provisions of section 2741(a)(2) shall not 
     apply to a health insurance issuer that offers health 
     insurance coverage in the individual market in a State, but 
     only with respect to an individual, or dependent of such 
     individual, with a preexisting mental health condition 
     desiring to enroll in such individual health insurance 
     coverage.''.

     

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