[Congressional Record Volume 149, Number 58 (Thursday, April 10, 2003)]
[Senate]
[Pages S5178-S5180]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself and Mr. Kerry):
  S. 853. 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 Health Copayment Equity 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 copayment for outpatient 
services, including doctor's visits and Medicare pays the remaining 80 
percent. But for treatment of mental disorders, Medicare law requires 
patients pay a 50-percent copayment. Under my bill, this copayment will 
be reduced over a six year period, starting in 2004, from the current 
50 percent to 20 percent. This means that in 2010, patients seeking 
outpatient treatment for mental illness will pay the same 20 percent 
copayment required of Medicare patients that receive treatment for any 
other illness.
  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 copayment 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  Indeed, my bill has a larger purpose, to help end an outdated 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 health 
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 with a substantial 
proportion of the population 55 and older--almost 20 percent of this 
age group--experiencing specific mental disorders that are not part of 
``normal'' aging.
  Further, older Americans have the highest rate of suicide in the 
country,

[[Page S5179]]

and the risk of suicide increases with age. In fact, in the State of 
Maine, the suicide rate for seniors is three times as high as the rate 
for adolescents. Untreated depression among the elderly substantially 
increases the risk of death by suicide.
  There is another sad irony. While Medicare often is 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 disability.
  But there also is 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. By 
removing financial barriers that inhibit access to treatment services, 
we will be able to eliminate stigmas and overcome a lack of 
understanding of mental disorders.
  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 
Snowe in introducing the Medicare Mental Health Copayment Equity 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-payments 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, those in need of 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 Health Copayment Equity Act will phase-down the 50 percent co-
payment for mental health care services to 20 percent over six years. 
By applying the same co-payment rate to mental health services to which 
all other outpatient services are subjected, the Medicare Mental Health 
Copayment Equity 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. I urge my colleagues to join with us to 
pass this critical legislation.
  I ask unanimous consent that several letters of support be printed in 
the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:


                                Maine Osteopathic Association,

                                    Manchester, ME, April 9, 2003.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe: On behalf of the osteopathic physicians 
     (D.O.'s) in Maine, I want to applaud your leadership efforts 
     in sponsoring the Medicare Mental Health Co-payment Equity 
     Act of 2003. This bill would end Medicare's unfortunate 
     discrimination against patients with mental illness.
       We support this legislation that would end this 
     discrimination because it requires that Medicare patients pay 
     only the same 20 percent co-payment for mental illness 
     treatment that they pay when seeking other medical treatment, 
     such as treatment for diabetes, asthma or influenza.
       The Maine Osteopathic Association appreciates your 
     thoughtfulness, commitment and compassion in equitably 
     treating persons with mental illness.
       Your sponsorship of this most important bill is a major 
     step to end Medicare's discrimination coverage of mental 
     illness treatment.
           Sincerely,
                                            Daniel M. Pierce, D.O.
     President.
                                  ____

                                                    April 9, 2003.
     Hon. John Kerry,
     U.S. Senate, Washington, DC.
       Dear Senator Kerry: On behalf of the American Association 
     for Geriatric Psychiatry (AAGP), I am writing to add AAGP's 
     endorsement to legislation which you are planning to 
     introduce with Senator Snowe to end the discriminatory 
     copayment required by Medicare for treatment of mental 
     illness.
       Medicare coverage of mental health services is fragmented 
     and subject to arbitrary and discriminatory limitations. 
     Although coinsurance for most services covered by Medicare is 
     20 percent, current law requires a 50 percent co-payment for 
     mental health services furnished by psychiatrists and other 
     health care professionals who specialize in the treatment of 
     mental illness. This limit, which dates back to the inception 
     of the Medicare program in 1965, is based on the outmoded 
     assumption that all mental illness is chronic and requires 
     unlimited therapeutic services. Advances in treatment have 
     made this assumption highly inaccurate. Your bill would 
     establish copayment parity between mental health benefits and 
     other medical benefits under the Medicare program.
       Your legislation stands to dramatically improve the lives 
     of Medicare beneficiaries by providing them with the access 
     to mental health care that they deserve.
       AAGP commends you for your dedication to ensuring that all 
     Americans have adequate access to effective mental health 
     treatments, and we look forward to working with you to 
     achieve the enactment of this legislation.
           Sincerely,
                                             Joel E. Streim, M.D.,
     President.
                                  ____



                             American Psychiatric Association,

                                     Arlington, VA, April 9, 2003.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe: On behalf of the 38,000 physician 
     members of the American Psychiatric Association (APA), and 
     most particularly on behalf of the patients they treat, 
     please accept my thanks for your House sponsorship of the 
     Medicare Mental Health Copayment Equity Act of 2003.
       As you know, Medicare Part B requires by statute that 
     beneficiaries pay a copayment of 20 percent, except for the 
     discriminatory 50 percent copayment charged for outpatient 
     mental health treatment. It is time for Congress to end what 
     amounts to cost-sharing discrimination by diagnosis. The bill 
     you are introducing with Representative Richard Neal would 
     ultimately require Medicare beneficiaries to pay the same 20 
     percent copayment amount for outpatient mental health 
     treatment as they would otherwise pay for other Part B 
     services. Asking our Medicare beneficiaries to pay half the 
     cost of their mental health care out of pocket is simply 
     unjust, and is a significant barrier to necessary treatment.
       Thank you for your foresight and leadership in your lead 
     sponsorship of the Medicare Mental Health Copayment Equity 
     Act of 2003. Thanks are also due to the outstanding work by 
     Catherine Finely, who ably represents you. The APA looks 
     forward to working with you to make your bill a reality this 
     year.
           Sincerely,
                                          Paul S. Appelbaum, M.D.,
     President.
                                  ____

                                                             NAMI,


                                         The Nation's Voice on

                                                Mental Health,

                                     Arlington, VA, April 9, 2003.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe: On behalf of NAMI's 210,000 members and 
     1,200 affiliates I am writing to offer our strong support for 
     the Medicare Mental Illness Nondiscrimination Act. Thank you 
     for bringing forward this important legislation to bring a 
     discrimination in outpatient treatment services in the 
     Medicare program. As the nation's largest organization 
     representing persons with severe mental illness and their 
     families, we are extremely grateful for your leadership on 
     this important issue.
       Perhaps the most glaring shortcoming in the Medicare 
     program is the discriminatory

[[Page S5180]]

     co-payment for most outpatient mental illness treatment 
     services. As you know, outpatient psychotherapy services are 
     covered at 50 percent under Medicare, with a 50 percent 
     beneficiary co-payment requirement. This is stark contrast to 
     the 80 percent payment, and 20 percent co-payment for all 
     other outpatient services. In NAMI's view, this is a clear 
     form of discrimination in one of the federal government's 
     most important health care programs--providing coverage to 
     more than 39 million Americans--both seniors and non-elderly 
     people with severe disabilities such as serious mental 
     illnesses. We know that treatment makes a tremendous 
     difference in the lives of persons with mental illness. Your 
     legislation removes a significant financial barrier to such 
     necessary care for the Medicare population.
       Thank you for once again leading the way in the Congress in 
     bringing an end to discrimination against persons living with 
     severe mental illness.
           Sincerely,
                                                Richard C. Birkel,
     Executive Director.
                                  ____

                                          American Association for


                                         Geriatric Psychiatry,

                                      Bethesda, MD, April 9, 2003.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe: On behalf of the American Association 
     for Geriatric Psychiatry (AAGP), I writing to add AAGP's 
     endorsement to legislation which you are planning to 
     introduce with Senator Kerry to end the discriminatory 
     copayment required by Medicare for treatment of mental 
     illness.
       Medicare coverage of mental health services is fragmented 
     and subject to arbitrary and discriminatory limitations. 
     Although coinsurance for most services by Medicare is 20 
     percent, current law requires a 50 percent co-payment for 
     mental health services furnished by psychiatrists and other 
     health care professionals who specialize in the treatment of 
     mental illness. This limit, which dates back to the inception 
     of the Medicare program in 1965, is based on the outmoded 
     assumption that all mental illness is chronic and requires 
     unlimited therapeutic services. Advances in treatment have 
     made this assumption highly inaccurate. Your bill would 
     establish copayment parity between mental health benefits and 
     other medical benefits under the Medicare program.
       Your legislation stands to dramatically improve the lives 
     of Medicare beneficiaries by providing them with the access 
     to mental health care that they deserve.
       AAGP commends you for your dedication to ensuring that all 
     Americans have adequate access to effective mental health 
     treatments, and we look forward to working with you to 
     achieve the enactment of this legislation.
           Sincerely,
                                             Joel E. Streim, M.D.,
     President.
                                  ____

                                    Maine Psychiatric Association,
                                   Manchester, ME, March 19, 2003.
     Hon.  Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe, on behalf of the psychiatric physicians 
     of the Maine Psychiatric Society, I want to offer you my 
     sincere appreciation for your leadership in sponsoring the 
     Medicare Mental Health Copayment Equity Act of 2003, working 
     to end Medicare's historic discrimination against patients 
     with mental illness.
       Your legislation would end this discrimination by requiring 
     that discriminatory copayments required of Medicare patients 
     for mental illness treatment would eventually be reduced from 
     the current 50 percent level to the 20 percent level patients 
     pay for other medical treatment, such as treatment for 
     diabetes, heart disease, or the flu. This legislation 
     promotes parity for mental health benefits and improves 
     access to mental health care for all Medicare beneficiaries 
     in Maine and across the country.
       The Maine Psychiatric Association appreciates your ongoing 
     commitment to persons with mental illness, and your 
     sponsorship of this most important bill to end Medicare's 
     discriminatory coverage of mental illness treatment.
           Sincerely,

                                         Edward Pontius, M.D.,

                             Chair, Legislative Affairs Committee,
     Maine Psychiatric Association.
                                  ____



                                    Maine Medical Association,

                                                    April 9, 2003.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senator Snowe: I am writing to you on behalf of the 
     Maine Medical Association and the Maine Psychiatric 
     Association, representing over 2500 Maine-licensed 
     physicians, to thank you sincerely for assuming the 
     leadership in sponsoring the Medicare Mental Health Co-
     payment Equity Act of 2003, that would end Medicare's 
     historic discrimination against patients with mental illness.
       As you know, mental health illness and treatment are very 
     often complicated by concurrent major physical illnesses, 
     like cancer, heart disease, and diabetes. Unfortunately, co-
     payment for treatment of mental illnesses are two and a half 
     times higher than that for physical illnesses. Your 
     legislation would end this discrimination by requiring that 
     Medicare patients pay only the same 20 percent co-payment for 
     mental illness treatment that they would pay when seeking 
     other medical treatment.
       The Maine Medical Association and the Maine Psychiatric 
     Association appreciate your ongoing commitment to persons 
     with mental illness and your sponsorship of this most 
     important bill to end Medicare's discriminatory coverage of 
     mental illness treatment.
           Sincerely,
                                             Krishna Bhatta, M.D.,
     President.
                                  ____



                             American Psychiatric Association,

                                     Arlington, VA, April 9, 2003.
     Hon. John Kerry,
     U.S. Senate, Washington, DC.
       Dear Senator Kerry: On behalf of the 38,000 physician 
     members of the American Psychiatric Association (APA), and 
     most particularly on behalf of the patients they treat, 
     please accept my thanks for your House sponsorship of the 
     Medicare Mental Health Copayment Equity Act of 2003.
       As you know, Medicare Part B requires by statute that 
     beneficiaries pay a copayment of 20 percent, except for the 
     discriminatory 50 percent copayment charged for outpatient 
     mental health treatment. It is time for Congress to end what 
     amounts to cost-sharing discrimination by diagnosis. The bill 
     you are introducing with Representative Richard Neal would 
     ultimately require Medicare beneficiaries to pay the same 20 
     percent copayment amount for outpatient mental health 
     treatment as they would otherwise pay for other Part B 
     services. Asking our Medicare beneficiaries to pay half the 
     cost of their mental health care out of pocket is simply 
     unjust, and is a significant barrier to necessary treatment.
       Thank you for your foresight and leadership in your lead 
     sponsorship of the Medicare Mental Health Copayment Equity 
     Act of 2003. Thanks are also due to the outstanding work by 
     Kelly Bovio, who ably represented you. The APA looks forward 
     to working with you to make your bill a reality this year.
           Sincerely,
                                          Paul S. Applebaum, M.D.,
                                                        President.
                                 ______