[Congressional Record Volume 151, Number 72 (Thursday, May 26, 2005)]
[Senate]
[Pages S6051-S6052]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Kerry, Mr. Smith, and Ms. 
        Collins):
  S. 1152. 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 of 2005 with my colleagues, Senator 
John Kerry, Senator Gordon Smith, and Senator Susan Collins.
  Briefly, our bill would correct a serious disparity in Medicare 
payment policy for mental health treatment. Medicare beneficiaries 
typically pay 20 percent of the cost of covered outpatient services, 
including doctor's visits, as a ``copayment'' or coinsurance, and 
Medicare pays the remaining 80 percent. But Medicare law imposes a 
special limitation for outpatient mental health services which requires 
patients to pay a much higher copayment, 50 percent. As a result, 
Medicare beneficiaries pay two and a half times as much--50 percent 
coinsurance--for treatment of any mental disorders.
  Our bill will eliminate the disparity in payment by reducing this 
discriminatory copayment over a 6-year period, starting in 2006, from 
the current 50 percent to the standard 20 percent. This means that, in 
2012, patients seeking outpatient treatment for mental illness will pay 
the same 20 percent copayment that is required of Medicare patients 
today who receive outpatient treatment for other illnesses. The goal of 
our bill is ultimately to achieve ``copayment equity'' for Medicare 
mental health services.
  Let me give an example of the current disparity in copayments. If a 
Medicare patient sees a doctor in an office for treatment of cancer, 
heart disease, or the flu, the patient must pay 20 percent of the fee 
for the visit. But if a Medicare patient sees a psychiatrist, 
psychologist, social worker, or other professional in an office for 
treatment of depression, schizophrenia, or any other type of mental 
illness, the patient must pay 50 percent of the fee. What sense does 
this make?
  Indeed, our bill has a larger purpose, to help end an outdated 
distinction--between treatment of physical and mental disorders--and to 
ensure that Medicare beneficiaries have equal access to treatment for 
all their health conditions. Perhaps this disparity would not matter so 
much if mental disorders were less prevalent. But the Surgeon General 
has told us otherwise.
  A landmark report of the Surgeon General in 1999 emphasized the 
importance of access to treatment for mental disorders. The Surgeon 
General found that mental illness was a leading cause--second only to 
cardiovascular diseases--of otherwise healthy years of life lost to 
premature death or disability. The Surgeon General found that the 
occurrence of mental illness among older adults is widespread, with a 
substantial portion of the population aged 55 and older--almost 20 
percent--experiencing specific disorders that are not a part of 
``normal'' aging.
  Older Americans also have the highest rate of suicide in the country, 
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. It is not surprising, therefore, to find that 
untreated depression among the elderly has substantially increased 
their risk of death by suicide.
  Another sad irony involves individuals with disabilities. Medicare is 
often viewed as health insurance for people over age 65 but it also 
provides health insurance for those with severe disabilities. The 
single most frequent cause of disability for both Social Security and 
Medicare benefits is mental disorders--affecting almost 1.4 million of 
6 million Americans who receive Social Security disability benefits. 
Yet, Medicare pays far less for the critical mental health services 
needed by these beneficiaries than it does for medical treatment for 
their physical disabilities.
  However, the good news is that, today, there are increasingly 
effective treatments for mental illness. The majority of people with 
mental disorders who receive proper treatment can lead productive 
lives. Congress should remove disincentives that inhibit access to 
mental health services so that those seeking treatment for these 
disorders do not have to face financial barriers to care. It is time to 
remove stigmas and overcome the lack of understanding of mental 
disorders by equalizing Medicare copayment requirements for mental 
health services.
  I urge my colleagues to join with me and bring Medicare payment 
policy into the 21st century.
  I would also like to submit letters from the American Psychiatric 
Association and the Mental Health Liaison Group, 36 national 
organizations supporting this legislation, and I ask unanimous consent 
that these letters of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                             American Psychiatric Association,

                                      Arlington, VA, May 26, 2005.
     Hon. Olympia Snowe,
     U.S. Senate,
     Washington, DC.
     Hon. John Kerry,
     U.S. Senate,
     Washington, DC.
       Dear Senator Snowe and Senator Kerry: Later today you will 
     receive a letter, initiated by the American Psychiatric 
     Association, from some 35 members of the Mental Health 
     Liaison Group (MHLG) thanking you for your leadership in 
     again introducing legislation to phase out Medicare's 
     discriminatory 50 percent coinsurance.

[[Page S6052]]

       We are of course a cosigner of the MHLG letter, but I 
     wanted to add my own personal thanks for your tireless 
     efforts to end 40 years of discrimination against patients 
     seeking outpatient mental health services under Medicare Part 
     B. It should be simply unacceptable to compel such patients 
     to pay 50 percent of the cost of their care out of their own 
     pockets. The real ``winners'' under your legislation are 
     patients.
       I also wish to specifically acknowledge the hard work and 
     dedication of Sue Walden, Heather Mizeur, and Aaron Jenkins 
     of your staffs. You are each extremely well served by their 
     efforts.
           Sincerely,
                                             James H. Scully, Jr.,
     Medical Director.
                                  ____



                                  Mental Health Liaison Group,

                                     Washington, DC, May 26, 2005.
     Hon. Olympia Snowe,
     Russell Senate Office Building,
     Washington, DC.
     Hon. John Kerry,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senators Snowe and Kerry: The undersigned 
     organizations in the Mental Health Liaison Group, 
     representing patients, health professionals and family 
     members, are pleased to support your legislation, the 
     Medicare Mental Health Copayment Equity Act. Under your 
     legislation, Medicare's historic discriminatory 50 percent 
     coinsurance for outpatient mental health care would be 
     reduced over six years to 20 percent, bringing the 
     coinsurance into line with that required of Medicare 
     beneficiaries for other Part B services.
       Simply put, current law discriminates against Medicare 
     beneficiaries who seek treatment for mental illness. This 
     affects elderly and non-elderly Medicare beneficiaries alike 
     when they seek mental health care. According to the 1999 U.S. 
     Surgeon General's report on mental health, almost 20 percent 
     of elderly individuals have some type of mental disorder 
     uncommon in typical aging. In addition, elderly individuals 
     have the highest rate of suicide in the U.S., often the 
     result of depression. The Surgeon General's report states, 
     ``Late-life depression is particularly costly because of the 
     excess disability that it causes and its deleterious 
     interaction with physical health. Older primary care patients 
     with depression visit the doctor and emergency rooms more 
     often, use more medication, incur higher outpatient charges, 
     and stay longer at the hospital.''
       The 50 percent coinsurance requirement also is unfair to 
     the non-elderly disabled Medicare population. Because many of 
     these individuals have severe mental illnesses combined with 
     low incomes and high medical expenses, a 50 percent 
     coinsurance obligation is a serious patient burden. For 
     elderly and non-elderly Medicare beneficiaries alike, 
     Medicare is a critical source of care. Your legislation to 
     ensure that Medicare beneficiaries needing mental health care 
     incur only the same cost-sharing obligations as required of 
     all other Medicare patients would end the statutory 
     discrimination against Medicare beneficiaries seeking 
     treatment for mental disorders.
       Thank you for your leadership in addressing this important 
     issue for the nation's 40 million Medicare patients.
           Sincerely,
       Alliance for Children and Families; American Academy of 
     Child and Adolescent Psychiatry; American Association for 
     Geriatric Psychiatry; American Association of Children's 
     Residential Centers; American Association of Pastoral 
     Counselors; American Association of Practicing Psychiatrists; 
     American Group Psychotherapy Association; American Managed 
     Behavioral Healthcare Association; American Mental Health 
     Counselors Association; American Occupational Therapy 
     Association; American Psychiatric Association; American 
     Psychiatric Nurses Association.
       American Psychoanalytic Association; American Psychological 
     Association; American Psychotherapy Association; Anxiety 
     Disorders Association of America; Association for the 
     Advancement of Psychology; Association for Ambulatory 
     Behavioral Healthcare; Bazelon Center for Mental Health Law; 
     Children and Adults with Attention-Deficit/Hyperactivity 
     Disorder; Clinical Social Work Federation; Clinical Social 
     Work Guild; Depression and Bipolar Support Alliance; Eating 
     Disorders Coalition for Research, Policy & Action.
       Ensuring Solutions to Alcohol Problems; International 
     Society of Psychiatric-Mental Health Nurses; NAADAC, The 
     Association for Addiction Professionals; National Alliance 
     for the Mentally Ill; National Association for Children's 
     Behavioral Health; National Association for Rural Mental 
     Health; National Association of Anorexia Nervosa and 
     Associated Disorders (ANAD); National Association of Mental 
     Health Planning & Advisory Councils; National Association of 
     Protection and Advocacy Systems; National Association of 
     Psychiatric Health Systems; National Mental Health 
     Association; and Suicide Prevention Action Network USA.
                                 ______