[Congressional Record Volume 153, Number 105 (Wednesday, June 27, 2007)]
[Senate]
[Page S8616]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Kerry, Mr. Smith, Mr. Biden, Ms. 
        Collins, and Mr. Reed):
  S. 1715. 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 to introduce the Medicare Mental 
Health Copayment Equity Act of 2007. I am pleased to be joined again 
this year by my colleague from Massachusetts, Senator Kerry. Since the 
107th Congress, Senator Kerry has worked tirelessly with me to address 
the problem of mental health care parity. Today, we unite yet again to 
achieve equality between mental and physical health services under 
Medicare.
  Mental illness ranks as the second leading reason that Americans lose 
healthy years of life to premature death or disability. The occurrence 
of mental illness among older adults is widespread, with nearly one in 
five Americans aged 55 and older experiencing specific disorders that 
are not a part of normal aging. In fact, older Americans have the 
highest rate of suicide in the country, and their risk increases with 
age, and is further exacerbated by impediments to treatment.
  It is critical to note that while Medicare is often viewed as health 
insurance for people over age 65, it also provides care for those with 
severe disabilities. In fact, mental disorders are the single most 
frequent cause of disability, affecting more than one out of four 
Medicare beneficiaries. So the problem of access to mental health 
treatment is a pressing one for Medicare.
  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.
  Yet Medicare pays far less for critical mental health services needed 
by these beneficiaries than it does for medical treatment for physical 
disabilities. Medicare beneficiaries typically pay 20 percent of the 
cost of covered outpatient services, including doctor's visits, and 
Medicare pays the remaining 80 percent. However, this does not apply to 
outpatient mental health services; here Medicare law imposes a special 
limitation, which requires patients to pay a much higher copayment of 
50 percent.
  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. Yet 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. That impedes 
critically-needed treatment, creating disability and resulting in lives 
needlessly lost.
  Our bill will eliminate the barrier to access which the present 
discriminatory copayment imposes, by phasing out the disparate payment 
policy over a 6-year period. This will lower the copayment rate for 
mental health services from the current 50 percent to the standard 20 
percent. This means that, in 2013, 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. Our bill creates ``copayment equity'' 
for Medicare mental health services. It is time to end the distinction 
between physical and mental disorders under Medicare.
  I urge my colleagues to join with Senator Kerry and myself in 
supporting the Medicare Mental Health Copayment Equity Act of 2007 for 
equal treatment of mental health services under Medicare.
  Mr. KERRY. Mr. President, I am pleased to join my colleague Senator 
Snowe in once again introducing the Medicare Mental Health Copayment 
Equity Act of 2007. This legislation will establish mental health care 
parity in the Medicare Program.
  Medicare currently requires patients to pay a 20 percent copayment 
for all Part B services except mental health care services, for which 
patients are assessed a 50 percent copayment. 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 
copayment is 20 percent of the cost of the visit. If, however, a 
Medicare patient visits a psychiatrist for treatment of mental illness, 
the copayment is 50 percent of the cost of the visit. This disparity in 
outpatient copayment 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 U.S., and there is a clear 
correlation between major depression and suicide: 60 to 75 percent of 
suicides among patients 75 and older have diagnosable depression. In 
addition to our seniors, hundreds of thousands of nonelderly 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 Health 
Copayment Equity Act will provide for the reduction of the coinsurance 
rate for outpatient mental health services over a 6-year period. By 
applying the same 20 percent copayment 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.
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