[Congressional Record Volume 153, Number 138 (Tuesday, September 18, 2007)]
[Senate]
[Pages S11679-S11684]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MENTAL HEALTH PARITY ACT OF 2007
Mr. REID. I ask unanimous consent that the Senate proceed to the
consideration of Calendar No. 93, S. 558.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 558) to provide parity between health insurance
coverage of mental health benefits and benefits for medical
and surgical services.
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Health, Education, Labor
and Pensions with an amendment to strike all after the enacting clause
and insert in lieu thereof the following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mental Health Parity Act of
2007''.
SEC. 2. MENTAL HEALTH PARITY.
(a) Amendments of ERISA.--Subpart B of part 7 of title I of
the Employee Retirement Income Security Act of 1974 is
amended by inserting after section 712 (29 U.S.C. 1185a) the
following:
``SEC. 712A. MENTAL HEALTH PARITY.
``(a) In General.--In the case of a group health plan (or
health insurance coverage offered in connection with such a
plan) that provides both medical and surgical benefits and
mental health benefits, such plan or coverage shall ensure
that--
``(1) the financial requirements applicable to such mental
health benefits are no more restrictive than the financial
requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage),
including deductibles, copayments, coinsurance, out-of-pocket
expenses, and annual and lifetime limits, except that the
plan (or coverage) may not establish separate cost sharing
requirements that are applicable only with respect to mental
health benefits; and
``(2) the treatment limitations applicable to such mental
health benefits are no more restrictive than the treatment
limitations applied to substantially all medical and surgical
benefits covered by the plan (or coverage), including limits
on the frequency of treatment, number of visits, days of
coverage, or other similar limits on the scope or duration of
treatment.
``(b) Clarifications.--In the case of a group health plan
(or health insurance coverage offered in connection with such
a plan) that provides both medical and surgical benefits and
mental health benefits, such plan or coverage shall not be
prohibited from--
``(1) negotiating separate reimbursement or provider
payment rates and service delivery systems for different
benefits consistent with subsection (a);
``(2) managing the provision of mental health benefits in
order to provide medically necessary services for covered
benefits, including through the use of any utilization
review, authorization or management practices, the
application of medical necessity and appropriateness criteria
applicable to behavioral health, and the contracting with and
use of a network of providers; or
``(3) applying the provisions of this section in a manner
that takes into consideration similar treatment settings or
similar treatments.
``(c) In- and Out-of-Network.--
``(1) In general.--In the case of a group health plan (or
health insurance coverage offered in connection with such a
plan) that provides both medical and surgical benefits and
mental health benefits, and that provides such benefits on
both an in- and out-of-network basis pursuant to the terms of
the plan (or coverage), such plan (or coverage) shall ensure
that the requirements of this section are applied to both in-
and out-of-network services by comparing in-network medical
and surgical benefits to in-network mental health benefits
and out-of-network medical and surgical benefits to out-of-
network mental health benefits.
``(2) Clarification.--Nothing in paragraph (1) shall be
construed as requiring that a group health plan (or coverage
in connection with such a plan) eliminate, reduce, or provide
out-of-network coverage with respect to such plan (or
coverage).
``(d) Small Employer Exemption.--
``(1) In general.--This section shall not apply to any
group health plan (and group health insurance coverage
offered in connection with a group health plan) for any plan
year of any employer who employed an average of at least 2
(or 1 in the case of an employer residing in a State that
permits small groups to include a single individual) but not
more than 50 employees on business days during the preceding
calendar year.
``(2) Application of certain rules in determination of
employer size.--For purposes of this subsection:
``(A) Application of aggregation rule for employers.--Rules
similar to the rules under subsections (b), (c), (m), and (o)
of section 414 of the Internal Revenue Code of 1986 shall
apply for purposes of treating persons as a single employer.
``(B) Employers not in existence in preceding year.--In the
case of an employer which was not in existence throughout the
preceding calendar year, the determination of whether such
employer is a small employer shall be based on the average
number of employees that it is reasonably expected such
employer will employ on business days in the current calendar
year.
``(C) Predecessors.--Any reference in this paragraph to an
employer shall include a reference to any predecessor of such
employer.
``(e) Cost Exemption.--
``(1) In general.--With respect to a group health plan (or
health insurance coverage offered in connections with such a
plan), if the application of this section to such plan (or
coverage) results in an increase for the plan year involved
of the actual total costs of coverage with respect to medical
and surgical benefits and mental health benefits under the
plan (as determined and certified under paragraph (3)) by an
amount that exceeds the applicable percentage described in
paragraph (2) of the actual total plan costs, the provisions
of this section shall not apply to such plan (or coverage)
during the following plan year, and such exemption shall
apply to the plan (or coverage) for 1 plan year. An employer
may elect to continue to apply mental health parity pursuant
to this section with respect to the group health plan (or
coverage) involved regardless of any increase in total costs.
``(2) Applicable percentage.--With respect to a plan (or
coverage), the applicable percentage described in this
paragraph shall be--
``(A) 2 percent in the case of the first plan year in which
this section is applied; and
``(B) 1 percent in the case of each subsequent plan year.
``(3) Determinations by actuaries.--Determinations as to
increases in actual costs under a plan (or coverage) for
purposes of this section shall be made by a qualified actuary
who is a member in good standing of the American Academy of
Actuaries. Such determinations shall be certified by the
actuary and be made available to the general public.
``(4) 6-month determinations.--If a group health plan (or a
health insurance issuer offering coverage in connections with
a group health plan) seeks an exemption under this
subsection, determinations under paragraph (1) shall be made
after such plan (or coverage) has complied with this section
for the first 6 months of the plan year involved.
``(5) Notification.--An election to modify coverage of
mental health benefits as permitted under this subsection
shall be treated as a material modification in the terms of
the plan as described in section 102(a)(1) and shall be
subject to the applicable notice requirements under section
104(b)(1).
``(f) Rule of Construction.--Nothing in this section shall
be construed to require a group health plan (or health
insurance coverage offered in connection with such a plan) to
provide any mental health benefits.
``(g) Mental Health Benefits.--In this section, the term
`mental health benefits' means benefits with respect to
mental health services (including substance abuse treatment)
as defined under the terms of the group health plan or
coverage.''.
(b) Public Health Service Act.--Subpart 2 of part A of
title XXVII of the Public Health Service Act is amended by
inserting after section 2705 (42 U.S.C. 300gg-5) the
following:
``SEC. 2705A. MENTAL HEALTH PARITY.
``(a) In General.--In the case of a group health plan (or
health insurance coverage offered in connection with such a
plan) that provides both medical and surgical benefits and
mental health benefits, such plan or coverage shall ensure
that--
``(1) the financial requirements applicable to such mental
health benefits are no more restrictive than the financial
requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage),
including deductibles, copayments, coinsurance, out-of-pocket
expenses, and annual and lifetime limits, except that the
plan (or coverage) may not establish separate cost sharing
requirements that are applicable only with respect to mental
health benefits; and
``(2) the treatment limitations applicable to such mental
health benefits are no more restrictive than the treatment
limitations applied to substantially all medical and surgical
benefits covered by the plan (or coverage), including limits
on the frequency of treatment, number of visits, days of
coverage, or other similar limits on the scope or duration of
treatment.
``(b) Clarifications.--In the case of a group health plan
(or health insurance coverage offered in connection with such
a plan) that provides both medical and surgical benefits and
mental health benefits, such plan or coverage shall not be
prohibited from--
``(1) negotiating separate reimbursement or provider
payment rates and service delivery systems for different
benefits consistent with subsection (a);
``(2) managing the provision of mental health benefits in
order to provide medically necessary services for covered
benefits, including through the use of any utilization
review, authorization or management practices, the
application of medical necessity and appropriateness criteria
applicable to behavioral health, and the contracting with and
use of a network of providers; or
[[Page S11680]]
``(3) be prohibited from applying the provisions of this
section in a manner that takes into consideration similar
treatment settings or similar treatments.
``(c) In- and Out-of-Network.--
``(1) In general.--In the case of a group health plan (or
health insurance coverage offered in connection with such a
plan) that provides both medical and surgical benefits and
mental health benefits, and that provides such benefits on
both an in- and out-of-network basis pursuant to the terms of
the plan (or coverage), such plan (or coverage) shall ensure
that the requirements of this section are applied to both in-
and out-of-network services by comparing in-network medical
and surgical benefits to in-network mental health benefits
and out-of-network medical and surgical benefits to out-of-
network mental health benefits.
``(2) Clarification.--Nothing in paragraph (1) shall be
construed as requiring that a group health plan (or coverage
in connection with such a plan) eliminate, reduce, or provide
out-of-network coverage with respect to such plan (or
coverage).
``(d) Small Employer Exemption.--
``(1) In general.--This section shall not apply to any
group health plan (and group health insurance coverage
offered in connection with a group health plan) for any plan
year of any employer who employed an average of at least 2
(or 1 in the case of an employer residing in a State that
permits small groups to include a single individual) but not
more than 50 employees on business days during the preceding
calendar year.
``(2) Application of certain rules in determination of
employer size.--For purposes of this subsection:
``(A) Application of aggregation rule for employers.--Rules
similar to the rules under subsections (b), (c), (m), and (o)
of section 414 of the Internal Revenue Code of 1986 shall
apply for purposes of treating persons as a single employer.
``(B) Employers not in existence in preceding year.--In the
case of an employer which was not in existence throughout the
preceding calendar year, the determination of whether such
employer is a small employer shall be based on the average
number of employees that it is reasonably expected such
employer will employ on business days in the current calendar
year.
``(C) Predecessors.--Any reference in this paragraph to an
employer shall include a reference to any predecessor of such
employer.
``(e) Cost Exemption.--
``(1) In general.--With respect to a group health plan (or
health insurance coverage offered in connections with such a
plan), if the application of this section to such plan (or
coverage) results in an increase for the plan year involved
of the actual total costs of coverage with respect to medical
and surgical benefits and mental health benefits under the
plan (as determined and certified under paragraph (3)) by an
amount that exceeds the applicable percentage described in
paragraph (2) of the actual total plan costs, the provisions
of this section shall not apply to such plan (or coverage)
during the following plan year, and such exemption shall
apply to the plan (or coverage) for 1 plan year. An employer
may elect to continue to apply mental health parity pursuant
to this section with respect to the group health plan (or
coverage) involved regardless of any increase in total costs.
``(2) Applicable percentage.--With respect to a plan (or
coverage), the applicable percentage described in this
paragraph shall be--
``(A) 2 percent in the case of the first plan year in which
this section is applied; and
``(B) 1 percent in the case of each subsequent plan year.
``(3) Determinations by actuaries.--Determinations as to
increases in actual costs under a plan (or coverage) for
purposes of this section shall be made by a qualified actuary
who is a member in good standing of the American Academy of
Actuaries. Such determinations shall be certified by the
actuary and be made available to the general public.
``(4) 6-month determinations.--If a group health plan (or a
health insurance issuer offering coverage in connections with
a group health plan) seeks an exemption under this
subsection, determinations under paragraph (1) shall be made
after such plan (or coverage) has complied with this section
for the first 6 months of the plan year involved.
``(5) Notification.--An election to modify coverage of
mental health benefits as permitted under this subsection
shall be treated as a material modification in the terms of
the plan as described in section 102(a)(1) and shall be
subject to the applicable notice requirements under section
104(b)(1).
``(f) Rule of Construction.--Nothing in this section shall
be construed to require a group health plan (or health
insurance coverage offered in connection with such a plan) to
provide any mental health benefits.
``(g) Mental Health Benefits.--In this section, the term
`mental health benefits' means benefits with respect to
mental health services (including substance abuse treatment)
as defined under the terms of the group health plan or
coverage, and when applicable as may be defined under State
law when applicable to health insurance coverage offered in
connection with a group health plan.''.
SEC. 3. EFFECTIVE DATE.
(a) In General.--The provisions of this Act shall apply to
group health plans (or health insurance coverage offered in
connection with such plans) beginning in the first plan year
that begins on or after January 1 of the first calendar year
that begins more than 1 year after the date of the enactment
of this Act.
(b) Termination of Certain Provisions.--
(1) ERISA.--Section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a) is amended by striking
subsection (f) and inserting the following:
``(f) Sunset.--This section shall not apply to benefits for
services furnished after the effective date described in
section 3(a) of the Mental Health Parity Act of 2007.''.
(2) PHSA.--Section 2705 of the Public Health Service Act
(42 U.S.C. 300gg-5) is amended by striking subsection (f) and
inserting the following:
``(f) Sunset.--This section shall not apply to benefits for
services furnished after the effective date described in
section 3(a) of the Mental Health Parity Act of 2007.''.
SEC. 4. SPECIAL PREEMPTION RULE.
(a) ERISA Preemption.--Section 731 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1191) is
amended--
(1) by redesignating subsections (c) and (d) as subsections
(e) and (f), respectively; and
(2) by inserting after subsection (b), the following:
``(c) Special Rule in Case of Mental Health Parity
Requirements.--
``(1) In general.--Notwithstanding any provision of section
514 to the contrary, the provisions of this part relating to
a group health plan or a health insurance issuer offering
coverage in connection with a group health plan shall
supercede any provision of State law that establishes,
implements, or continues in effect any standard or
requirement which differs from the specific standards or
requirements contained in subsections (a), (b), (c), or (e)
of section 712A.
``(2) Clarifications.--Nothing in this subsection shall be
construed to preempt State insurance laws relating to the
individual insurance market or to small employers (as such
term is defined for purposes of section 712A(d)).''.
(b) PHSA Preemption.--Section 2723 of the Public Health
Service Act (42 U.S.C. 300gg-23) is amended--
(1) by redesignating subsections (c) and (d) as subsections
(e) and (f), respectively; and
(2) by inserting after subsection (b), the following:
``(c) Special Rule in Case of Mental Health Parity
Requirements.--
``(1) In general.--Notwithstanding any provision of section
514 of the Employee Retirement Income Security Act of 1974 to
the contrary, the provisions of this part relating to a group
health plan or a health insurance issuer offering coverage in
connection with a group health plan shall supercede any
provisions of State law that establishes, implements, or
continues in effect any standard or requirement which differs
from the specific standards or requirements contained in
subsections (a), (b), (c), or (e) of section 2705A.
``(2) Clarifications.--Nothing in this subsection shall be
construed to preempt State insurance laws relating to the
individual insurance market or to small employers (as such
term is defined for purposes of section 2705A(d)).''.
(c) Effective Date.--The provisions of this section shall
take effect with respect to a State, on the date on which the
provisions of section 2 apply with respect to group health
plans and health insurance coverage offered in connection
with group health plans.
SEC. 5. FEDERAL ADMINISTRATIVE RESPONSIBILITIES.
(a) Group Health Plan Ombudsman.--
(1) Department of labor.--The Secretary of Labor shall
designate an individual within the Department of Labor to
serve as the group health plan ombudsman for the Department.
Such ombudsman shall serve as an initial point of contact to
permit individuals to obtain information and provide
assistance concerning coverage of mental health services
under group health plans in accordance with this Act.
(2) Department of health and human services.--The Secretary
of Health and Human Services shall designate an individual
within the Department of Health and Human Services to serve
as the group health plan ombudsman for the Department. Such
ombudsman shall serve as an initial point of contact to
permit individuals to obtain information and provide
assistance concerning coverage of mental health services
under health insurance coverage issued in connection with
group health plans in accordance with this Act.
(b) Audits.--The Secretary of Labor and the Secretary of
Health and Human Services shall each provide for the conduct
of random audits of group health plans (and health insurance
coverage offered in connection with such plans) to ensure
that such plans are in compliance with this Act (and the
amendments made by this Act).
(c) Government Accountability Office Study.--
(1) Study.--The Comptroller General shall conduct a study
that evaluates the effect of the implementation of the
amendments made by this Act on the cost of health insurance
coverage, access to health insurance coverage (including the
availability of in-network providers), the quality of health
care, the impact on benefits and coverage for mental health
and substance abuse, the impact of any additional cost or
savings to the plan, the impact on out-of-network coverage
for mental health benefits (including substance abuse
treatment), the impact on State mental health benefit mandate
laws, other impact on the business community and the Federal
Government, and other issues as determined appropriate by the
Comptroller General.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall prepare
and submit to the appropriate committees of Congress a report
containing the results of the study conducted under paragraph
(1).
(d) Regulations.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Labor and the
Secretary of Health and Human Services shall jointly
promulgate final regulations to carry out this Act.
[[Page S11681]]
Mr. KENNEDY. Mr. President, today is a landmark day in our nation's
struggle to achieve access to mental health services for all Americans.
The Mental Health Parity Act of 2007 reflects a major agreement by the
mental health community, business leaders, and the insurance industry
to guarantee that persons with mental health needs receive fair and
equitable health insurance. Its passage will mean dramatic new help for
113 million Americans who today are without mental health care and
treatment.
Access to such care and treatment is one of the most important and
neglected civil rights issues facing the nation. For too long, persons
living with mental disorders have suffered discriminatory treatment at
all levels of society. They have been forced to pay more for the
services they need and to worry about their job security if their
employer learns of their condition. Sadly, in America today, patients
with biochemical problems in their livers receive better care and
greater compassion than patients with biochemical problems in their
brains.
This bill will help end such unacceptable discrimination. As we have
seen in the recent bipartisan CHIP legislation, no one questions the
need for affordable treatment of physical illnesses, but those who
suffer from mental illnesses face serious barriers in obtaining the
care they need at a cost they can afford.
Like those suffering from physical illnesses, persons with mental
disorders deserve the opportunity for quality care. The failure to
obtain treatment can mean years of shattered dreams, unfulfilled
potential and broken lives.
The need is clear. One in five Americans will suffer some form of
mental illness this year, but only a third of them will receive
treatment. Millions of our fellow citizens are unnecessarily enduring
the pain and sadness of seeing a family member, friend, or loved one
suffer illnesses that seize the mind and break the spirit.
Battling mental illness is a difficult process, but discrimination
against persons with such illnesses is especially cruel, since the
success rates for treatment often equal or surpass those for physical
conditions. According to the National Institute of Mental Health,
clinical depression treatment can be 70 percent successful, and
treatment for schizophrenia can be 60 percent successful.
Eleven years ago, a bipartisan majority in Congress approved the
original Mental Health Parity Act. That legislation was an important
first step in bringing attention to discriminatory practices against
the mentally ill, but it did little to correct the injustices that so
many Americans continue to face. This bill takes the actions needed to
end the long-standing discrimination against persons with mental
illness.
Over the years we have heard compelling testimony from experts,
activists, and patients about the need to equalize coverage of physical
and mental illnesses. Some of the most forceful testimony came several
years ago from Lisa Cohen, a hardworking American from New Jersey, who
suffers from both physical and mental illnesses, and is forced to pay
exorbitant costs for treating her mental disorder, while paying very
little for her physical disorder. Lisa is typical of millions of
Americans for whom the burden of mental illness is compounded by the
burden of unfair discrimination.
No Americans should be denied equal treatment for an illness because
it involves the brain instead of the heart, the lungs, or other parts
of their body. Mental health parity is a good investment for the
Nation. The costs from lost worker productivity and extra physical care
outweigh the costs of implementing parity for mental health treatment.
Study after study has shown that parity makes good financial sense.
Mental illness imposes a huge financial burden on the Nation. It costs
us $300 billion each year in treatment expenses, lost worker
productivity, and crime. This country can afford mental health parity.
What we can't afford is to continue denying persons with mental
disorders the care they need.
But equal treatment of those affected by mental illness is not just
an insurance issue. It is a civil rights issue. At its heart, mental
health parity is a question of simple justice.
Today is a turning point. We are finally moving toward ending this
shameful form of discrimination in our society--discrimination against
persons with mental illness. This bill is a true commitment by the
insurance industry, business industry and the mental health community
to bring fairness and dignity to the millions of Americans who have
been second class patients for too long.
The 1996 act was an important step towards ending health insurance
discrimination against mental illness. This bill takes another large
step to close the loopholes that remain.
We would not be here without the strong commitment and skillful
determination of the late Senator Paul Wellstone and Senator Pete
Domenici. They deserve immense credit for their bipartisan leadership
on mental health parity.
I also commend the staff, both Democrat and Republican, who worked so
long and hard on this legislation. I particularly thank Carolyn Gluck
of Senator Reid's office and all the Democratic staff who worked in
recent weeks to help us produce the bill we have today.
I also commend Ed Hild of Senator Domenici's staff and Andrew Patzman
of Senator Enzi's staff for the many hours they spent with my staff to
negotiate the bill.
On my staff, I especially commend several who worked so long and hard
and well on this legislation--Michael Myers, Carmel Martin, Kelsey
Phipps, Daniel Dawes, Jennie Fay, Ches Garrison, and above all Connie
Garner, whose passion, counsel and commitment I value so highly on this
and many other issues. Without her dedicated guidance, we would not be
at this important threshold today.
My hope is that as we improve access to mental health services for
all Americans, we will also help end the stigma and discrimination
against those with mental illness. Mental illnesses are treatable and
curable, and it is high time to bring relief to those who suffer from
them.
Mr. President, I yield the floor.
Mr. ENZI. Mr. President, I rise to join my colleagues and sponsors of
this legislation, Senators Domenici and Kennedy, for their long and
tireless work bringing us to passage of this bill tonight.
This legislation is literally years, if not decades in the making,
and reflects countless hours of sweat and negotiation.
With much effort and indispensable help, we managed to bring together
long-opposed advocates from the mental health advocacy, provider,
employer, and insurance communities around a solid, responsible,
bipartisan, and long-overdue bill.
Passage of this bill is a beacon example of what can be accomplished
when people roll up their sleeves and work together in a bipartisan
way.
This legislation will bring fairness and relief to millions of
Americans suffering from mental illness. The road is not yet over, but
tonight is a tremendous step forward.
Mr. REID. Mr. President, Passage of the Mental Health Parity Act of
2007 is an important victory for individuals who are affected by mental
illnesses. Over a decade has passed since we enacted the landmark 1996
mental health parity law that was championed by my good friend, the
late Senator Paul Wellstone, and Senator Domenici. Before his untimely
death, Paul Wellstone was a tireless and eloquent advocate for
legislation that would strengthen the 1996 law and achieve full parity
in coverage between mental and physical illnesses.
The Mental Health Parity Act of 2007 is the culmination of many years
of work to build on and strengthen the 1996 Mental Health Parity Act.
It is a good compromise that will ensure that plans covering mental
health services cannot provide different financial requirements or
treatment limitations than they would for medical or surgical benefits.
This legislation is long overdue and I will continue to work to ensure
it is enacted as soon as possible.
Mr. DODD. Mr. President, I rise in support of S. 558, the Mental
Health Parity Act of 2007. After many months of negotiations, I am
pleased to call myself a strong supporter of this legislation. I thank
the Chairman of the Health, Education, Labor and pensions Committee and
the senior Senator
[[Page S11682]]
from New Mexico for working with me and congratulate them on passage of
S. 558. They and their staff have worked long hours to craft this
compromise bill. Supporters of mental health parity, old and new,
should commend the leadership of Senators Kennedy and Domenici for
their years of commitment and struggle to pass expanded Federal mental
health parity legislation.
Millions of Americans are affected by mental illness. Each year, more
than 50 million American adults will suffer from a mental disorder. All
of us know a friend, a relative, a neighbor, a colleague whose life has
been touched by mental illness, either their own or the illness of a
loved one. Yet despite the compelling need, under many health plans,
mental health benefits are much more limited than benefits for medical
or surgical care. Even though a range of effective treatments exist for
almost all mental disorders, those suffering from mental illness often
face increased barriers to care and the stigma that underlies
discriminatory practices in how we treat mental illness. These are the
individuals that have insurance. It can only be worse for those without
insurance. Mental health must not take a backseat to other health
conditions.
My own State of Connecticut recognized the disparity between
insurance coverage for physical and mental illness and made significant
steps to address it by enacting strong mental health parity and
consumer protection laws. These laws far exceed what exists currently
at the Federal level and I believe the bill being passed by the Senate
today will allow my State to maintain those strong laws in the future.
I was an original cosponsor of the original mental health parity bill
in 1996 along with Senator Domenici and the late Senator Wellstone and
have been a strong supporter of efforts to strengthen that bill since
it was signed into law. But the legislation the HELP Committee marked
up last February was different from what our late colleague Paul
championed for so many years. The legislation our committee marked up
contained preemption language which was broader in scope than what was
in Federal mental health parity bills in the past.
For that reason, I offered amendments during that markup to address
preemption in a way I believed would have taken a major step toward
protecting State insurance laws and ensuring that we do no harm to
State-based consumer protections through passage of Federal mental
health parity. At that markup, I voiced concerns about the impact the
bill would have on States like Connecticut who have strong mental
health parity laws, strong consumer protection laws, and strong benefit
mandate laws.
As a result of my continued concerns about the impact this bill would
have on the residents of my State, I withheld cosponsorship of the
legislation until the issues surrounding preemption could be resolved.
Due to the hard work and dedication of members on both sides of the
aisle, my concerns have been addressed and I can now support the
legislation.
Specifically, the bill being passed today removed the broad
preemption language entirely. The bill now relies on the existing
preemption of State law standard currently in the Employee Retirement
Income Security Act and the Public Health Service Act, preserving
States' laws relating to health insurance issuers. In many States, such
issuers contract out the key insurance function of reviewing medical
claims by their insureds to utilization review or medical management
companies, which are licensed and regulated by the states. In fact, the
legislation written by Chairman Kennedy, called the Health Insurance
Portability and Accountability Act, HIPAA, was an innovative approach
to Federal health care reform that has worked well in setting a minimum
standard of protections while allowing stronger State-based consumer
protections. It is my understanding that the bill passed today will
operate in a very similar manner.
I thank Senators Kennedy and Domenici for entering into a colloquy
with me to further clarify the intent of this legislation. They have
been open and willing to working with me since the HELP Committee
markup occurred to address the concerns I had with this legislation. I
would also like to acknowledge and thank the tremendous work and
expertise of Mila Kofman, Associate Research Professor, Health Policy
Institute, Georgetown University. She worked tirelessly to assist the
members and staff through the complex issues of ERISA and preemption.
From my own State of Connecticut, I would like to thank Kevin Lembo,
Victoria Veltri, and Richard Kehoe who worked closely with my staff to
ensure that Connecticut's strong mental health parity laws would be
protected under this legislation.
The bill we are passing today will not only mean new Federal
protections for people in self-insured ERISA plans, but it will also
protect workers and families in States with insurance laws that are
stronger than the Federal ones by allowing those State laws to remain
in effect. It reflects months and years of hard work and compromise. It
is a victory for patients who need coverage for mental health services
and I am pleased to stand in support of this legislation.
Mr. DOMENICI. Mr. President, I want to start by thanking my
colleagues, Senators Kennedy and Enzi, for all of their work and
dedication on the Mental Health Parity Act of 2007. We would not be
here this evening without them and a whole host of others both in and
out of the Senate.
Simply put, our legislation will ensure individuals with a mental
illness have parity between mental health coverage and medical and
surgical coverage. No longer will people with a mental illness have
their mental health coverage treated differently than their coverage
for other illnesses. That means parity between the coverage of mental
illnesses and other medical conditions like cancer, heart disease, and
diabetes.
No longer will people be treated differently only because they suffer
from a mental illness, and that means 113 million people in group
health plans will benefit from our bill. We are here after years of
hard work. We have worked with the mental health community and the
business and insurance groups to carefully craft a compromise bill.
No longer will a more restrictive standard be applied to mental
health coverage and another more lenient standard be applied to medical
and surgical coverage. What we are doing is a matter of simple
fairness. I believe that becomes even more important when you consider
the following: 26 percent of American adults, or nearly 58 million
people, suffer from a diagnosable mental disorder each year, and 6
percent of those adults suffer from a serious mental illness. More than
30,000 people commit suicide each year in the United States, and 16
percent of all inmates in State and local jails suffer from a mental
illness.
I would like to take a minute to talk about what we are doing with
the passage of the Mental Health Parity Act of 2007. The bill provides
mental health parity for about 113 million Americans who work for
employers with 50 or more employees, ensures that 98 percent of
businesses which provide a mental health benefit do so in a manner that
is no more restrictive than the coverage of medical and surgical
benefits, and ensures health plans do not place more restrictive
conditions on mental health coverage than on medical and surgical
coverage. The bill accomplishes this by providing parity for financial
requirements like deductibles, copayments, and annual and lifetime
limits and parity for treatment limitations, the number of covered
hospital days and visits.
Again, I want to thank everyone for their extraordinary efforts that
have allowed us to achieve Senate passage of the Mental Health Parity
Act of 2007.
Mr. DURBIN. Mr. President, today the Senate takes a long overdue step
in the right direction for the health of all Americans. The passage of
the Mental Health Parity Act of 2007 recognizes the millions of people
living with a mental illness and the millions of friends, family
members, and communities who support them.
Mental health parity legislation simply calls for health plans to
provide comparable levels of coverage for mental health services as are
provided for traditional medical services. It doesn't sound like a
radical proposal, yet it has taken years to move this legislation
through the Senate.
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We have made progress, though, and much of the leadership on this
issue has been provided by Senator Kennedy and Senator Domenici in
recent years. We started in 1992, when my good friend, the late Senator
Paul Wellstone, and Senator Pete Domenici introduced the Mental Health
Parity Act to correct the unfair burden placed on American families
living with mental illness without access to mental health services.
It took a while, but in 1996, the first mental health parity
legislation was enacted into law. It wasn't a perfect bill. It fell far
short of its goal in many respects, but it was a significant piece of
legislation that acknowledged the longstanding bias against covering
mental health services.
Based on what we did in 1996, current law requires insurers that
offer mental health care to offer comparable benefit caps for mental
health and physical health. Unfortunately, that left a loophole that
has allowed the common practice in which insurers set higher
deductibles, charge higher copays, and cover fewer services for mental
health care. As a result, millions of Americans are left without
affordable mental health treatment. What they are left with is the
often crushing aftermath--loss of employment, poor school performance,
poverty, and even suicide.
Every year since that 1996 law was enacted, the Senate has had a
mental health parity bill to fix this problem, but to no avail. This
year, for the first time in a decade, the Senate has passed a bill to
address the loopholes in the mental health parity law. I commend
Senators Kennedy and Domenici for their dedication to seeing this
through. I only wish that Paul Wellstone could have lived to see this
day.
Paul Wellstone was a good friend of mine and an inspiration to me and
to many others who served with him in the Chamber. Throughout his
congressional career, Paul fought tirelessly for equal rights for all,
regardless of their race, religion, socioeconomic status, or health
status. He was a champion of many causes, but no cause was more dear,
or more personal, to him than making sure that people with mental
illness were treated fairly and with dignity.
Paul Wellstone was touched personally by mental illness. His older
brother lived and struggle with mental illness most of his life. Paul
believed that for his brother, and for all Americans, mental health was
as important as physical health. Senator Pete Domenici,
too, understands the importance of having access to mental health
services. His daughter also has struggled with mental illness.
Fifteen years ago, Senators Wellstone and Domenici brought home a
fact that is as true today as it was then--nearly everyone knows
someone living with a mental illness. According to the National
Institute of Mental Health, more than one in four adults in the United
States--more than 57 million adults--suffer from a diagnosable mental
disorder in a given year. One in seventeen Americans suffers from a
serious mental illness.
These two Senators were fiercely determined to end discrimination
against people with mental illness. We all lost a spirited champion for
mental health on October 25, 2002, when Paul Wellstone was in a fatal
plane crash. But the fight for mental health parity has lived on.
Senator Kennedy quickly took up the fight, and he and Senator Domenici
have resolutely worked to strengthen common ground and supporters who
would bring us to this day, the day of Senate passage of the mental
health parity bill.
Last year, the Senate passed a resolution I submitted that marked the
fourth anniversary of Paul Wellstone's death. The resolution expresses
the sense of the Senate that Congress should act ``to provide for equal
coverage of mental health benefits with respect to health insurance
coverage''--in other words, pass mental health parity.
I am proud to note the Senate's action today. With the passage of the
Mental Health Parity Act of 2007, we are assuring millions of Americans
that mental illness deserves equal treatment as physical illness. We
are telling millions of families that help is available and that they
no longer have to feel excluded. And most importantly, we are opening
doors to hope and closing doors to desperation.
We may not live in a perfect world but we are closer to a more
perfect union. It is in the spirit of Paul Wellstone and--thanks to
Senators Kennedy and Domenici--the spirit of bipartisanship that we
pass this historic piece of legislation. Senator Wellstone was quoted
as saying:
I don't think politics has anything to do with left, right,
or center. It has to do with trying to do right by the
people.
Today, I think Paul would agree that the Senate has done right.
PREEMPTION AND PROTECTING STATE LAWS
Mr. DOMENICI. Mr. President, as someone who has worked to bring a
greater understanding of mental illness and to end all forms of
discrimination against people who suffer from a mental illness, I am
pleased to report that the Senate has passed a monumental mental health
parity bill that could bring hope and greater measure of fairness in
mental health insurance care coverage to as many as 113 million
Americans and nearly 500,000 New Mexicans. This legislation, the Mental
Health Parity Act of 2007, builds on the 1996 Mental Health Parity law
that I authored with the late Senator Paul Wellstone. It is supported
by more than 230 organizations and has been a bipartisan effort from
the beginning. I thank Senator Kennedy, the chairman of the Health,
Education, Labor and Pensions Committee, for his vision, his leadership
and his support for this legislation.
Mr. KENNEDY. I thank the Senator from New Mexico for his tremendous
leadership on this bill. He has fought for this legislation for many
years, and I am grateful for his commitment to getting this bill
passed. This legislation represents the culmination of more than a
year's negotiations involving lawmakers, mental health, insurance and
business organizations to craft compromise legislation. During the
markup of the bill last February, my colleague Senator Dodd raised very
important issues regarding the effects of the preemption language in
the legislation. Since then, he was joined by several other Senators,
attorneys general, and State insurance commissioners who have voiced
concerns about unintended consequences of the bill. It was never the
intent of the bill to harm or weaken State insurance laws but in
response to concerns raised by several of my colleagues and insurance
experts, the language pertaining to preemption was stricken from the
legislation.
Mr. DODD. I thank the chairman of the HELP Committee and the
distinguished senior Senator from New Mexico and congratulate them on
passage of S. 558, the Mental Health Parity Act. They and their staff
have worked long hours to craft this compromise bill, and I
congratulate them on this victory for individuals with mental illness
throughout the country. Supporters of mental health parity, old and
new, should commend the leadership of Senators Domenici and Kennedy for
their years of commitment and struggle to pass Federal mental health
parity legislation.
I was an original cosponsor of the original mental health parity bill
in 1996, along with Senator Domenici and the late Senator Wellstone,
and have been a strong supporter of efforts to strengthen that bill
since it was signed into law. But, as my colleagues may know, the
legislation the HELP Committee marked up last February which is now
before the Senate is different from what our late colleague Paul
championed for so many years. The legislation our committee marked up
contained preemption language which was broader in scope than what was
in Federal mental health parity bills in the past. For that reason, I
filed amendments during that markup to address preemption in a way I
believed would have taken a major step toward protecting State
insurance laws and ensuring that we do no harm to State-based consumer
protections through Federal mental health parity. At that markup, I
voiced concerns about the impact the bill would have on States like
Connecticut who have strong mental health parity laws, strong consumer
protection laws, and strong benefit mandate laws.
As a result of my continued concerns about the impact this bill would
have on the residents of my State, I withheld cosponsorship of the
legislation until the issues surrounding preemption could be resolved.
I am pleased to say that because of the hard work and
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dedication of Members on both sides of the aisle, my concerns have been
addressed and I can now support the legislation.
Mr. KENNEDY. I thank the senior Senator from Connecticut and
appreciate his leadership on this issue. He raised a number of
important issues during the consideration of this bill. I believe we
have addressed those concerns in the legislation and I am pleased that
he is now a strong supporter of the legislation.
Mr. DODD. The bill passing the Senate today relies on the existing
preemption of State law standard currently in ERISA and the Public
Health Service Act, preserving States laws relating to health insurance
issuers. In many States, such issuers contract out the key insurance
function of reviewing medical claims by their insurers to utilization
review or medical management companies, which are licensed and
regulated by the States. In fact, the legislation written by the
Senator from Massachusetts, called HIPAA, was an innovative approach to
Federal health care reform that has worked so well in setting a minimum
standard of protections while allowing stronger State-based consumer
protections. Is it the distinguished senior Senator from Massachusetts'
belief that S. 558 preserves the States' ability to regulate such
companies?
Mr. KENNEDY. Yes, nothing in this bill affects any State law or State
regulation of any company or issuer who performs utilization review or
other medical management services. The changes made to the preemption
section of S. 558 mean that the current HIPAA standard would apply to
this legislation, just like it applies to existing law passed in 1996.
By using existing preemption language, we mean only the narrowest
preemption of State laws. A minimum standard of Federal protection
allows States to provide additional protection for their citizens.
State laws designed to regulate medical management or utilization
review to protect plan participants are not preempted under the bill
because they do not ``prevent the application'' of the substantive
provisions of this bill.
Mr. DODD. Is it also the understanding of the senior Senator from New
Mexico that this legislation will not only mean new Federal protections
for people in self-insured ERISA plans, but it will also protect
workers and families in States with insurance laws that are stronger
than the Federal ones by allowing those State laws to remain in effect?
Mr. DOMENICI. Yes, the senior Senator from Connecticut is correct.
Mr. DODD. I thank the Senator and want to thank the Senator from
Massachusetts for allowing my concerns about preemption and protecting
State laws to be heard in the committee and for working tirelessly with
me to address those concerns. The bill we are passing reflects months
and years of hard work and compromise, and I am pleased to voice my
strong support for S. 558. It is a victory for patients who need
coverage for mental health services.
Mr. REID. I ask unanimous consent that the amendment at the desk be
considered and agreed to; the committee-reported amendment, as amended,
be agreed to; the motions to reconsider be laid upon the table, en
bloc; the bill, as amended, be read three times and passed; the motion
to reconsider be laid upon the table; and that any statements be
printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 2908) was agreed to.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The bill (S. 558), as amended, was ordered to be engrossed for a
third reading, was read the third time, and passed.
Mr. REID. Mr. President, I congratulate Senators Kennedy, Enzi, and
others who worked on this legislation for such a long time. They are to
be commended. Senator Wellstone, I am sure, is smiling on us today.
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