[Congressional Record Volume 154, Number 37 (Wednesday, March 5, 2008)]
[House]
[Pages H1274-H1309]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     PAUL WELLSTONE MENTAL HEALTH AND ADDICTION EQUITY ACT OF 2007

  Mr. PALLONE. Mr. Speaker, pursuant to House Resolution 1014, I call 
up the bill (H.R. 1424) to amend section 712 of the Employee Retirement 
Income Security Act of 1974, section 2705 of the Public Health Service 
Act, and section 9812 of the Internal Revenue Code of 1986 to require 
equity in the provision of mental health and substance-related disorder 
benefits under group health plans, and ask for its immediate 
consideration.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1424

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Paul 
     Wellstone Mental Health and Addiction Equity Act of 2007''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Amendments to the Employee Retirement Income Security Act of 
              1974.
Sec. 3. Amendments to the Public Health Service Act relating to the 
              group market.
Sec. 5. Amendments to the Internal Revenue Code of 1986.
Sec. 5. Government Accountability Office studies and reports.

     SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 712 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1185a) is 
     amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--
       ``(A) No treatment limit.--If the plan or coverage does not 
     include a treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services, the plan or coverage may not 
     impose any treatment limit on mental health and substance-
     related disorder benefits that are classified in the same 
     category of items or services.
       ``(B) Treatment limit.--If the plan or coverage includes a 
     treatment limit on substantially all medical and surgical 
     benefits in any category of items or services, the plan or 
     coverage may not impose such a treatment limit on mental 
     health and substance-related disorder benefits for items and 
     services within such category that are more restrictive than 
     the predominant treatment limit that is applicable to medical 
     and surgical benefits for items and services within such 
     category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following four categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits and all mental health and 
     substance related benefits shall be classified into one of 
     the following categories:
       ``(i) Inpatient, in-network.--Items and services furnished 
     on an inpatient basis and within a network of providers 
     established or recognized under such plan or coverage.
       ``(ii) Inpatient, out-of-network.--Items and services 
     furnished on an inpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iii) Outpatient, in-network.--Items and services 
     furnished on an outpatient basis and within a network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iv) Outpatient, out-of-network.--Items and services 
     furnished on an outpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan or coverage, limitation on the frequency of treatment, 
     number of visits or days of coverage, or other similar limit 
     on the duration or scope of treatment under the plan or 
     coverage.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--
       ``(A) No beneficiary financial requirement.--If the plan or 
     coverage does not include a beneficiary financial requirement 
     (as defined in subparagraph (C)) on substantially all medical 
     and surgical benefits within a category of items and services 
     (specified under paragraph (3)(C)), the plan or coverage may 
     not impose such a beneficiary financial requirement on mental 
     health and substance-related disorder benefits for items and 
     services within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan or coverage 
     includes a deductible, a limitation on out-of-pocket 
     expenses, or similar beneficiary financial requirement that 
     does not apply separately to individual items and services on 
     substantially all medical and surgical benefits within a 
     category of items and services (as specified in paragraph 
     (3)(C)), the plan or coverage shall apply such requirement 
     (or, if there is more than one such requirement for such 
     category of items and services, the predominant requirement 
     for such category) both to medical and surgical benefits 
     within such category and to mental health and substance-
     related disorder benefits within such category and shall not 
     distinguish in the application of such requirement between 
     such medical and surgical benefits and such mental health and 
     substance-related disorder benefits.
       ``(ii) Other financial requirements.--If the plan or 
     coverage includes a beneficiary financial requirement not 
     described in clause (i) on substantially all medical and 
     surgical benefits within a category of items and services, 
     the plan or coverage may not impose such financial 
     requirement on mental health and substance-related disorder 
     benefits for items and services within such category in a way 
     that is more costly to the participant or beneficiary than 
     the predominant beneficiary financial requirement applicable 
     to medical and surgical benefits for items and services 
     within such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan or coverage, 
     any deductible, coinsurance, co-payment,

[[Page H1275]]

     other cost sharing, and limitation on the total amount that 
     may be paid by a participant or beneficiary with respect to 
     benefits under the plan or coverage, but does not include the 
     application of any aggregate lifetime limit or annual 
     limit.''; and
       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'';
       (B) by striking ``; or'' and inserting a period; and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Such section is further amended--
       (1) by striking ``mental health benefits'' and inserting 
     ``mental health and substance-related disorder benefits'' 
     each place it appears; and
       (2) in paragraph (4) of subsection (e)--
       (A) by striking ``Mental health benefits'' and inserting 
     ``Mental health and substance-related disorder benefits'';
       (B) by striking ``benefits with respect to mental health 
     services'' and inserting ``benefits with respect to services 
     for mental health conditions or substance-related 
     disorders''; and
       (C) by striking ``, but does not include benefits with 
     respect to treatment of substances abuse or chemical 
     dependency''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of such section, as 
     amended by subsection (a)(1), is further amended by adding at 
     the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits (or the health insurance coverage offered in 
     connection with the plan with respect to such benefits) shall 
     be made available by the plan administrator (or the health 
     insurance issuer offering such coverage) to any current or 
     potential participant, beneficiary, or contracting provider 
     upon request. The reason for any denial under the plan (or 
     coverage) of reimbursement or payment for services with 
     respect to mental health and substance-related disorder 
     benefits in the case of any participant or beneficiary shall, 
     upon request, be made available by the plan administrator (or 
     the health insurance issuer offering such coverage) to the 
     participant or beneficiary.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of such 
     section is further amended by adding at the end the following 
     new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides any mental health and substance-related 
     disorder benefits, the plan or coverage shall include 
     benefits for any mental health condition or substance-related 
     disorder for which benefits are provided under the benefit 
     plan option offered under chapter 89 of title 5, United 
     States Code, with the highest average enrollment as of the 
     beginning of the most recent year beginning on or before the 
     beginning of the plan year involved.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) In general.--In the case of a plan or coverage that 
     provides both medical and surgical benefits and mental health 
     and substance-related disorder benefits, if medical and 
     surgical benefits are provided for substantially all items 
     and services in a category specified in clause (ii) furnished 
     outside any network of providers established or recognized 
     under such plan or coverage, the mental health and substance-
     related disorder benefits shall also be provided for items 
     and services in such category furnished outside any network 
     of providers established or recognized under such plan or 
     coverage in accordance with the requirements of this section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (including an emergency 
     condition relating to mental health and substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     subsection (c) of such section is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan (or 
     health insurance coverage offered in connection 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 and substance-related 
     disorder benefits under the plan (as determined and certified 
     under subparagraph (C)) by an amount that exceeds the 
     applicable percentage described in subparagraph (B) 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.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     paragraph shall be--
       ``(i) 2 percent in the case of the first plan year which 
     begins after the date of the enactment of the Paul Wellstone 
     Mental Health and Addiction Equity Act of 2007; and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan (or coverage) for 
     purposes of this subsection 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.
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     such a plan) seeks an exemption under this paragraph, 
     determinations under subparagraph (A) shall be made after 
     such plan (or coverage) has complied with this section for 
     the first 6 months of the plan year involved.
       ``(E) Notification.--An election to modify coverage of 
     mental health and substance-related disorder benefits as 
     permitted under this paragraph 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) Change in Exclusion for Smallest Employers.--Subsection 
     (c)(1)(B) of such section is amended--
       (1) by inserting ``(or 1 in the case of an employer 
     residing in a State that permits small groups to include a 
     single individual)'' after ``at least 2'' the first place it 
     appears; and
       (2) by striking ``and who employs at least 2 employees on 
     the first day of the plan year''.
       (g) Elimination of Sunset Provision.--Such section is 
     amended by striking out subsection (f).
       (h) Clarification Regarding Preemption.--Such section is 
     further amended by inserting after subsection (e) the 
     following new subsection:
       ``(f) Preemption, Relation to State Laws.--
       ``(1) In general.--Nothing in this section shall be 
     construed to preempt any State law that provides greater 
     consumer protections, benefits, methods of access to 
     benefits, rights or remedies that are greater than the 
     protections, benefits, methods of access to benefits, rights 
     or remedies provided under this section.
       ``(2) ERISA.--Nothing in this section shall be construed to 
     affect or modify the provisions of section 514 with respect 
     to group health plans.''.
       (i) Conforming Amendments to Heading.--
       (1) In general.--The heading of such section is amended to 
     read as follows:

     ``SEC. 712. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (2) Clerical amendment.--The table of contents in section 1 
     of such Act is amended by striking the item relating to 
     section 712 and inserting the following new item:

``Sec. 712. Equity in mental health and substance-related disorder 
              benefits.''.

       (j) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2008.

     SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING 
                   TO THE GROUP MARKET.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 2705 of the Public Health 
     Service Act (42 U.S.C. 300gg-5) is amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--
       ``(A) No treatment limit.--If the plan or coverage does not 
     include a treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services (specified in subparagraph 
     (C)), the plan or coverage may not impose any treatment limit 
     on mental health and substance-related disorder benefits that 
     are classified in the same category of items or services.
       ``(B) Treatment limit.--If the plan or coverage includes a 
     treatment limit on substantially all medical and surgical 
     benefits in any category of items or services, the plan or 
     coverage may not impose such a treatment limit on mental 
     health and substance-related disorder benefits for items and 
     services within such category that are more restrictive than 
     the predominant treatment limit that is applicable to medical 
     and surgical benefits for items and services within such 
     category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following four categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits

[[Page H1276]]

     and all mental health and substance related benefits shall be 
     classified into one of the following categories:
       ``(i) Inpatient, in-network.--Items and services furnished 
     on an inpatient basis and within a network of providers 
     established or recognized under such plan or coverage.
       ``(ii) Inpatient, out-of-network.--Items and services 
     furnished on an inpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iii) Outpatient, in-network.--Items and services 
     furnished on an outpatient basis and within a network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iv) Outpatient, out-of-network.--Items and services 
     furnished on an outpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan or coverage, limitation on the frequency of treatment, 
     number of visits or days of coverage, or other similar limit 
     on the duration or scope of treatment under the plan or 
     coverage.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--
       ``(A) No beneficiary financial requirement.--If the plan or 
     coverage does not include a beneficiary financial requirement 
     (as defined in subparagraph (C)) on substantially all medical 
     and surgical benefits within a category of items and services 
     (specified in paragraph (3)(C)), the plan or coverage may not 
     impose such a beneficiary financial requirement on mental 
     health and substance-related disorder benefits for items and 
     services within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan or coverage 
     includes a deductible, a limitation on out-of-pocket 
     expenses, or similar beneficiary financial requirement that 
     does not apply separately to individual items and services on 
     substantially all medical and surgical benefits within a 
     category of items and services, the plan or coverage shall 
     apply such requirement (or, if there is more than one such 
     requirement for such category of items and services, the 
     predominant requirement for such category) both to medical 
     and surgical benefits within such category and to mental 
     health and substance-related disorder benefits within such 
     category and shall not distinguish in the application of such 
     requirement between such medical and surgical benefits and 
     such mental health and substance-related disorder benefits.
       ``(ii) Other financial requirements.--If the plan or 
     coverage includes a beneficiary financial requirement not 
     described in clause (i) on substantially all medical and 
     surgical benefits within a category of items and services, 
     the plan or coverage may not impose such financial 
     requirement on mental health and substance-related disorder 
     benefits for items and services within such category in a way 
     that is more costly to the participant or beneficiary than 
     the predominant beneficiary financial requirement applicable 
     to medical and surgical benefits for items and services 
     within such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan or coverage, 
     any deductible, coinsurance, co-payment, other cost sharing, 
     and limitation on the total amount that may be paid by a 
     participant or beneficiary with respect to benefits under the 
     plan or coverage, but does not include the application of any 
     aggregate lifetime limit or annual limit.''; and
       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'';
       (B) by striking ``; or'' and inserting a period; and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Such section is further amended--
       (1) by striking ``mental health benefits'' and inserting 
     ``mental health and substance-related disorder benefits'' 
     each place it appears; and
       (2) in paragraph (4) of subsection (e)--
       (A) by striking ``Mental health benefits'' and inserting 
     ``Mental health and substance-related disorder benefits'';
       (B) by striking ``benefits with respect to mental health 
     services'' and inserting ``benefits with respect to services 
     for mental health conditions or substance-related 
     disorders''; and
       (C) by striking ``, but does not include benefits with 
     respect to treatment of substances abuse or chemical 
     dependency''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of such section, as 
     amended by subsection (a)(1), is further amended by adding at 
     the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits (or the health insurance coverage offered in 
     connection with the plan with respect to such benefits) shall 
     be made available by the plan administrator (or the health 
     insurance issuer offering such coverage) to any current or 
     potential participant, beneficiary, or contracting provider 
     upon request. The reason for any denial under the plan (or 
     coverage) of reimbursement or payment for services with 
     respect to mental health and substance-related disorder 
     benefits in the case of any participant or beneficiary shall, 
     upon request, be made available by the plan administrator (or 
     the health insurance issuer offering such coverage) to the 
     participant or beneficiary.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of such 
     section is further amended by adding at the end the following 
     new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides any mental health and substance-related 
     disorder benefits, the plan or coverage shall include 
     benefits for any mental health condition or substance-related 
     disorder for which benefits are provided under the benefit 
     plan option offered under chapter 89 of title 5, United 
     States Code, with the highest average enrollment as of the 
     beginning of the most recent year beginning on or before the 
     beginning of the plan year involved.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) In general.--In the case of a plan or coverage that 
     provides both medical and surgical benefits and mental health 
     and substance-related disorder benefits, if medical and 
     surgical benefits are provided for substantially all items 
     and services in a category specified in clause (ii) furnished 
     outside any network of providers established or recognized 
     under such plan or coverage, the mental health and substance-
     related disorder benefits shall also be provided for items 
     and services in such category furnished outside any network 
     of providers established or recognized under such plan or 
     coverage in accordance with the requirements of this section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (including an emergency 
     condition relating to mental health and substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     subsection (c) of such section is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan (or 
     health insurance coverage offered in connection 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 and substance-related 
     disorder benefits under the plan (as determined and certified 
     under subparagraph (C)) by an amount that exceeds the 
     applicable percentage described in subparagraph (B) 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.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     paragraph shall be--
       ``(i) 2 percent in the case of the first plan year which 
     begins after the date of the enactment of the Paul Wellstone 
     Mental Health and Addiction Equity Act of 2007; and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan (or coverage) for 
     purposes of this subsection 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.
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     such a plan) seeks an exemption under this paragraph, 
     determinations under subparagraph (A) shall be made after 
     such plan (or coverage) has complied with this section for 
     the first 6 months of the plan year involved.
       ``(E) Notification.--A group health plan under this part 
     shall comply with the notice requirement under section 
     712(c)(2)(E) of the

[[Page H1277]]

     Employee Retirement Income Security Act of 1974 with respect 
     to the a modification of mental health and substance-related 
     disorder benefits as permitted under this paragraph as if 
     such section applied to such plan.''.
       (f) Change in Exclusion for Smallest Employers.--Subsection 
     (c)(1)(B) of such section is amended--
       (1) by inserting ``(or 1 in the case of an employer 
     residing in a State that permits small groups to include a 
     single individual)'' after ``at least 2'' the first place it 
     appears; and
       (2) by striking ``and who employs at least 2 employees on 
     the first day of the plan year''.
       (g) Elimination of Sunset Provision.--Such section is 
     amended by striking out subsection (f).
       (h) Clarification Regarding Preemption.--Such section is 
     further amended by inserting after subsection (e) the 
     following new subsection:
       ``(f) Preemption, Relation to State Laws.--
       ``(1) In general.--Nothing in this section shall be 
     construed to preempt any State law that provides greater 
     consumer protections, benefits, methods of access to 
     benefits, rights or remedies that are greater than the 
     protections, benefits, methods of access to benefits, rights 
     or remedies provided under this section.
       ``(2) Construction.--Nothing in this section shall be 
     construed to affect or modify the provisions of section 2723 
     with respect to group health plans.''.
       (i) Conforming Amendment to Heading.--The heading of such 
     section is amended to read as follows:

     ``SEC. 2705. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (j) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2008.

     SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 9812 of the Internal Revenue 
     Code of 1986 is amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--
       ``(A) No treatment limit.--If the plan does not include a 
     treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services (specified in subparagraph 
     (C)), the plan may not impose any treatment limit on mental 
     health and substance-related disorder benefits that are 
     classified in the same category of items or services.
       ``(B) Treatment limit.--If the plan includes a treatment 
     limit on substantially all medical and surgical benefits in 
     any category of items or services, the plan may not impose 
     such a treatment limit on mental health and substance-related 
     disorder benefits for items and services within such category 
     that are more restrictive than the predominant treatment 
     limit that is applicable to medical and surgical benefits for 
     items and services within such category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following four categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits and all mental health and 
     substance related benefits shall be classified into one of 
     the following categories:
       ``(i) Inpatient, in-network.--Items and services furnished 
     on an inpatient basis and within a network of providers 
     established or recognized under such plan or coverage.
       ``(ii) Inpatient, out-of-network.--Items and services 
     furnished on an inpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iii) Outpatient, in-network.--Items and services 
     furnished on an outpatient basis and within a network of 
     providers established or recognized under such plan or 
     coverage.
       ``(iv) Outpatient, out-of-network.--Items and services 
     furnished on an outpatient basis and outside any network of 
     providers established or recognized under such plan or 
     coverage.
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan, limitation on the frequency of treatment, number of 
     visits or days of coverage, or other similar limit on the 
     duration or scope of treatment under the plan.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--
       ``(A) No beneficiary financial requirement.--If the plan 
     does not include a beneficiary financial requirement (as 
     defined in subparagraph (C)) on substantially all medical and 
     surgical benefits within a category of items and services 
     (specified in paragraph (3)(C)), the plan may not impose such 
     a beneficiary financial requirement on mental health and 
     substance-related disorder benefits for items and services 
     within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan or coverage 
     includes a deductible, a limitation on out-of-pocket 
     expenses, or similar beneficiary financial requirement that 
     does not apply separately to individual items and services on 
     substantially all medical and surgical benefits within a 
     category of items and services, the plan or coverage shall 
     apply such requirement (or, if there is more than one such 
     requirement for such category of items and services, the 
     predominant requirement for such category) both to medical 
     and surgical benefits within such category and to mental 
     health and substance-related disorder benefits within such 
     category and shall not distinguish in the application of such 
     requirement between such medical and surgical benefits and 
     such mental health and substance-related disorder benefits.
       ``(ii) Other financial requirements.--If the plan includes 
     a beneficiary financial requirement not described in clause 
     (i) on substantially all medical and surgical benefits within 
     a category of items and services, the plan may not impose 
     such financial requirement on mental health and substance-
     related disorder benefits for items and services within such 
     category in a way that is more costly to the participant or 
     beneficiary than the predominant beneficiary financial 
     requirement applicable to medical and surgical benefits for 
     items and services within such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan, any 
     deductible, coinsurance, co-payment, other cost sharing, and 
     limitation on the total amount that may be paid by a 
     participant or beneficiary with respect to benefits under the 
     plan, but does not include the application of any aggregate 
     lifetime limit or annual limit.''; and
       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'';
       (B) by striking ``; or'' and inserting a period; and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Such section is further amended--
       (1) by striking ``mental health benefits'' and inserting 
     ``mental health and substance-related disorder benefits'' 
     each place it appears; and
       (2) in paragraph (4) of subsection (e)--
       (A) by striking ``Mental health benefits'' in the heading 
     and inserting ``Mental health and substance-related disorder 
     benefits'';
       (B) by striking ``benefits with respect to mental health 
     services'' and inserting ``benefits with respect to services 
     for mental health conditions or substance-related 
     disorders''; and
       (C) by striking ``, but does not include benefits with 
     respect to treatment of substances abuse or chemical 
     dependency''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of such section, as 
     amended by subsection (a)(1), is further amended by adding at 
     the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits shall be made available by the plan administrator to 
     any current or potential participant, beneficiary, or 
     contracting provider upon request. The reason for any denial 
     under the plan of reimbursement or payment for services with 
     respect to mental health and substance-related disorder 
     benefits in the case of any participant or beneficiary shall, 
     upon request, be made available by the plan administrator to 
     the participant or beneficiary.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of such 
     section is further amended by adding at the end the following 
     new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides any mental health and substance-related 
     disorder benefits, the plan or coverage shall include 
     benefits for any mental health condition or substance-related 
     disorder for which benefits are provided under the benefit 
     plan option offered under chapter 89 of title 5, United 
     States Code, with the highest average enrollment as of the 
     beginning of the most recent year beginning on or before the 
     beginning of the plan year involved.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) In general.--In the case of a plan that provides both 
     medical and surgical benefits and mental health and 
     substance-related disorder benefits, if medical and surgical 
     benefits are provided for substantially all items and 
     services in a category specified in clause (ii) furnished 
     outside any network of providers established or recognized 
     under such plan or coverage, the mental health and substance-
     related disorder benefits shall also be

[[Page H1278]]

     provided for items and services in such category furnished 
     outside any network of providers established or recognized 
     under such plan in accordance with the requirements of this 
     section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (including an emergency 
     condition relating to mental health and substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     subsection (c) of such section is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan, if 
     the application of this section to such plan 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 and substance-related disorder benefits under 
     the plan (as determined and certified under subparagraph (C)) 
     by an amount that exceeds the applicable percentage described 
     in subparagraph (B) of the actual total plan costs, the 
     provisions of this section shall not apply to such plan 
     during the following plan year, and such exemption shall 
     apply to the plan for 1 plan year.
       ``(B) Applicable percentage.--With respect to a plan, the 
     applicable percentage described in this paragraph shall be--
       ``(i) 2 percent in the case of the first plan year which 
     begins after the date of the enactment of the Paul Wellstone 
     Mental Health and Addiction Equity Act of 2007; and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan for purposes of this 
     subsection 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.
       ``(D) 6-month determinations.--If a group health plan seeks 
     an exemption under this paragraph, determinations under 
     subparagraph (A) shall be made after such plan has complied 
     with this section for the first 6 months of the plan year 
     involved.''.
       (f) Change in Exclusion for Smallest Employers.--Subsection 
     (c)(1) of such section is amended to read as follows:
       ``(1) Small employer exemption.--
       ``(A) In general.--This section shall not apply to any 
     group health plan for any plan year of a small employer.
       ``(B) Small employer.--For purposes of subparagraph (A), 
     the term `small employer' means, with respect to a calendar 
     year and a plan year, an 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. For purposes of the 
     preceding sentence, all persons treated as a single employer 
     under subsection (b), (c), (m), or (o) of section 414 shall 
     be treated as 1 employer and rules similar to rules of 
     subparagraphs (B) and (C) of section 4980D(d)(2) shall 
     apply.''.
       (g) Elimination of Sunset Provision.--Such section is 
     amended by striking subsection (f).
       (h) Conforming Amendments to Heading.--
       (1) In general.--The heading of such section is amended to 
     read as follows:

     ``SEC. 9812. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (2) Clerical amendment.--The table of sections for 
     subchapter B of chapter 100 of the Internal Revenue Code of 
     1986 is amended by striking the item relating to section 9812 
     and inserting the following new item:

``Sec. 9812. Equity in mental health and substance-related disorder 
              benefits.''.

       (i) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2008.

     SEC. 5. GOVERNMENT ACCOUNTABILITY OFFICE STUDIES AND REPORTS.

       (a) Implementation of Act.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study that evaluates the effect of the 
     implementation of the amendments made by this Act on--
       (A) the cost of health insurance coverage;
       (B) access to health insurance coverage (including the 
     availability of in-network providers);
       (C) the quality of health care;
       (D) Medicare, Medicaid, and State and local mental health 
     and substance abuse treatment spending;
       (E) the number of individuals with private insurance who 
     received publicly funded health care for mental health and 
     substance-related disorders;
       (F) spending on public services, such as the criminal 
     justice system, special education, and income assistance 
     programs;
       (G) the use of medical management of mental health and 
     substance-related disorder benefits and medical necessity 
     determinations by group health plans (and health insurance 
     issuers offering health insurance coverage in connection with 
     such plans) and timely access by participants and 
     beneficiaries to clinically-indicated care for mental health 
     and substance-use disorders; and
       (H) other matters 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 the Congress a 
     report containing the results of the study conducted under 
     paragraph (1).
       (b) Biannual Report on Obstacles in Obtaining Coverage.--
     Every two years, the Comptroller General shall submit to each 
     House of the Congress a report on obstacles that individuals 
     face in obtaining mental health and substance-related 
     disorder care under their health plans.
       (c) Uniform Patient Placement Criteria.--Not later than 18 
     months after the date of the enactment of this Act, the 
     Comptroller General shall submit to each House of the 
     Congress a report on availability of uniform patient 
     placement criteria for mental health and substance-related 
     disorders that could be used by group health plans and health 
     insurance issuers to guide determinations of medical 
     necessity and the extent to which health plans utilize such 
     critiera. If such criteria do not exist, the report shall 
     include recommendations on a process for developing such 
     criteria.

  The SPEAKER pro tempore. Pursuant to House Resolution 1014, in lieu 
of the amendments recommended by the Committees on Energy and Commerce, 
Ways and Means, and Education and Labor printed in the bill, the 
amendment in the nature of a substitute printed in House report 110-538 
is adopted and the bill, as amended, is considered read.
  The text of the bill, as amended, is as follows:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Paul 
     Wellstone Mental Health and Addiction Equity Act of 2007''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Amendments to the Employee Retirement Income Security Act of 
              1974.
Sec. 3. Amendments to the Public Health Service Act relating to the 
              group market.
Sec. 4. Amendments to the Internal Revenue Code of 1986.
Sec. 5. Medicaid drug rebate.
Sec. 6. Limitation on Medicare exception to the prohibition on certain 
              physician referrals for hospitals.
Sec. 7. Studies and reports.

     SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 712 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1185a) is 
     amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--In the case of a group health plan 
     that provides both medical and surgical benefits and mental 
     health or substance-related disorder benefits--
       ``(A) No treatment limit.--If the plan or coverage does not 
     include a treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services, the plan or coverage may not 
     impose any treatment limit on mental health or substance-
     related disorder benefits that are classified in the same 
     category of items or services.
       ``(B) Treatment limit.--If the plan or coverage includes a 
     treatment limit on substantially all medical and surgical 
     benefits in any category of items or services, the plan or 
     coverage may not impose such a treatment limit on mental 
     health or substance-related disorder benefits for items and 
     services within such category that is more restrictive than 
     the predominant treatment limit that is applicable to medical 
     and surgical benefits for items and services within such 
     category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following five categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits and all mental health and 
     substance related benefits shall be classified into one of 
     the following categories:
       ``(i) Inpatient, in-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     within a network of providers established or recognized under 
     such plan or coverage.
       ``(ii) Inpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     outside any network of providers established or recognized 
     under such plan or coverage.
       ``(iii) Outpatient, in-network.--Items and services not 
     described in clause (v) furnished

[[Page H1279]]

     on an outpatient basis and within a network of providers 
     established or recognized under such plan or coverage.
       ``(iv) Outpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an outpatient basis and 
     outside any network of providers established or recognized 
     under such plan or coverage.
       ``(v) Emergency care.--Items and services, whether 
     furnished on an inpatient or outpatient basis or within or 
     outside any network of providers, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan or coverage, limitation on the frequency of treatment, 
     number of visits or days of coverage, or other similar limit 
     on the duration or scope of treatment under the plan or 
     coverage.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--In the case of a 
     group health plan that provides both medical and surgical 
     benefits and mental health or substance-related disorder 
     benefits--
       ``(A) No beneficiary financial requirement.--If the plan or 
     coverage does not include a beneficiary financial requirement 
     (as defined in subparagraph (C)) on substantially all medical 
     and surgical benefits within a category of items and services 
     (specified under paragraph (3)(C)), the plan or coverage may 
     not impose such a beneficiary financial requirement on mental 
     health or substance-related disorder benefits for items and 
     services within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan or coverage 
     includes a deductible, a limitation on out-of-pocket 
     expenses, or similar beneficiary financial requirement that 
     does not apply separately to individual items and services on 
     substantially all medical and surgical benefits within a 
     category of items and services (as specified in paragraph 
     (3)(C)), the plan or coverage shall apply such requirement 
     (or, if there is more than one such requirement for such 
     category of items and services, the predominant requirement 
     for such category) both to medical and surgical benefits 
     within such category and to mental health and substance-
     related disorder benefits within such category and shall not 
     distinguish in the application of such requirement between 
     such medical and surgical benefits and such mental health and 
     substance-related disorder benefits.
       ``(ii) Other financial requirements.--If the plan or 
     coverage includes a beneficiary financial requirement not 
     described in clause (i) on substantially all medical and 
     surgical benefits within a category of items and services, 
     the plan or coverage may not impose such financial 
     requirement on mental health or substance-related disorder 
     benefits for items and services within such category in a way 
     that results in greater out-of-pocket expenses to the 
     participant or beneficiary than the predominant beneficiary 
     financial requirement applicable to medical and surgical 
     benefits for items and services within such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan or coverage, 
     any deductible, coinsurance, co-payment, other cost sharing, 
     and limitation on the total amount that may be paid by a 
     participant or beneficiary with respect to benefits under the 
     plan or coverage, but does not include the application of any 
     aggregate lifetime limit or annual limit.''; and
       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'';
       (B) by striking ``; or'' and inserting a period; and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Such section is further amended--
       (1) by striking ``mental health benefits'' each place it 
     appears (other than in any provision amended by paragraph 
     (2)) and inserting ``mental health or substance-related 
     disorder benefits'',
       (2) by striking ``mental health benefits'' each place it 
     appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), 
     and (a)(2)(C) and inserting ``mental health and substance-
     related disorder benefits'', and
       (3) in subsection (e), by striking paragraph (4) and 
     inserting the following new paragraphs:
       ``(4) Mental health benefits.--The term `mental health 
     benefits' means benefits with respect to services for mental 
     health conditions, as defined under the terms of the plan and 
     in accordance with applicable law, but does not include 
     substance-related disorder benefits.
       ``(5) Substance-related disorder benefits.--The term 
     `substance-related disorder benefits' means benefits with 
     respect to services for substance-related disorders, as 
     defined under the terms of the plan and in accordance with 
     applicable law.''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of such section, as 
     amended by subsection (a)(1), is further amended by adding at 
     the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits (or the health insurance coverage offered in 
     connection with the plan with respect to such benefits) shall 
     be made available by the plan administrator (or the health 
     insurance issuer offering such coverage) in accordance with 
     regulations to any current or potential participant, 
     beneficiary, or contracting provider upon request. The reason 
     for any denial under the plan (or coverage) of reimbursement 
     or payment for services with respect to mental health and 
     substance-related disorder benefits in the case of any 
     participant or beneficiary shall, on request or as otherwise 
     required, be made available by the plan administrator (or the 
     health insurance issuer offering such coverage) to the 
     participant or beneficiary in accordance with regulations.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of such 
     section is further amended by adding at the end the following 
     new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides any mental health or substance-related 
     disorder benefits, the plan or coverage shall include 
     benefits for any mental health condition or substance-related 
     disorder included in the most recent edition of the 
     Diagnostic and Statistical Manual of Mental Disorders 
     published by the American Psychiatric Association.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) In general.--In the case of a plan or coverage that 
     provides both medical and surgical benefits and mental health 
     or substance-related disorder benefits, if medical and 
     surgical benefits are provided for substantially all items 
     and services in a category specified in clause (ii) furnished 
     outside any network of providers established or recognized 
     under such plan or coverage, the mental health and substance-
     related disorder benefits shall also be provided for items 
     and services in such category furnished outside any network 
     of providers established or recognized under such plan or 
     coverage in accordance with the requirements of this section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     subsection (c) of such section is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan (or 
     health insurance coverage offered in connection 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 and substance-related 
     disorder benefits under the plan (as determined and certified 
     under subparagraph (C)) by an amount that exceeds the 
     applicable percentage described in subparagraph (B) 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.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     paragraph shall be--
       ``(i) 2 percent in the case of the first plan year to which 
     this paragraph applies; and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan (or coverage) for 
     purposes of this subsection shall be made in writing and 
     prepared and certified by a qualified and licensed actuary 
     who is a member in good standing of the American Academy of 
     Actuaries. Such determinations shall be made available by the 
     plan administrator (or

[[Page H1280]]

     health insurance issuer, as the case may be) to the general 
     public.
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     such a plan) seeks an exemption under this paragraph, 
     determinations under subparagraph (A) shall be made after 
     such plan (or coverage) has complied with this section for 
     the first 6 months of the plan year involved.
       ``(E) Notification.--An election to modify coverage of 
     mental health and substance-related disorder benefits as 
     permitted under this paragraph shall be treated as a material 
     modification in the terms of the plan as described in section 
     102(a) and notice of which shall be provided a reasonable 
     period in advance of the change.
       ``(F) Notification of appropriate agency.--
       ``(i) In general.--A group health plan that, based on a 
     certification described under subparagraph (C), qualifies for 
     an exemption under this paragraph, and elects to implement 
     the exemption, shall notify the Department of Labor of such 
     election.
       ``(ii) Requirement.--A notification under clause (i) shall 
     include--

       ``(I) a description of the number of covered lives under 
     the plan (or coverage) involved at the time of the 
     notification, and as applicable, at the time of any prior 
     election of the cost-exemption under this paragraph by such 
     plan (or coverage);
       ``(II) for both the plan year upon which a cost exemption 
     is sought and the year prior, a description of the actual 
     total costs of coverage with respect to medical and surgical 
     benefits and mental health and substance-related disorder 
     benefits under the plan; and
       ``(III) for both the plan year upon which a cost exemption 
     is sought and the year prior, the actual total costs of 
     coverage with respect to mental health and substance-related 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification under clause (i) 
     shall be confidential. The Department of Labor shall make 
     available, upon request to the appropriate committees of 
     Congress and on not more than an annual basis, an anonymous 
     itemization of such notifications, that includes--

       ``(I) a breakdown of States by the size and any type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(G) No impact on application of state law.--The fact that 
     a plan or coverage is exempt from the provisions of this 
     section under subparagraph (A) shall not affect the 
     application of State law to such plan or coverage.
       ``(H) Construction.--Nothing in this paragraph shall be 
     construed as preventing a group health plan (or health 
     insurance coverage offered in connection with such a plan) 
     from complying with the provisions of this section 
     notwithstanding that the plan or coverage is not required to 
     comply with such provisions due to the application of 
     subparagraph (A).''.
       (f) Change in Exclusion for Smallest Employers.--Subsection 
     (c)(1)(B) of such section is amended--
       (1) by inserting ``(or 1 in the case of an employer 
     residing in a State that permits small groups to include a 
     single individual)'' after ``at least 2'' the first place it 
     appears; and
       (2) by striking ``and who employs at least 2 employees on 
     the first day of the plan year''.
       (g) Elimination of Sunset Provision.--Such section is 
     amended by striking subsection (f).
       (h) Clarification Regarding Preemption.--Such section is 
     further amended by inserting after subsection (e) the 
     following new subsection:
       ``(f) Preemption, Relation to State Laws.--
       ``(1) In general.--This part shall not be construed to 
     supersede any provision of State law which establishes, 
     implements, or continues in effect any consumer protections, 
     benefits, methods of access to benefits, rights, external 
     review programs, or remedies solely relating to health 
     insurance issuers in connection with group health insurance 
     coverage (including benefit mandates or regulation of group 
     health plans of 50 or fewer employees) except to the extent 
     that such provision prevents the application of a requirement 
     of this part.
       ``(2) Continued preemption with respect to group health 
     plans.--Nothing in this section shall be construed to affect 
     or modify the provisions of section 514 with respect to group 
     health plans.
       ``(3) Other state laws.--Nothing in this section shall be 
     construed to exempt or relieve any person from any laws of 
     any State not solely related to health insurance issuers in 
     connection with group health coverage insofar as they may now 
     or hereafter relate to insurance, health plans, or health 
     coverage.' ''.
       (i) Conforming Amendments to Heading.--
       (1) In general.--The heading of such section is amended to 
     read as follows:

     ``SEC. 712. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (2) Clerical amendment.--The table of contents in section 1 
     of such Act is amended by striking the item relating to 
     section 712 and inserting the following new item:

``Sec. 712. Equity in mental health and substance-related disorder 
              benefits.''.

       (j) Effective Date.--
       (1) In general.--The amendments made by this section shall 
     apply with respect to plan years beginning on or after 
     January 1, 2009.
       (2) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to one or 
     more collective bargaining agreements between employee 
     representatives and one or more employers ratified before the 
     date of the enactment of this Act, the amendments made by 
     this section shall not apply to plan years beginning before 
     the later of--
       (A) the date on which the last of the collective bargaining 
     agreements relating to the plan terminates (determined 
     without regard to any extension thereof agreed to after the 
     date of the enactment of this Act), or
       (B) January 1, 2009.

     For purposes of subparagraph (A), any plan amendment made 
     pursuant to a collective bargaining agreement relating to the 
     plan which amends the plan solely to conform to any 
     requirement added by this section shall not be treated as a 
     termination of such collective bargaining agreement.
       (k) DOL Annual Sample Compliance.--The Secretary of Labor 
     shall annually sample and conduct random audits of group 
     health plans (and health insurance coverage offered in 
     connection with such plans) in order to determine their 
     compliance with the amendments made by this Act and shall 
     submit to the appropriate committees of Congress an annual 
     report on such compliance with such amendments. The Secretary 
     shall share the results of such audits with the Secretaries 
     of Health and Human Services and of the Treasury.
       (l) Assistance to Participants and Beneficiaries.--The 
     Secretary of Labor shall provide assistance to participants 
     and beneficiaries of group health plans with any questions or 
     problems with compliance with the requirements of this Act. 
     The Secretary shall notify participants and beneficiaries how 
     they can obtain assistance from State consumer and insurance 
     agencies and the Secretary shall coordinate with State 
     agencies to ensure that participants and beneficiaries are 
     protected and afforded the rights provided under this Act.

     SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING 
                   TO THE GROUP MARKET.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 2705 of the Public Health 
     Service Act (42 U.S.C. 300gg-5) is amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--In the case of a group health plan 
     that provides both medical and surgical benefits and mental 
     health or substance-related disorder benefits--
       ``(A) No treatment limit.--If the plan or coverage does not 
     include a treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services (specified in subparagraph 
     (C)), the plan or coverage may not impose any treatment limit 
     on mental health or substance-related disorder benefits that 
     are classified in the same category of items or services.
       ``(B) Treatment limit.--If the plan or coverage includes a 
     treatment limit on substantially all medical and surgical 
     benefits in any category of items or services, the plan or 
     coverage may not impose such a treatment limit on mental 
     health or substance-related disorder benefits for items and 
     services within such category that is more restrictive than 
     the predominant treatment limit that is applicable to medical 
     and surgical benefits for items and services within such 
     category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following five categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits and all mental health and 
     substance related benefits shall be classified into one of 
     the following categories:
       ``(i) Inpatient, in-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     within a network of providers established or recognized under 
     such plan or coverage.
       ``(ii) Inpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     outside any network of providers established or recognized 
     under such plan or coverage.
       ``(iii) Outpatient, in-network.--Items and services not 
     described in clause (v) furnished on an outpatient basis and 
     within a network of providers established or recognized under 
     such plan or coverage.
       ``(iv) Outpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an outpatient basis and 
     outside any network of providers established or recognized 
     under such plan or coverage.
       ``(v) Emergency care.--Items and services, whether 
     furnished on an inpatient or outpatient basis or within or 
     outside any network of providers, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan or coverage, limitation on the frequency of treatment, 
     number of visits or days of coverage,

[[Page H1281]]

     or other similar limit on the duration or scope of treatment 
     under the plan or coverage.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--In the case of a 
     group health plan that provides both medical and surgical 
     benefits and mental health or substance-related disorder 
     benefits--
       ``(A) No beneficiary financial requirement.--If the plan or 
     coverage does not include a beneficiary financial requirement 
     (as defined in subparagraph (C)) on substantially all medical 
     and surgical benefits within a category of items and services 
     (specified in paragraph (3)(C)), the plan or coverage may not 
     impose such a beneficiary financial requirement on mental 
     health or substance-related disorder benefits for items and 
     services within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan or coverage 
     includes a deductible, a limitation on out-of-pocket 
     expenses, or similar beneficiary financial requirement that 
     does not apply separately to individual items and services on 
     substantially all medical and surgical benefits within a 
     category of items and services, the plan or coverage shall 
     apply such requirement (or, if there is more than one such 
     requirement for such category of items and services, the 
     predominant requirement for such category) both to medical 
     and surgical benefits within such category and to mental 
     health and substance-related disorder benefits within such 
     category and shall not distinguish in the application of such 
     requirement between such medical and surgical benefits and 
     such mental health and substance-related disorder benefits.
       ``(ii) Other financial requirements.--If the plan or 
     coverage includes a beneficiary financial requirement not 
     described in clause (i) on substantially all medical and 
     surgical benefits within a category of items and services, 
     the plan or coverage may not impose such financial 
     requirement on mental health or substance-related disorder 
     benefits for items and services within such category in a way 
     that results in greater out-of-pocket expenses to the 
     participant or beneficiary than the predominant beneficiary 
     financial requirement applicable to medical and surgical 
     benefits for items and services within such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan or coverage, 
     any deductible, coinsurance, co-payment, other cost sharing, 
     and limitation on the total amount that may be paid by a 
     participant or beneficiary with respect to benefits under the 
     plan or coverage, but does not include the application of any 
     aggregate lifetime limit or annual limit.''; and
       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'';
       (B) by striking ``; or'' and inserting a period; and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Such section is further amended--
       (1) by striking ``mental health benefits'' each place it 
     appears (other than in any provision amended by paragraph 
     (2)) and inserting ``mental health or substance-related 
     disorder benefits'',
       (2) by striking ``mental health benefits'' each place it 
     appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), 
     and (a)(2)(C) and inserting ``mental health and substance-
     related disorder benefits'', and
       (3) in subsection (e), by striking paragraph (4) and 
     inserting the following new paragraphs:
       ``(4) Mental health benefits.--The term `mental health 
     benefits' means benefits with respect to services for mental 
     health conditions, as defined under the terms of the plan and 
     in accordance with applicable law, but does not include 
     substance-related disorder benefits.
       ``(5) Substance-related disorder benefits.--The term 
     `substance-related disorder benefits' means benefits with 
     respect to services for substance-related disorders, as 
     defined under the terms of the plan and in accordance with 
     applicable law.''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of such section, as 
     amended by subsection (a)(1), is further amended by adding at 
     the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits (or the health insurance coverage offered in 
     connection with the plan with respect to such benefits) shall 
     be made available by the plan administrator (or the health 
     insurance issuer offering such coverage) in accordance with 
     regulations to any current or potential participant, 
     beneficiary, or contracting provider upon request. The reason 
     for any denial under the plan (or coverage) of reimbursement 
     or payment for services with respect to mental health and 
     substance-related disorder benefits in the case of any 
     participant or beneficiary shall, on request or as otherwise 
     required, be made available by the plan administrator (or the 
     health insurance issuer offering such coverage) to the 
     participant or beneficiary in accordance with regulations.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of such 
     section is further amended by adding at the end the following 
     new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides any mental health or substance-related 
     disorder benefits, the plan or coverage shall include 
     benefits for any mental health condition or substance-related 
     disorder included in the most recent edition of the 
     Diagnostic and Statistical Manual of Mental Disorders 
     published by the American Psychiatric Association.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) 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 or substance-related disorder benefits, if 
     medical and surgical benefits are provided for substantially 
     all items and services in a category specified in clause (ii) 
     furnished outside any network of providers established or 
     recognized under such plan or coverage, the mental health and 
     substance-related disorder benefits shall also be provided 
     for items and services in such category furnished outside any 
     network of providers established or recognized under such 
     plan or coverage in accordance with the requirements of this 
     section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     subsection (c) of such section is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan (or 
     health insurance coverage offered in connection 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 and substance-related 
     disorder benefits under the plan (as determined and certified 
     under subparagraph (C)) by an amount that exceeds the 
     applicable percentage described in subparagraph (B) 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.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     paragraph shall be--
       ``(i) 2 percent in the case of the first plan year to which 
     this paragraph applies; and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan (or coverage) for 
     purposes of this subsection shall be made in writing and 
     prepared and certified by a qualified and licensed actuary 
     who is a member in good standing of the American Academy of 
     Actuaries. Such determinations shall be made available by the 
     plan administrator (or health insurance issuer, as the case 
     may be) to the general public.
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     such a plan) seeks an exemption under this paragraph, 
     determinations under subparagraph (A) shall be made after 
     such plan (or coverage) has complied with this section for 
     the first 6 months of the plan year involved.
       ``(E) Notification.--A group health plan under this part 
     shall comply with the notice requirement under section 
     712(c)(2)(E) of the Employee Retirement Income Security Act 
     of 1974 with respect to a modification of mental health and 
     substance-related disorder benefits as permitted under this 
     paragraph as if such section applied to such plan.
       ``(F) Notification of appropriate agency.--
       ``(i) In general.--A group health plan that, based on a 
     certification described under subparagraph (C), qualifies for 
     an exemption

[[Page H1282]]

     under this paragraph, and elects to implement the exemption, 
     shall notify the Secretary of Health and Human Services of 
     such election.
       ``(ii) Requirement.--A notification under clause (i) shall 
     include--

       ``(I) a description of the number of covered lives under 
     the plan (or coverage) involved at the time of the 
     notification, and as applicable, at the time of any prior 
     election of the cost-exemption under this paragraph by such 
     plan (or coverage);
       ``(II) for both the plan year upon which a cost exemption 
     is sought and the year prior, a description of the actual 
     total costs of coverage with respect to medical and surgical 
     benefits and mental health and substance-related disorder 
     benefits under the plan; and
       ``(III) for both the plan year upon which a cost exemption 
     is sought and the year prior, the actual total costs of 
     coverage with respect to mental health and substance-related 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification under clause (i) 
     shall be confidential. The Secretary of Health and Human 
     Services shall make available, upon request to the 
     appropriate committees of Congress and on not more than an 
     annual basis, an anonymous itemization of such notifications, 
     that includes--

       ``(I) a breakdown of States by the size and any type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(G) Construction.--Nothing in this paragraph shall be 
     construed as preventing a group health plan (or health 
     insurance coverage offered in connection with such a plan) 
     from complying with the provisions of this section 
     notwithstanding that the plan or coverage is not required to 
     comply with such provisions due to the application of 
     subparagraph (A).''.
       (f) Change in Exclusion for Smallest Employers.--Subsection 
     (c)(1)(B) of such section is amended--
       (1) by inserting ``(or 1 in the case of an employer 
     residing in a State that permits small groups to include a 
     single individual)'' after ``at least 2'' the first place it 
     appears; and
       (2) by striking ``and who employs at least 2 employees on 
     the first day of the plan year''.
       (g) Elimination of Sunset Provision.--Such section is 
     amended by striking out subsection (f).
       (h) Clarification Regarding Preemption.--Such section is 
     further amended by inserting after subsection (e) the 
     following new subsection:
       ``(f) Preemption, Relation to State Laws.--
       ``(1) In general.--Nothing in this section shall be 
     construed to preempt any State law that provides greater 
     consumer protections, benefits, methods of access to 
     benefits, rights or remedies that are greater than the 
     protections, benefits, methods of access to benefits, rights 
     or remedies provided under this section.
       ``(2) Construction.--Nothing in this section shall be 
     construed to affect or modify the provisions of section 2723 
     with respect to group health plans.''.
       (i) Conforming Amendment to Heading.--The heading of such 
     section is amended to read as follows:

     ``SEC. 2705. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (j) Effective Date.--
       (1) In general.--Except as otherwise provided in this 
     subsection, the amendments made by this section shall apply 
     with respect to plan years beginning on or after January 1, 
     2009.
       (2) Elimination of sunset.--The amendment made by 
     subsection (g) shall apply to benefits for services furnished 
     after December 31, 2007.
       (3) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to one or 
     more collective bargaining agreements between employee 
     representatives and one or more employers ratified before the 
     date of the enactment of this Act, the amendments made by 
     this section shall not apply to plan years beginning before 
     the later of--
       (A) the date on which the last of the collective bargaining 
     agreements relating to the plan terminates (determined 
     without regard to any extension thereof agreed to after the 
     date of the enactment of this Act), or
       (B) January 1, 2009.
     For purposes of subparagraph (A), any plan amendment made 
     pursuant to a collective bargaining agreement relating to the 
     plan which amends the plan solely to conform to any 
     requirement added by this section shall not be treated as a 
     termination of such collective bargaining agreement.

     SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

       (a) Extension of Parity to Treatment Limits and Beneficiary 
     Financial Requirements.--Section 9812 of the Internal Revenue 
     Code of 1986 is amended--
       (1) in subsection (a), by adding at the end the following 
     new paragraphs:
       ``(3) Treatment limits.--In the case of a group health plan 
     that provides both medical and surgical benefits and mental 
     health or substance-related disorder benefits--
       ``(A) No treatment limit.--If the plan does not include a 
     treatment limit (as defined in subparagraph (D)) on 
     substantially all medical and surgical benefits in any 
     category of items or services (specified in subparagraph 
     (C)), the plan may not impose any treatment limit on mental 
     health or substance-related disorder benefits that are 
     classified in the same category of items or services.
       ``(B) Treatment limit.--If the plan includes a treatment 
     limit on substantially all medical and surgical benefits in 
     any category of items or services, the plan may not impose 
     such a treatment limit on mental health or substance-related 
     disorder benefits for items and services within such category 
     that is more restrictive than the predominant treatment limit 
     that is applicable to medical and surgical benefits for items 
     and services within such category.
       ``(C) Categories of items and services for application of 
     treatment limits and beneficiary financial requirements.--For 
     purposes of this paragraph and paragraph (4), there shall be 
     the following five categories of items and services for 
     benefits, whether medical and surgical benefits or mental 
     health and substance-related disorder benefits, and all 
     medical and surgical benefits and all mental health and 
     substance related benefits shall be classified into one of 
     the following categories:
       ``(i) Inpatient, in-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     within a network of providers established or recognized under 
     such plan.
       ``(ii) Inpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an inpatient basis and 
     outside any network of providers established or recognized 
     under such plan.
       ``(iii) Outpatient, in-network.--Items and services not 
     described in clause (v) furnished on an outpatient basis and 
     within a network of providers established or recognized under 
     such plan.
       ``(iv) Outpatient, out-of-network.--Items and services not 
     described in clause (v) furnished on an outpatient basis and 
     outside any network of providers established or recognized 
     under such plan.
       ``(v) Emergency care.--Items and services, whether 
     furnished on an inpatient or outpatient basis or within or 
     outside any network of providers, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(D) Treatment limit defined.--For purposes of this 
     paragraph, the term `treatment limit' means, with respect to 
     a plan, limitation on the frequency of treatment, number of 
     visits or days of coverage, or other similar limit on the 
     duration or scope of treatment under the plan.
       ``(E) Predominance.--For purposes of this subsection, a 
     treatment limit or financial requirement with respect to a 
     category of items and services is considered to be 
     predominant if it is the most common or frequent of such type 
     of limit or requirement with respect to such category of 
     items and services.
       ``(4) Beneficiary financial requirements.--In the case of a 
     group health plan that provides both medical and surgical 
     benefits and mental health or substance-related disorder 
     benefits--
       ``(A) No beneficiary financial requirement.--If the plan 
     does not include a beneficiary financial requirement (as 
     defined in subparagraph (C)) on substantially all medical and 
     surgical benefits within a category of items and services 
     (specified in paragraph (3)(C)), the plan may not impose such 
     a beneficiary financial requirement on mental health or 
     substance-related disorder benefits for items and services 
     within such category.
       ``(B) Beneficiary financial requirement.--
       ``(i) Treatment of deductibles, out-of-pocket limits, and 
     similar financial requirements.--If the plan includes a 
     deductible, a limitation on out-of-pocket expenses, or 
     similar beneficiary financial requirement that does not apply 
     separately to individual items and services on substantially 
     all medical and surgical benefits within a category of items 
     and services, the plan shall apply such requirement (or, if 
     there is more than one such requirement for such category of 
     items and services, the predominant requirement for such 
     category) both to medical and surgical benefits within such 
     category and to mental health and substance-related disorder 
     benefits within such category and shall not distinguish in 
     the application of such requirement between such medical and 
     surgical benefits and such mental health and substance-
     related disorder benefits.
       ``(ii) Other financial requirements.--If the plan includes 
     a beneficiary financial requirement not described in clause 
     (i) on substantially all medical and surgical benefits within 
     a category of items and services, the plan may not impose 
     such financial requirement on mental health or substance-
     related disorder benefits for items and services within such 
     category in a way that results in greater out-of-pocket 
     expenses to the participant or beneficiary than the 
     predominant beneficiary financial requirement applicable to 
     medical and surgical benefits for items and services within 
     such category.
       ``(C) Beneficiary financial requirement defined.--For 
     purposes of this paragraph, the term `beneficiary financial 
     requirement' includes, with respect to a plan, any 
     deductible, coinsurance, co-payment, other cost sharing, and 
     limitation on the total amount that may be paid by a 
     participant or beneficiary with respect to benefits under the 
     plan, but does not include the application of any aggregate 
     lifetime limit or annual limit.'', and

[[Page H1283]]

       (2) in subsection (b)--
       (A) by striking ``construed--'' and all that follows 
     through ``(1) as requiring'' and inserting ``construed as 
     requiring'',
       (B) by striking ``; or'' and inserting a period, and
       (C) by striking paragraph (2).
       (b) Expansion to Substance-Related Disorder Benefits and 
     Revision of Definition.--Section 9812 of such Code is further 
     amended--
       (1) by striking ``mental health benefits'' each place it 
     appears (other than in any provision amended by paragraph 
     (2)) and inserting ``mental health or substance-related 
     disorder benefits'',
       (2) by striking ``mental health benefits'' each place it 
     appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), 
     and (a)(2)(C) and inserting ``mental health and substance-
     related disorder benefits'', and
       (3) in subsection (e), by striking paragraph (4) and 
     inserting the following new paragraphs:
       ``(4) Mental health benefits.--The term `mental health 
     benefits' means benefits with respect to services for mental 
     health conditions, as defined under the terms of the plan and 
     in accordance with applicable law, but does not include 
     substance-related disorder benefits.
       ``(5) Substance-related disorder benefits.--The term 
     `substance-related disorder benefits' means benefits with 
     respect to services for substance-related disorders, as 
     defined under the terms of the plan and in accordance with 
     applicable law.''.
       (c) Availability of Plan Information About Criteria for 
     Medical Necessity.--Subsection (a) of section 9812 of such 
     Code, as amended by subsection (a)(1), is further amended by 
     adding at the end the following new paragraph:
       ``(5) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health and substance-related disorder 
     benefits shall be made available by the plan administrator in 
     accordance with regulations to any current or potential 
     participant, beneficiary, or contracting provider upon 
     request. The reason for any denial under the plan of 
     reimbursement or payment for services with respect to mental 
     health and substance-related disorder benefits in the case of 
     any participant or beneficiary shall, on request or as 
     otherwise required, be made available by the plan 
     administrator to the participant or beneficiary in accordance 
     with regulations.''.
       (d) Minimum Benefit Requirements.--Subsection (a) of 
     section 9812 of such Code is further amended by adding at the 
     end the following new paragraph:
       ``(6) Minimum scope of coverage and equity in out-of-
     network benefits.--
       ``(A) Minimum scope of mental health and substance-related 
     disorder benefits.--In the case of a group health plan that 
     provides any mental health or substance-related disorder 
     benefits, the plan shall include benefits for any mental 
     health condition or substance-related disorder included in 
     the most recent edition of the Diagnostic and Statistical 
     Manual of Mental Disorders published by the American 
     Psychiatric Association.
       ``(B) Equity in coverage of out-of-network benefits.--
       ``(i) In general.--In the case of a group health plan that 
     provides both medical and surgical benefits and mental health 
     or substance-related disorder benefits, if medical and 
     surgical benefits are provided for substantially all items 
     and services in a category specified in clause (ii) furnished 
     outside any network of providers established or recognized 
     under such plan, the mental health and substance-related 
     disorder benefits shall also be provided for items and 
     services in such category furnished outside any network of 
     providers established or recognized under such plan in 
     accordance with the requirements of this section.
       ``(ii) Categories of items and services.--For purposes of 
     clause (i), there shall be the following three categories of 
     items and services for benefits, whether medical and surgical 
     benefits or mental health and substance-related disorder 
     benefits, and all medical and surgical benefits and all 
     mental health and substance-related disorder benefits shall 
     be classified into one of the following categories:

       ``(I) Emergency.--Items and services, whether furnished on 
     an inpatient or outpatient basis, required for the treatment 
     of an emergency medical condition (as defined in section 
     1867(e) of the Social Security Act, including an emergency 
     condition relating to mental health or substance-related 
     disorders).
       ``(II) Inpatient.--Items and services not described in 
     subclause (I) furnished on an inpatient basis.
       ``(III) Outpatient.--Items and services not described in 
     subclause (I) furnished on an outpatient basis.''.

       (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
     section 9812(c) of such Code is amended to read as follows:
       ``(2) Increased cost exemption.--
       ``(A) In general.--With respect to a group health plan, if 
     the application of this section to such plan 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 and substance-related disorder benefits under 
     the plan (as determined and certified under subparagraph (C)) 
     by an amount that exceeds the applicable percentage described 
     in subparagraph (B) of the actual total plan costs, the 
     provisions of this section shall not apply to such plan 
     during the following plan year, and such exemption shall 
     apply to the plan for 1 plan year.
       ``(B) Applicable percentage.--With respect to a plan, the 
     applicable percentage described in this paragraph shall be--
       ``(i) 2 percent in the case of the first plan year to which 
     this paragraph applies, and
       ``(ii) 1 percent in the case of each subsequent plan year.
       ``(C) Determinations by actuaries.--Determinations as to 
     increases in actual costs under a plan for purposes of this 
     subsection shall be made in writing and prepared and 
     certified by a qualified and licensed actuary who is a member 
     in good standing of the American Academy of Actuaries. Such 
     determinations shall be made available by the plan 
     administrator to the general public.
       ``(D) 6-month determinations.--If a group health plan seeks 
     an exemption under this paragraph, determinations under 
     subparagraph (A) shall be made after such plan has complied 
     with this section for the first 6 months of the plan year 
     involved.
       ``(E) Notification of appropriate agency.--
       ``(i) In general.--A group health plan that, based on a 
     certification described under subparagraph (C), qualifies for 
     an exemption under this paragraph, and elects to implement 
     the exemption, shall notify the Secretary of the Treasury of 
     such election.
       ``(ii) Requirement.--A notification under clause (i) shall 
     include--

       ``(I) a description of the number of covered lives under 
     the plan (or coverage) involved at the time of the 
     notification, and as applicable, at the time of any prior 
     election of the cost-exemption under this paragraph by such 
     plan (or coverage);
       ``(II) for both the plan year upon which a cost exemption 
     is sought and the year prior, a description of the actual 
     total costs of coverage with respect to medical and surgical 
     benefits and mental health and substance-related disorder 
     benefits under the plan; and
       ``(III) for both the plan year upon which a cost exemption 
     is sought and the year prior, the actual total costs of 
     coverage with respect to mental health and substance-related 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification under clause (i) 
     shall be confidential. The Secretary of the Treasury shall 
     make available, upon request to the appropriate committees of 
     Congress and on not more than an annual basis, an anonymous 
     itemization of such notifications, that includes--

       ``(I) a breakdown of States by the size and any type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(F) Construction.--Nothing in this paragraph shall be 
     construed as preventing a group health plan from complying 
     with the provisions of this section notwithstanding that the 
     plan is not required to comply with such provisions due to 
     the application of subparagraph (A).''.
       (f) Change in Exclusion for Smallest Employers.--Paragraph 
     (1) of section 9812(c) of such Code is amended to read as 
     follows:
       ``(1) Small employer exemption.--
       ``(A) In general.--This section shall not apply to any 
     group health plan for any plan year of a small employer.
       ``(B) Small employer.--For purposes of subparagraph (A), 
     the term `small employer' means, with respect to a calendar 
     year and a plan year, an 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. For purposes of the 
     preceding sentence, all persons treated as a single employer 
     under subsection (b), (c), (m), or (o) of section 414 shall 
     be treated as 1 employer and rules similar to rules of 
     subparagraphs (B) and (C) of section 4980D(d)(2) shall 
     apply.''.
       (g) Elimination of Sunset Provision.--Section 9812 of such 
     Code is amended by striking subsection (f).
       (h) Conforming Amendments to Heading.--
       (1) In general.--The heading of section 9812 of such Code 
     is amended to read as follows:

     ``SEC. 9812. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 
                   DISORDER BENEFITS.''.

       (2) Clerical amendment.--The table of sections for 
     subchapter B of chapter 100 of such Code is amended by 
     striking the item relating to section 9812 and inserting the 
     following new item:

``Sec. 9812. Equity in mental health and substance-related disorder 
              benefits.''.
       (i) Effective Date.--
       (1) In general.--Except as otherwise provided in this 
     subsection, the amendments made by this section shall apply 
     with respect to plan years beginning on or after January 1, 
     2009.
       (2) Elimination of sunset.--The amendment made by 
     subsection (g) shall apply to benefits for services furnished 
     after December 31, 2007.
       (3) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to one or 
     more collective bargaining agreements between employee 
     representatives and one or more employers ratified before the 
     date of

[[Page H1284]]

     the enactment of this Act, the amendments made by this 
     section (other than subsection (g)) shall not apply to plan 
     years beginning before the later of--
       (A) the date on which the last of the collective bargaining 
     agreements relating to the plan terminates (determined 
     without regard to any extension thereof agreed to after the 
     date of the enactment of this Act), or
       (B) January 1, 2009.
     For purposes of subparagraph (A), any plan amendment made 
     pursuant to a collective bargaining agreement relating to the 
     plan which amends the plan solely to conform to any 
     requirement added by this section shall not be treated as a 
     termination of such collective bargaining agreement.

     SEC. 5. MEDICAID DRUG REBATE.

       Paragraph (1)(B)(i) of section 1927(c) of the Social 
     Security Act (42 U.S.C. 1396r-8(c)) is amended--
       (1) by striking ``and'' at the end of subclause (IV);
       (2) in subclause (V)--
       (A) by inserting ``and before January 1, 2009, and after 
     December 31, 2014,'' after ``December 31, 1995,''; and
       (B) by striking the period at the end and inserting ``; 
     and''; and
       (3) by adding at the end the following new subclause:

       ``(VI) after December 31, 2008, and before January 1, 2015, 
     is 20.1 percent.''.

     SEC. 6. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION 
                   ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.

       (a) In General.--Section 1877 of the Social Security Act 
     (42 U.S.C. 1395nn) is amended--
       (1) in subsection (d)(2)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(C) in the case where the entity is a hospital, the 
     hospital meets the requirements of paragraph (3)(D).'';
       (2) in subsection (d)(3)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(D) the hospital meets the requirements described in 
     subsection (i)(1) not later than 18 months after the date of 
     the enactment of this subparagraph.''; and
       (3) by adding at the end the following new subsection:
       ``(i) Requirements for Hospitals To Qualify for Hospital 
     Exception to Ownership or Investment Prohibition.--
       ``(1) Requirements described.--For purposes of subsection 
     (d)(3)(D), the requirements described in this paragraph for a 
     hospital are as follows:
       ``(A) Provider agreement.--The hospital had--
       ``(i) physician ownership on the date of enactment of this 
     subsection; and
       ``(ii) a provider agreement under section 1866 in effect on 
     such date of enactment.
       ``(B) Limitation on expansion of facility capacity.--Except 
     as provided in paragraph (3), the number of operating rooms 
     and beds of the hospital at any time on or after the date of 
     the enactment of this subsection are no greater than the 
     number of operating rooms and beds as of such date.
       ``(C) Preventing conflicts of interest.--
       ``(i) The hospital submits to the Secretary an annual 
     report containing a detailed description of--

       ``(I) the identity of each physician owner and any other 
     owners of the hospital; and
       ``(II) the nature and extent of all ownership interests in 
     the hospital.

       ``(ii) The hospital has procedures in place to require that 
     any referring physician owner discloses to the patient being 
     referred, by a time that permits the patient to make a 
     meaningful decision regarding the receipt of care, as 
     determined by the Secretary--

       ``(I) the ownership interest of such referring physician in 
     the hospital; and
       ``(II) if applicable, any such ownership interest of the 
     treating physician.

       ``(iii) The hospital does not condition any physician 
     ownership interests either directly or indirectly on the 
     physician owner making or influencing referrals to the 
     hospital or otherwise generating business for the hospital.
       ``(iv) The hospital discloses the fact that the hospital is 
     partially owned by physicians--

       ``(I) on any public website for the hospital; and
       ``(II) in any public advertising for the hospital.

       ``(D) Ensuring bona fide investment.--
       ``(i) Physician owners in the aggregate do not own more 
     than 40 percent of the total value of the investment 
     interests held in the hospital or in an entity whose assets 
     include the hospital.
       ``(ii) The investment interest of any individual physician 
     owner does not exceed 2 percent of the total value of the 
     investment interests held in the hospital or in an entity 
     whose assets include the hospital.
       ``(iii) Any ownership or investment interests that the 
     hospital offers to a physician owner are not offered on more 
     favorable terms than the terms offered to a person who is not 
     a physician owner.
       ``(iv) The hospital (or any investors in the hospital) does 
     not directly or indirectly provide loans or financing for any 
     physician owner investments in the hospital.
       ``(v) The hospital (or any investors in the hospital) does 
     not directly or indirectly guarantee a loan, make a payment 
     toward a loan, or otherwise subsidize a loan, for any 
     individual physician owner or group of physician owners that 
     is related to acquiring any ownership interest in the 
     hospital.
       ``(vi) Investment returns are distributed to each investor 
     in the hospital in an amount that is directly proportional to 
     the investment of capital by such investor in the hospital.
       ``(vii) Physician owners do not receive, directly or 
     indirectly, any guaranteed receipt of or right to purchase 
     other business interests related to the hospital, including 
     the purchase or lease of any property under the control of 
     other investors in the hospital or located near the premises 
     of the hospital.
       ``(viii) The hospital does not offer a physician owner the 
     opportunity to purchase or lease any property under the 
     control of the hospital or any other investor in the hospital 
     on more favorable terms than the terms offered to an 
     individual who is not a physician owner.
       ``(E) Patient safety.--
       ``(i) Insofar as the hospital admits a patient and does not 
     have any physician available on the premises to provide 
     services during all hours in which the hospital is providing 
     services to such patient, before admitting the patient--

       ``(I) the hospital discloses such fact to a patient; and
       ``(II) following such disclosure, the hospital receives 
     from the patient a signed acknowledgment that the patient 
     understands such fact.

       ``(ii) The hospital has the capacity to--

       ``(I) provide assessment and initial treatment for 
     patients; and
       ``(II) refer and transfer patients to hospitals with the 
     capability to treat the needs of the patient involved.

       ``(2) Publication of information reported.--The Secretary 
     shall publish, and update on an annual basis, the information 
     submitted by hospitals under paragraph (1)(C)(i) on the 
     public Internet website of the Centers for Medicare & 
     Medicaid Services.
       ``(3) Exception to prohibition on expansion of facility 
     capacity.--
       ``(A) Process.--
       ``(i) Establishment.--The Secretary shall establish and 
     implement a process under which an applicable hospital (as 
     defined in subparagraph (E)) may apply for an exception from 
     the requirement under paragraph (1)(B).
       ``(ii) Opportunity for community input.--The process under 
     clause (i) shall provide individuals and entities in the 
     community that the applicable hospital applying for an 
     exception is located with the opportunity to provide input 
     with respect to the application.
       ``(iii) Timing for implementation.--The Secretary shall 
     implement the process under clause (i) on the date that is 18 
     months after the date of enactment of this subsection.
       ``(iv) Regulations.--Not later than the date that is 18 
     months after the date of enactment of this subsection, the 
     Secretary shall promulgate regulations to carry out the 
     process under clause (i).
       ``(B) Frequency.--The process described in subparagraph (A) 
     shall permit an applicable hospital to apply for an exception 
     up to once every 2 years.
       ``(C) Permitted increase.--
       ``(i) In general.--Subject to clause (ii) and subparagraph 
     (D), an applicable hospital granted an exception under the 
     process described in subparagraph (A) may increase the number 
     of operating rooms and beds of the applicable hospital above 
     the baseline number of operating rooms and beds of the 
     applicable hospital (or, if the applicable hospital has been 
     granted a previous exception under this paragraph, above the 
     number of operating rooms and beds of the hospital after the 
     application of the most recent increase under such an 
     exception) by an amount determined appropriate by the 
     Secretary.
       ``(ii) Lifetime 50 percent increase limitation.--The 
     Secretary shall not permit an increase in the number of 
     operating rooms and beds of an applicable hospital under 
     clause (i) to the extent such increase would result in the 
     number of operating rooms and beds of the applicable hospital 
     exceeding 150 percent of the baseline number of operating 
     rooms and beds of the applicable hospital.
       ``(iii) Baseline number of operating rooms and beds.--In 
     this paragraph, the term `baseline number of operating rooms 
     and beds' means the number of operating rooms and beds of the 
     applicable hospital as of the date of enactment of this 
     subsection.
       ``(D) Increase limited to facilities on the main campus of 
     the hospital.--Any increase in the number of operating rooms 
     and beds of an applicable hospital pursuant to this paragraph 
     may only occur in facilities on the main campus of the 
     applicable hospital.
       ``(E) Applicable hospital.--In this paragraph, the term 
     `applicable hospital' means a hospital--
       ``(i) that is located in a county in which the percentage 
     increase in the population during the most recent 5-year 
     period (as of the date of the application under subparagraph 
     (A)) is at least 200 percent of the percentage increase in 
     the population growth of the United States during that 
     period, as estimated by Bureau of the Census;
       ``(ii) whose annual percent of total inpatient admissions 
     and outpatient visits that

[[Page H1285]]

     represent inpatient admissions and outpatient visits under 
     the program under title XIX is equal to or greater than the 
     average percent with respect to such admissions and visits 
     for all hospitals located in the State;
       ``(iii) that does not discriminate against beneficiaries of 
     Federal health care programs and does not permit physicians 
     practicing at the hospital to discriminate against such 
     beneficiaries;
       ``(iv) that is located in a State in which the average bed 
     capacity in the State is less than the national average bed 
     capacity; and
       ``(v) in the case of a hospital located--

       ``(I) in a core-based statistical area, that is located in 
     such an area in which the average bed occupancy rate in such 
     area is greater than 80 percent; or
       ``(II) outside of a core-based statistical area, that is 
     located in a State in which the average bed occupancy rate is 
     greater than 80 percent.

       ``(F) Publication of final decisions.--The Secretary shall 
     publish final decisions with respect to applications under 
     this paragraph in the Federal Register.
       ``(G) Limitation on review.--There shall be no 
     administrative or judicial review under section 1869, section 
     1878, or otherwise of the process under this paragraph 
     (including the establishment of such process).
       ``(4) Collection of ownership and investment information.--
     For purposes of clauses (i) and (ii) of paragraph (1)(D), the 
     Secretary shall collect physician ownership and investment 
     information for each hospital as it existed on the date of 
     the enactment of this subsection.
       ``(5) Physician owner defined.--For purposes of this 
     subsection, the term `physician owner' means a physician (or 
     an immediate family member of such physician) with a direct 
     or an indirect ownership interest in the hospital.''.
       (b) Enforcement.--
       (1) Ensuring compliance.--The Secretary of Health and Human 
     Services shall establish policies and procedures to ensure 
     compliance with the requirements described in subsection 
     (i)(1) of section 1877 of the Social Security Act, as added 
     by subsection (a)(3), beginning on the date such requirements 
     first apply. Such policies and procedures may include 
     unannounced site reviews of hospitals.
       (2) Audits.--Beginning not later than 18 months after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services shall conduct audits to determine if 
     hospitals violate the requirements referred to in paragraph 
     (1).
       (c) Adjustment to PAQI Fund.--Section 1848(l)(2)(A)(i)(III) 
     of the Social Security Act (42 U.S.C. 1395w-
     4(l)(2)(A)(i)(III)), as amended by section 101(a)(2) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended by striking ``$4,960,000,000'' and 
     inserting ``$5,120,000,000''.

     SEC. 7. STUDIES AND REPORTS.

       (a) Implementation of Act.--
       (1) GAO study.--The Comptroller General of the United 
     States shall conduct a study that evaluates the effect of the 
     implementation of the amendments made by this Act on--
       (A) the cost of health insurance coverage;
       (B) access to health insurance coverage (including the 
     availability of in-network providers);
       (C) the quality of health care;
       (D) Medicare, Medicaid, and State and local mental health 
     and substance abuse treatment spending;
       (E) the number of individuals with private insurance who 
     received publicly funded health care for mental health and 
     substance-related disorders;
       (F) spending on public services, such as the criminal 
     justice system, special education, and income assistance 
     programs;
       (G) the use of medical management of mental health and 
     substance-related disorder benefits and medical necessity 
     determinations by group health plans (and health insurance 
     issuers offering health insurance coverage in connection with 
     such plans) and timely access by participants and 
     beneficiaries to clinically-indicated care for mental health 
     and substance-use disorders; and
       (H) other matters 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 the Congress a 
     report containing the results of the study conducted under 
     paragraph (1).
       (b) GAO Report on Uniform Patient Placement Criteria.--Not 
     later than 18 months after the date of the enactment of this 
     Act, the Comptroller General shall submit to each House of 
     the Congress a report on availability of uniform patient 
     placement criteria for mental health and substance-related 
     disorders that could be used by group health plans and health 
     insurance issuers to guide determinations of medical 
     necessity and the extent to which health plans utilize such 
     criteria. If such criteria do not exist, the report shall 
     include recommendations on a process for developing such 
     criteria.
       (c) DOL Biannual Report on Any Obstacles in Obtaining 
     Coverage.--Every two years, the Secretary of Labor, in 
     consultation with the Secretaries of Health and Human 
     Services and the Treasury, shall submit to the appropriate 
     committees of each House of the Congress a report on 
     obstacles, if any, that individuals face in obtaining mental 
     health and substance-related disorder care under their health 
     plans.

  The SPEAKER pro tempore. Debate shall not exceed 2 hours, equally 
divided and controlled by the chairman and ranking minority member of 
the Committees on Energy and Commerce, Ways and Means, and Education 
and Labor.
  The gentleman from New Jersey (Mr. Pallone), the gentleman from 
Georgia (Mr. Deal), the gentleman from California (Mr. Stark), the 
gentleman from Michigan (Mr. Camp), the gentleman from California (Mr. 
George Miller), and the gentleman from California (Mr. McKeon) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and to insert extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise today to support the passage of H.R. 1424, the Paul Wellstone 
Mental Health and Addiction Equity Act of 2007, a comprehensive bill 
which will establish full mental health and addiction care parity. My 
colleagues, Representative Patrick Kennedy and Representative Jim 
Ramstad, have worked exhaustively to complete the mission that Congress 
embarked upon more than 10 years ago through the passage of the Mental 
Health Parity Act of 1996. That 1996 act authorized for 5 years partial 
parity by mandating that the annual and lifetime dollar limit for 
mental health treatment under group health plans offering mental health 
coverage be no less than that for physical illnesses.
  H.R. 1424, introduced by Representatives Kennedy and Ramstad, will 
fully ensure equity in coverage for mental illness and substance abuse 
disorders by requiring that group health plans with mental health 
coverage offer that coverage without the imposition of discriminatory 
financial requirements or discriminatory treatment limitations. The 
bill also protects against discrimination by diagnosis and requires 
plans to cover all mental health and substance abuse disorders.
  Mental illnesses are biologically based disorders, and there is no 
reason we should affirmatively provide protections to a student with 
depression or a young adult with schizophrenia, but not a child with 
autism or an elderly person with dementia. The bill also requires 
equality in out-of-network coverage. Again, a plan need not offer out-
of-network coverage, but if it does for medical conditions, it should 
for mental illnesses as well. There are many good actors that already 
offer equity in care. However, some try and create a phantom network of 
providers, where doctors in the network have long waiting lists or are 
not appropriate to treat certain illnesses.
  Mental disorders are the leading cause of disability in the United 
States for individuals between the ages of 15 and 44. But many health 
disorders are very treatable illnesses. H.R. 1424 would allow those 
individuals and families struggling to cope with the diverse array of 
illnesses which fall under the category of mental illness to have 
greater access to affordable care in order to alleviate the tremendous 
burden that these conditions can cause.
  Furthermore, H.R. 1424 will help to allow individuals that have been 
disabled by mental health and addiction disorders to acquire the 
treatment that they need in order to once again become productive 
members of society.
  Mr. Speaker, I strongly urge my colleagues to vote in favor of the 
passage of this important legislation which will ensure the equitable 
treatment of very serious diseases.
  I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I would yield myself such time as I 
may consume.
  Mr. Speaker, I rise today in opposition to this legislation. It is 
unfortunate that the majority in the House refused to pursue a strategy 
that our colleagues in the other body found appropriate for this 
legislation. Legislating, as we know, means compromising, and our 
colleagues on the other side of the Capitol worked together to craft a 
consensus piece of mental health parity legislation.

[[Page H1286]]

  As a supporter of the concept of mental health parity, it is 
disappointing to me that the House has instead decided to jeopardize 
the possibility of getting legislation on mental health parity this 
year by ignoring the broad consensus among Members and stakeholders 
which was developed in the Senate.
  Mental illness affects tens of millions of Americans. According to 
the Surgeon General, approximately one in five Americans suffers 
adverse mental conditions during any given year. The impact from such 
illnesses on families can be devastating, and we must be doing more to 
improve access to mental health services. However, this bill before us 
today is not the correct approach.
  At a time of climbing premiums and health insurance costs, it is 
strange to me that we would pursue a path which the CBO acknowledges 
will raise the price of health insurance. CBO also projected that H.R. 
1424 would cause some to lose their health insurance benefits and some 
employers to terminate mental health benefits altogether. In the face 
of a growing uninsured population in this country, statements like 
these from CBO concern me. We must find a more balanced approach to 
this problem that protects access to health insurance and mental health 
benefits.
  The bill's focus is also overly broad and includes coverage of some 
conditions that fall well short of diseases under most scientifically 
accepted definitions. Our legislation should focus on serious 
biologically based mental disorders like schizophrenia and bipolar 
disorder, not on jet lag and caffeine addiction, as this bill would 
include. Employers may be willing to provide coverage for serious 
mental disorders, but under this bill could decide to drop coverage of 
mental illness altogether because they cannot afford the scope of the 
DSM-IV, the Diagnostic and Statistical Manual of Mental Disorders. 
Surely, this is an unintended consequence we should all want to avoid.
  It is also important to note that under the bill, no executive or 
congressional action would intercede between the decisions of the 
American Psychiatric Association in the creation of the DSM and future 
legal requirements with which employers and insurers must comply under 
penalty of Federal law. I have always been concerned that this 
represents a likely constitutional conflict under the delegations 
doctrine. The bill appears to leave any update of what qualifies as 
mental health conditions and, therefore, coverage under the bill to the 
American Psychiatric Association. There are no criteria for judicial 
review, required notice and comment, or congressional review of future 
decisions made by a nongovernment entity.
  I want to be clear that I am not questioning the value of the DSM or 
the practice of medicine, or the process by which the manual is 
developed. But I believe giving the future decisions of a 
nongovernmental body the force of law raises serious constitutional 
questions. I would support a more balanced approach to mental health 
parity along the lines of the Senate bill.
  I would ask my colleagues to vote ``no'' today so that we can take up 
the Senate bill and avoid a possible stalemate in a House-Senate 
conference on an issue that should be signed into law this Congress.
  I would reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from Washington (Mr. Baird).
  Mr. BAIRD. Mr. Speaker, this is indeed a landmark day in the United 
States of America in the history of health care because the Congress of 
the United States, the House of Representatives, is going to say that 
mental illness deserves treatment and people suffering from mental 
illness deserve to have that treatment covered under their insurance 
plans.
  I want to commend Jim Ramstad and Patrick Kennedy for decades of work 
on this project. They are American heroes, in my judgment. They joined 
me for a field hearing in my congressional district where we heard from 
families, patients and providers about the toll mental illness takes on 
their lives.
  As a clinical psychologist who spent 23 years providing mental health 
care, I want to share with my colleagues this simple fact. I have never 
met, and I am sure you have never met, anyone who has not been touched 
personally by a family member, a friend, or a coworker whose lives have 
been disrupted by mental illness. All of us in some way have been 
touched by mental illness, in our families, our friends, or our 
coworkers. What this bill does is say that people suffering from such 
illnesses will be covered under insurance plans.
  I want to be clear about one thing. This is research-based, it is 
effective, it saves lives, and it saves dollars for our economy. 
Research-based, effective, it saves lives, and it saves dollars. This 
legislation supports it.
  Congratulations, Patrick Kennedy and Jim Ramstad. I urge a ``yes'' 
vote on behalf of millions of Americans.
  Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 2 minutes to 
Mr. Ferguson from New Jersey.
  Mr. FERGUSON. I thank the gentleman from Georgia.
  I rise in support of H.R. 1424, the Paul Wellstone Mental Health 
Addiction and Equity Act of 2007. This legislation brings treatment to 
individuals that desperately need the help. Addictions and mental 
illnesses are afflictions that have long been stigmatized and brushed 
aside by our society and institutions. Most of us have had a loved one 
or family member touched by mental illness or addictions. We know their 
painful stories all too well. Many individuals go years without 
treatment for serious illnesses due to society's stigma on mental 
illnesses. These individuals need and should receive the same care and 
treatment as if they had any other illness. However, I do have deep 
concerns about how this bill will be funded. Funding this legislation 
comes at the expense of United States medical researchers, which is 
ironic, since these are the folks who we look to to develop treatments 
for many of these very health conditions.
  One of the offsets included in this legislation is a more than 30 
percent increase in the Medicaid prescription drug rebate, which is a 
punitive and unwarranted move against the same medical researchers that 
we are relying on to find cures and treatments for illnesses and 
diseases. By increasing their cost and slapping a new tax on their 
work, we will be reducing their ability to invest in research and 
development of new products, new drugs. I believe that is profoundly 
shortsighted and misguided, and I believe it will set back the cause of 
research, which would ultimately lead to treatments for many of the 
diseases and afflictions that we are talking about here today.
  Therefore, while I support and am a cosponsor of the underlying 
legislation, I urge that this particular misguided offset be struck 
from the bill as we negotiate with our colleagues in the Senate on a 
final version of this important legislation.
  Mr. Speaker, I thank the gentleman, Mr. Deal, for his leadership. I 
thank Mr. Kennedy and Mr. Ramstad for their work.
  Mr. PALLONE. Mr. Speaker, I would yield 4\1/2\ minutes to the 
gentleman from Rhode Island (Mr. Kennedy), the sponsor of this 
legislation, who has been out on the road, and such a champion. I can't 
imagine what else to say about all his work on this.
  Mr. KENNEDY. I thank the chairman for yielding me this time, and I 
want to thank him for all of his hard work and that of the other 
chairmen, Chairman Dingell, Chairman Rangel, Chairman Miller, Chairman 
Stark, and obviously you, Chairman Pallone, for hosting that committee 
hearing in your district, as well as Chairman Andrews for all the work 
he did on this issue to bring H.R. 1424 to the floor today.
  Without all of your markups, this bill would not have made it as far 
as it did today to come to this floor as one of the most important 
public health bills that we have seen on this floor in decades. Of 
course, that would not have happened had it not been for the great 
support of our Speaker, Nancy Pelosi, and Leader Hoyer who without 
their support this would not have happened as well. I am indebted to 
them for their support.
  Today, this House of Representatives takes up a truly landmark piece 
of civil rights legislation. Why civil rights? Because just as it would 
account for the color of your skin, or any other immutable fact about 
you, you don't choose if you're born with a congenital defect or if 
you're born with

[[Page H1287]]

one characteristic or another, just as you don't choose to have a 
predisposition to cancer, a predisposition to having asthma, a 
predisposition to dying early of one disease or another. And that 
applies true with those with mental illness. Yet when you have health 
insurance in this country, you expect to buy health insurance and it 
should cover your whole body.

                              {time}  1645

  But unfortunately, unbelievably, the brain is still relegated to that 
part of the world where people think of it as something that should be 
in your control, something that you should take charge of and so forth; 
that even though you might have a biochemical imbalance in your brain, 
that it is your fault if you have that biochemical imbalance in your 
brain.
  So if you had diabetes and you don't produce enough insulin and you 
eat the wrong food and have sugar imbalances, no one holds it against 
you if you have complications to diabetes. But God forbid you have a 
dopamine imbalance in your brain that causes you to use alcohol or 
drugs, or you have a dopamine imbalance that has you in a depression or 
an imbalance in your brain that has you have a mental illness like 
schizophrenia. Then you are held to account because someone says that 
is your fault. And if you wander around the streets or if you are 
homeless, that must be your fault.
  Those are the physical symptoms of a mental illness. Yet an insurance 
company will hospitalize you for the symptoms of a chemical imbalance 
called diabetes, but they won't hospitalize you for the physical and 
chemical imbalances of a brain illness as a result of dopamine 
imbalances or glutamate imbalances. What sense does that make? It 
doesn't make any sense. But it is stereotyped in an old dark ages 
mindset that has people hanging in the shadows because they are afraid 
someone is going to point someone out and say you should be ashamed of 
yourself because you have a mental illness.
  My friends, I have a mental illness. I am fortunately getting the 
best care this country has to offer because I am a Member of Congress. 
If it is good enough for Members of Congress to have full parity, then 
it ought to be good enough for every American in this country who buys 
health insurance not to be discriminated against.
  If we care about health care in this country, why are we not taking 
care of health care, rather than sick care? We ought to be taking care 
of people before they end up sick. We are spending in our emergency 
rooms too much money taking care of all of the acute cases as a result 
of mental illnesses, the car accidents, stabbings and intubations. Why 
not take care of people before they end up ending up in the emergency 
rooms? Why not take care of the people before they end up in our jails?
  Let's pass mental parity, make this country stronger, make our people 
stronger, and let's make this day a great day for civil rights for all 
Americans.
  I want to say this couldn't have been done without my good friend and 
colleague Jim Ramstad. Let's put this bill on the floor and do it this 
year and make it a tribute to Congressman Jim Ramstad, who has fought 
for this bill so long and hard.
  Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 3 minutes to 
the gentleman from Pennsylvania (Mr. Tim Murphy), a member of the 
committee.
  Mr. TIM MURPHY of Pennsylvania. Mr. Speaker, I thank the ranking 
member.
  The CBO doesn't score savings. If it did, it would note that drug and 
alcohol addictions cost $400 billion each year, that depression costs 
employers $51 billion each year, that depression increases the risk for 
chronic illness, and that chronic illness and untreated depression 
doubles the cost of health care. It would also note that caffeine 
withdrawal and jet lag are not something that insurance companies pay 
for. In fact, they are not medically necessary. It is not occurring 
here.
  But let's see what really happens with a person with mental illness, 
and I am saying this as a psychologist, as someone who has seen this 
time and time again, how the symptom really works. A person with a 
deadly disease such as anorexia or bulimia withers away until 
malnutrition and dehydration puts them in the hospital. Once the 
hospital stabilizes them, they come out. Maybe they will have a visit 
or two with a counselor or psychiatrist or psychologist. Maybe their 
primary care physician will put that person on some medication. And 75 
percent of psychotropic drugs are prescribed by nonpsychiatrists, by 
people not trained in the field, because they don't have treatment 
possibilities under their health care plan.
  I oftentimes have a somewhat tongue-in-cheek agreement with 
obstetricians: I don't deliver babies, and they don't treat mental 
illness. Unfortunately, that may be all the plan allows for.
  But let's look at us as Members of Congress. Out of 435 Members of 
Congress, out of the 10,000 employees on our side of the Hill, we know 
that there are hundreds, thousands of people, quite frankly, who at 
some point in their working career will have some mental illness. What 
do we do with a well-trained employee? Do we say, you're fired? Do we 
say, go out and suck it up? Do we send them out into the unemployment 
system? Do we send them out into the welfare system? Do we take our 
children and send them out to the educational system and say, let the 
school take care of it? If it is a family member, do we say, well, be 
part of the criminal justice system, perhaps go into the emergency room 
system? No. We have the situation as Members of Congress where we can 
say, no, you can get help and you can get treatment.
  Why not for the rest of the country? Why not look at this as a cost-
saving measure? This is more than just a compassionate measure. I speak 
as someone who has treated the mentally ill all my professional life, 
for 25 years. I know time and time again, when the people who are 
trained in this field to do something are told, no, you can't see this 
patient anymore, what do you say to the autistic child's parents? What 
do you say to somebody suffering from depression? What do you say to 
that person with anorexia or bulimia or any host of other problems when 
you have to say you are not covered, and so they are treated by someone 
with nothing in terms of experience in that field?
  If we really want to save money, if we really are looking at things 
to help business, let's look at and see what AT&T and Pepsi and PPG and 
other corporations have said, that it saves them millions of dollars in 
indirect costs, billions of dollars.
  Let's be honest about this. If we leave the system the way it is, we 
will see more wasted money. We will see more deaths. We will see more 
people mistreated or lacking treatment. Let's do the right thing.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to our distinguished 
majority leader, the gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. Mr. Speaker, I thank the gentleman for yielding, and I am 
pleased to follow my friend Mr. Murphy who just spoke, with whom I 
agree entirely. This will be a cost savings. I want to congratulate as 
well Patrick Kennedy and Jim Ramstad, one a Democrat and one a 
Republican.
  But this is not a partisan issue. This is not a Republican or 
Democratic issue. It is an issue of human beings. It is an issue of 
people that need help and have been denied it, people who are one of 
us, as Mr. Murphy so eloquently and correctly pointed out.
  I rise in strong support of this legislation. I strongly support this 
long overdue bipartisan legislation to end discrimination against 
patients seeking treatment for mental illness. Mr. Kennedy spoke of 
that discrimination.
  I want to commend Congressman Kennedy and my friend Congressman 
Ramstad. Congressman Ramstad is going to be leaving us, but he has been 
one of the best Members that has served in this body, who looks at 
issues on their merits, not on partisanship. We all ought to do that.
  This legislation, the Paul Wellstone Mental Health and Addiction 
Equity Act, now has 274 cosponsors on both sides of the aisle. Under 
this bill, an insurer or group health plan must ensure that any 
financial requirements such as deductibles, copayments, coinsurance and 
out-of-pocket expenses which apply to mental health and addiction 
treatments are no more restrictive or costly than the financial 
requirements applied to comparable medical and surgical benefits that 
the plan confers.

[[Page H1288]]

  Why does it do that? It does it because in America we want healthy 
people; not physically healthy people or mentally healthy people, but 
people who are physically and mentally healthy, because obviously there 
is an extraordinary relationship between the two. Under this bill, we 
will accomplish that end.
  It also requires equity in treatment limits. This means that the 
treatment limits, such as the frequency of treatment, number of visits 
and days of coverage applied to mental health and addiction benefits, 
are no more restrictive than the treatment limits applied to comparable 
medical and surgical benefits. Why? Again, because we want to effect 
the health of the individuals we are serving.
  It is important to note that this bill only applies to insurers and 
group health plans that provide mental health benefits. That is, it 
does not require plans that do not currently offer mental health 
benefits to do so. It simply says, if you provide mental health 
benefits, do so equitably and fairly and equally. That is why Patrick 
Kennedy referred to this as a civil rights bill. It is a civil rights 
bill.
  It also exempts businesses with 50 or fewer employees and businesses 
that experience an overall premium increase of 2 percent or more in the 
first year and 1 percent in subsequent years. We believe that perhaps 
will not happen, but it provides for it.
  Research has shown that there has been no significant cost increase 
attributable to the parity requirement in the Federal Employees Health 
Benefits Program, which has made parity coverage for mental health care 
available to more than 8\1/2\ million Federal employees for 8 years. So 
we have had experience at this. This is not a radical departure. This 
is, however, the provision of equal treatment.
  Furthermore, this bill's enforcement mechanisms are real, permitting 
the IRS to enforce and levy fines and penalties on plans for 
disallowing employers from deducting health care costs as an expense.
  The two offsets in this bill were included in the Children's Health 
and Medical Protection Act, or the CHAMP Act, which passed the House 
last August. The first increases the rebate or discount that drug 
companies are required to provide State Medicaid programs for drugs 
provided for Medicaid beneficiaries. The second prohibits physicians 
from referring patients to hospitals in which they have an ownership 
interest, with the ability to grandfather existing physician-owned 
hospitals.
  It is telling, Mr. Speaker, that this bill is supported by, among 
others, the American Medical Association, the American Hospital 
Association, the American Nurses Association, the American Psychiatric 
Association, and the American Psychological Association.
  On the steps of the Capitol in a press conference with the Speaker, 
with Mrs. Rosalynn Carter, Mr. Kennedy and Mr. Ramstad, as well as 
David Wellstone, I said that the United Negro College Fund has a 
wonderful phrase that it uses, and that phrase is that ``a mind is a 
terrible thing to waste.'' That is so very accurate. And if a mind is a 
terrible thing to waste, it is a terrible thing not to treat, as we 
would treat the broken arm or the diabetes or any other physical 
ailment.
  This bill makes America healthier. This bill will save money. This 
bill makes good sense, morally and economically. Support this vital 
piece of legislation.
  Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 2 minutes to 
the gentleman from Oklahoma (Mr. Sullivan), another member of the 
committee.
  Mr. SULLIVAN. Mr. Speaker, I rise today in support of H.R. 1424, the 
Mental Health and Addiction Equity Act of 2007. I would like to commend 
Congressman Kennedy and Congressman Ramstad for the work they have done 
on this bill.
  There is a problem I have with it, though. I am disappointed with the 
offsets that are in there. I think these offsets do punish the 
pharmaceutical industry for participating in the Medicaid program, and 
it places financial limitations on physician-owned hospitals. 
Unfortunately, these offsets are essentially just a political game, and 
I hope at the end of the day they are not in this bill.
  Mental health illness, if someone has a biologically based mental 
disorder, it is no fault of their own. They either have it or they 
don't. It is a chemical imbalance of the brain, and I think it should 
be treated like any other illness, and it is high time in this country 
that we do that.
  This bill, people are going to say, we are going to score it, it is 
going to cost all this money. It is not. Some research says we spent 
$100 billion last year on untreated mental illness in lost productivity 
in the workforce in this country, and last year we lost $400 billion in 
lost productivity in the workforce due to substance abuse problems in 
this country. It is high time that we do not brush this issue aside 
anymore. We can't do it. It is costing us way too much.
  My State of Oklahoma has the highest rate of mental illness in the 
United States of America. I don't know why, but we do, and we need to 
address it. That is why I was so glad that Congressman Kennedy did come 
to my district to hold a field hearing there.
  We heard from businesses. We asked them point-blank, one of the 
biggest employers in my district, we said, is this going to cost you 
money? He said, no, it will help us. It will save money. We talked to 
other people in the district about that as well.
  People need this desperately. It is high time that we do treat people 
that have a mental disorder just like anyone else that has diabetes, a 
heart illness, or any other illness. I urge my colleagues to support 
this measure.

                              {time}  1700

  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Eshoo).
  Ms. ESHOO. I thank the gentleman, who is our wonderful chairman of 
the Health Subcommittee in the House, for yielding. I want to begin by 
paying tribute to our colleagues, Jim Ramstad and Patrick Kennedy. They 
came to my congressional district for a hearing, and there was an 
outpouring. But, in addition, there was an outpouring across the 
country and I believe that they carried a candle across the country and 
that candle has lit the way. They lit the way with their integrity, 
with their courage, with their patience to listen, and their 
legislative craft of the bill that is brought before the House today. 
So to both of you, I salute you and the country thanks you.
  America is best when we see where we have not done right, where there 
is a wrong, and we correct it. Congressman Kennedy said today that this 
is civil rights legislation, and it is. Every Member of the House 
should recognize that, today, we have the opportunity to break down a 
barrier, one of the last barriers in our country where those that have 
mental illness are indeed discriminated against in the insurance system 
of our country.
  Now there are some in my congressional district that have led the 
way. Tony and Fran Hoffman helped to found the National Association of 
Mental Health. Eve Oliphant has worked for that. And I am really proud 
that David Wellstone, the late Senator Wellstone's son, is a 
constituent as well.
  There are some very important points that have been made about the 
bill. There are also many things that have been thrown at it. For those 
that say that jet lag is going to be paid for by insurance companies, 
don't insult people that have mental health illnesses in our country. 
That will not happen. So, my colleagues, let's pass the civil rights 
legislation today. We will do the country good by doing so.
  Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 4 minutes to 
the ranking member of the Energy and Commerce Committee, the gentleman 
from Texas (Mr. Barton).
  Mr. BARTON of Texas. I want to thank Congressman Deal for his 
excellent leadership of this issue and floor time and his demeanor and 
ability to coordinate the effort. I really appreciate that.
  Mr. Speaker, I, along with every Member of this body, am very 
concerned about the almost invisible illness which we call mental 
illness. There is absolutely no question that it is real. There is no 
question that we need to do more to alleviate it and treat it and, if 
possible, make it possible for those that have it to be cured of it. 
Unfortunately, the bill before us today doesn't do that.

[[Page H1289]]

  We are in the process of putting together a bill that, if it passes 
in its current form, does nothing more than bureaucratize, in my 
opinion, the treatment of mental illness. It goes so far as to put the 
entire catalog of various diagnoses into Federal statute. I don't think 
that makes a lot of sense. This Diagnostic and Statistical Manual has 
numerous categories that are very real abuses, very real problems, but 
I think it is a debatable proposition whether they constitute mental 
illness.
  For example, code V71.01 of the Diagnostic and Statistical Manual 
covers professional thieves, racketeers, and dealers in illegal 
substances. Now in my book, those are thugs and criminals; they are not 
people suffering from a mental illness. And I don't want, if this bill 
were to become law and the Diagnostic and Statistical Manual be put 
into Federal statute, for a criminal defense attorney to stand up in 
court and cite this law as a reason that their client should be treated 
for mental illness and not be subject to criminal penalties and 
hopefully, if proven guilty, put behind bars.
  There is a better bill. It is a bill that has come out of the other 
body. It is a bill that was put together in the other body with 
bipartisan support. In my opinion, it is a better bill than the bill 
before us. I would hope that at the appropriate time we might work with 
the other body and adopt more of that language than the language before 
us.
  Finally, Mr. Speaker, I am concerned that this bill came before us 
under a closed rule. We did have an open debate in the committee and I 
want to commend Chairman Dingell for that. But coming to the floor, we 
were offered no substitute. We were offered no amendments.
  I am also concerned about the offset. The offset is an attack on 
physician-owned hospitals. And it is kind of odd that the same 
provision that the CBO now scores as saving hundreds of millions of 
dollars over 5 years and billions over 10 years, 3 years ago had no 
savings at all when we looked at a similar provision in the Budget 
Reconciliation Act.
  So I would oppose this on procedural reasons and also policy reasons 
and hope we would defeat it and then work with the other body on some 
version of the bill that has already come out of the other body.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Speaker, this bill has been a long time coming, and 
I am sure Senator Wellstone would both be pleased to see us addressing 
this issue, finally, and also so, so proud of our colleagues, Mr. 
Kennedy and Mr. Ramstad. The bill will provide countless protections to 
patients by preventing discrimination and treatment limitations by 
insurance companies.
  All too often I hear stories about children with eating disorders, 
parents who are substance abusers, individuals with bipolar disorder, 
or any other number of mental health disorders who have been unable to 
access coverage for mental health services. These disorders are just as 
great as any physical malady and, frankly, oftentimes they have a 
greater impact on an individual's ability to live a healthy, happy life 
as a productive member of society.
  Last year, during our hearing on this bill, for example, we heard 
from a woman named Marley Prunty-Lara, who was diagnosed with bipolar 
disease at the age of 15. Her family had to take out a second mortgage 
on their home and move to another State just to afford care. However, 
with proper treatment, she is now a fully productive member of society 
and in fact credits her treatment for saving her life.
  What I remember most vividly from her testimony is how lucky she felt 
that her family was able to afford coverage although they had to make 
sacrifices to do so. And then I thought, what about all of the other 
individuals in this country whose insurance companies do not provide 
them with mental health benefits and cannot afford treatment? What 
about the individuals whose benefits run out before they have fully 
recovered? And what about people with chronic conditions? Just like my 
little 14-year-old daughter has type I diabetes, she will get the 
treatment she needs for the rest of her life. But what about people 
with mental health conditions who do not? We know that mental health is 
fundamental to good health. That is why we need to support this 
legislation.
  I find it interesting that we are addressing the question of how we 
as a society want to pay for mental health at the same time as we are 
addressing the same question in the context of the President's budget 
and health care for children. I honestly hope that we can pass this 
legislation today and finally put the days of discrimination toward 
individuals with mental health or substance abuse disorders behind us. 
It is time to finally pass the Paul Wellstone Mental Health and 
Addiction Equity Act.
  Mr. DEAL of Georgia. I am pleased to yield 2 minutes to another 
member of the committee, the gentleman from Indiana (Mr. Buyer).
  (Mr. BUYER asked and was given permission to revise and extend his 
remarks.)
  Mr. BUYER. I support the Senate-passed version of the mental health 
parity legislation. It was carefully crafted between mental health 
groups and business groups. And everyone should note that not all of 
the mental advocacy groups support this House language. They see some 
dangers in it.
  In particular, in the bill that we are discussing, employers are 
allowed to drop their mental health benefits, and there is great 
concern that employers in fact will do that because of the overly broad 
coverage mandates as specified in the Diagnostics and Statistical 
Manual which is included in this bill.
  The American people must know that the bill before the House today, 
again, is not supported universally by mental health advocacy groups as 
the Senate bill is. Heather Wilson offered an amendment in the 
committee; it was defeated. I am very disappointed that no amendments 
were offered in the Rules Committee. This is, once again, shutting down 
the democratic process of this House.
  I don't know what you have to fear. I am really concerned about that. 
I am also concerned about the pay-fors for this. To substantially 
increase the Medicaid prescription drug rebate as one of the offsets, 
this significant increase could have a detrimental impact, because when 
you increase these rebates, there is going to be a cost shift, and that 
cost shift is going to have a depreciative effect. The effect will be 
you will increase the price on premiums, you will have an increased 
price of drugs on someone else.
  Also, I am very bothered that the second pay-for of the bill would 
limit Americans' access to the specialty hospitals. These are benefits 
that so many people are enjoying, these specialized hospitals. They 
have higher patient satisfaction, lower mortality rates, and lower 
overall costs for health care. So at a time when our Nation's health 
care costs are rising and the quality of our care is a top concern, I 
am very bothered that this provision would cut out that important 
market innovation.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. I first want to congratulate the sponsors and thank 
them, Congressman Kennedy and Congressman Ramstad, for their tireless 
effort on behalf of this bipartisan bill. I also want to pay tribute to 
Paul Wellstone. He and his wife Sheila were very good friends of me and 
my family. They were both leaders in ending discrimination and making 
sure that every person in this country has access to affordable 
comprehensive care, including comprehensive mental health and substance 
abuse treatment.
  And, if Paul were here today, he would no doubt tell some stories 
about those he had met throughout the years who would benefit from 
passing H.R. 1424. And in his absence today, I remember the many, many 
constituents who I have heard from since first being elected to the 
Illinois State legislature many years ago who shared with me the need, 
their desperate need to pass mental health parity legislation.
  Every year, about 40 million of us will experience some type of 
mental disorder; yet one out of every two children and two out of every 
three adults with diagnosable mental disorders go without treatment.
  The good news is that so many mental illnesses are manageable and 
treatable and curable. The bad news is that, for so many, treatment for 
mental illness lies far beyond their reach due to high cost sharing and 
lower caps on services.

[[Page H1290]]

  Some have said that using the handbook that defines mental health 
illnesses and is used by the mental health professionals somehow will 
add to the costs and jeopardize access altogether. But when implemented 
in the Federal Employee Health Benefit Program, our own program, in 
2001, costs did not increase and not one single insurer dropped out. If 
we are able to benefit from this level of coverage, shouldn't our 
constituents get at least that much?
  Maintaining strong mental health is just as important as maintaining 
strong physical health, and it is critical that we pass the strongest 
parity bill we can today.
  Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 1 minute to 
my colleague from Georgia (Mr. Broun).
  Mr. BROUN of Georgia. I thank the gentleman for yielding.
  As a physician, I have been involved in treating mental illnesses and 
my family has suffered from mental illnesses, and I have a tremendous 
interest in this area. But this bill is going to actually drive people 
away from being able to have health insurance coverage.
  There are many things about this bill that are wrong and bad. I know 
it is well-intended, but I highly encourage people to vote against this 
bill because, though the bill is well-intended, I think it is going to 
cause disastrous effects and I think employers are going to opt out 
from giving their employees mental health coverage on their insurance. 
So I highly encourage my colleagues to vote against this bill.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from 
Connecticut (Mr. Murphy).
  Mr. MURPHY of Connecticut. Mr. Speaker, right now there are millions 
of patients and families around this country who are too scared to talk 
about the mental illness they are dealing with. They are too scared to 
go and seek treatment for that mental illness.

                              {time}  1715

  And there are millions more in this country who are living in denial, 
thinking they can just wish away their debilitating illness.
  The legislation that we are passing today, that States like 
Connecticut and others around the country have been passing for the 
past 10 years, it is going to do a lot to get treatment to those who 
have insurance.
  But I think just as importantly, it says this, it puts the full power 
of the United States Congress behind the effort to lift that veil of 
shame and secrecy that too often visits families and patients who are 
living with mental illness. Mr. Kennedy and Mr. Ramstad are true heroes 
to those families dealing with mental illness today, and on their 
behalf, I thank them.
  Mr. DEAL of Georgia. Mr. Speaker, I yield the balance of our time, 2 
minutes, to a member of the committee, the gentleman from Texas (Mr. 
Burgess).
  Mr. BURGESS. Mr. Speaker, as a physician, I understand the high cost 
of treating mental illness and substance abuse. I am also personally 
familiar with how the cost of this care can keep people from receiving 
the help that they need. But the bill before us does not solve the 
problem. In fact, it creates some new ones.
  The bill is problematic for a multitude of reasons, and we can visit 
but a few of them. No insurance plan covers every possible physical 
diagnosis. Then why are we insisting that insurance plans cover every 
possible mental health or addiction diagnosis no matter the medical 
significance?
  This bill will cost Americans more money and could cost Americans 
health benefits. According to the CBO, H.R. 1424 will drive up the cost 
of health insurance for everyone and lead some employers to drop mental 
health insurance benefits completely.
  Another problem is the codification of the Diagnostic and Statistical 
Manual of Mental Disorders. The DSM-IV is not designed for legal use. 
It was designed for clinicians so we can adequately diagnose and 
adequately measure the response to therapy.
  The Senate bill, on the other hand, is reasonable. It has been 
developed with input from patient advocates, mental health providers, 
and employers. This bill has offsets, and the offsets are 
counterproductive, such as limiting physician ownership in specialty 
hospitals. They are very few in number, but specialty hospitals are 
strong in quality and performance. Maybe that is why the Democrats 
feared them: They represent high-quality performance that results from 
competition.
  For example, in my area in Texas, Baylor Health in Dallas was named 
the recipient of the National Quality Forum's 2008 National Quality 
Healthcare Award. Baylor has a joint venture, a partnership, with 
physicians sharing ownership of its facility. The bill before us today 
jeopardizes the high level of care and patient access to care provided 
by facilities such as Baylor.
  The basis for savings calculated by the Congressional Budget Office 
is flawed data; and quite frankly, it is not relevant to the delivery 
of health care in the 21st century. And once again, we have another 
example of how this House leadership will choose politics over policy 
to the detriment of the American people.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from 
Pennsylvania (Mr. Altmire).
  Mr. ALTMIRE. Mr. Speaker, last March Congressman Kennedy came to 
western Pennsylvania to hold a hearing with me and Congressman Tim 
Murphy about the critical need for mental health parity legislation. 
Now, almost exactly 1 year later, I am proud to rise in support of the 
Paul Wellstone Mental Health and Addiction Equity Act. This much-needed 
legislation will eliminate the discrepancies between health insurance 
coverage for mental and physical illnesses by ensuring that patients 
seeking mental health services are no longer penalized with higher 
copayments and coverage restrictions.
  Passage of this bill is a key step towards ending the stigma 
surrounding mental illness. Of the 44 million Americans living with 
mental illness, two-thirds did not receive the treatment they need. 
Treating mental illness is not only critical to mental health, but also 
prevents physical ailments that arise when mental health conditions go 
untreated.
  So, Mr. Speaker, this bill will help improve the mental and physical 
well-being of millions of Americans, and I ask my colleagues to support 
this bill.
  Mr. PALLONE. Mr. Speaker, I reserve the balance of my time until the 
end of the debate.
  The SPEAKER pro tempore. The gentleman from California (Mr. George 
Miller) is recognized for 20 minutes.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield myself 3 
minutes.
  Mr. Speaker, I rise in very strong support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act, named in honor of the 
late Paul Wellstone, who fought vigorously for better treatment for 
mental illness.
  We in the Congress have known for many, many years, and so many of 
our constituents in our communities that we represent have known for so 
many years, the need for coverage for those individuals who need mental 
health treatment, whether it is for themselves or members of their 
family, and the difficulty in not only having coverage, but providing 
that care and to make sure that some form of that care is reimbursed. 
This has been a struggle for many years.
  Today we address that struggle head-on with the consideration of this 
legislation, but we would not be standing here today without the 
efforts of Paul Wellstone and all of his efforts to rule out the 
discrimination against individuals in need of mental health services. 
He is joined in that fight, and they have led that fight, by 
Congressman Patrick Kennedy and Congressman Jim Ramstad. Again, we 
would not be here today debating this legislation and hopefully later 
this evening passing this legislation so that we can, for the first 
time, offer as a matter of national policy the idea that there would be 
parity in the coverage between physical illnesses and mental illnesses, 
to make sure that those people can get that coverage, can get the 
treatment that is necessary, can get the care that is necessary for 
them and for their families.
  Yes, the fact is that a number of States have laws governing this 
treatment for mental illness and the reimbursement for those services, 
but Federal law still hampers the reach of many of those laws. And as a 
result, many of the people who would be otherwise covered are not 
covered, and they continue to suffer under those discriminatory 
practices, and they fail to

[[Page H1291]]

get the services that they need so they can live a better life and so 
their families can live a better life.
  Today we get an opportunity because of the hard work, the efforts 
that Congressman Ramstad and Congressman Kennedy have made to travel 
this country, to talk in communities all across the country, to inform 
them and to discuss with them the possibilities of this legislation, 
what it would mean to individuals, what it would mean to families, what 
it would mean to the general health care in this country. They have 
taken on that mission, and they have convinced, I think, the vast 
majority of the country, and they have certainly enlisted those who 
understood the problem before their appearances that this is a problem 
that we need to address and we need to address now and we need to 
address in the most comprehensive fashion that we can.
  This legislation doesn't do all that I would like to see it do. It 
doesn't do all that Congressman Kennedy or Congressman Ramstad would 
hope that it would do. And it doesn't do all that Paul Wellstone wanted 
us to do in terms of eliminating all of those discriminatory 
provisions. But it is a magnificent start, and we should begin by 
passing this legislation today.
  Mr. Speaker, at this time I yield to the gentlewoman from New York 
(Mrs. Maloney) for a unanimous consent request.
  (Mrs. MALONEY of New York asked and was given permission to revise 
and extend her remarks.)
  Mrs. MALONEY of New York. Mr. Speaker, I rise in strong support of 
this bill. It is long overdue.
  Mr. Speaker, I rise in strong support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act.
  This bill requires group health plans to cover mental health and 
substance-related disorders the same way they cover medical and 
surgical disorders.
  It's time we permanently end discrimination on the basis of illness.
  We all know that mental illness is just like any physical illness. 
But we would never think of limiting treatment for cancer, heart 
disease, or diabetes.
  People would be outraged.
  So, it's amazing to me that some people still see mental illness as 
different and separate from physical illness.
  In New York City, since 9/11, we have all seen an increase in the 
number of people seeking mental health services.
  No one should feel ashamed for seeking needed healthcare and no one 
should be denied care simply because they cannot afford it.
  More than ever, our returning soldiers, our firefighters, and our 
police officers, are suffering from traumatic events and need the 
proper care.
  Our soldiers are coming home from Iraq and Afghanistan suffering from 
Post Traumatic Stress Disorder and other mental health problems.
  Too often, the stigma associated with mental health prevents them 
from seeking the care they so desperately need.
  In my own district, our police officers and others are still coping 
with the horrors they witnessed after the tragedy of 9/11.
  Thanks to the New York City Police Foundation's program, Project 
COPE, civilian and uniform members of the New York City Police 
Department (NYPD) are able to access mental health services.
  Project COPE is an example of an outside group providing mental 
health services because too many people are going without proper 
treatment.
  I am proud that today, as a bipartisan body, we will pass legislation 
that will help ease access to treatment and will help millions of 
people and their families battling mental illness.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield 3 minutes to 
Mr. Andrews of New Jersey.
  Mr. ANDREWS. Mr. Speaker, I thank my chairman for yielding and 
commend Congressman Kennedy and Congressman Ramstad for bringing this 
bill to our attention.
  Someone who is struggling with substance abuse addiction or bipolar 
disorder, they shouldn't be under a different set of rules for getting 
their bills paid by their insurance company than if they had a knee 
injury. That is what this is about. If you have a $500 deductible for 
knee surgery, you ought to have a $500 deductible for your care for 
alcoholism or drug treatment or bipolar disorder. The insurance 
industry would be required to do that under this provision.
  What would be wrong with that? Why would people be concerned about 
this? The first argument that we have heard is that there is a defined 
set of benefits that would have to be offered here to protect people 
with mental health and substance abuse issues. Well, there is a reason 
for that, because the insurance industry in this country has made it a 
practice of telling us what they don't cover. It is a cottage industry 
for people to find out that procedures are experimental or there is not 
enough justification. People find out every day that coverage they 
thought they had is no longer covered.
  The second objection we hear from people is that this costs too much. 
That directly contravenes the evidence. As a matter of fact, the 
evidence shows over the long haul this saves money. And in the worst 
case scenario, the premium increase because of mental health parity 
laws is 0.6 percent per year, a minimal cost that is far outweighed by 
the benefit.
  Finally, we hear concerns about small businesses. This provision 
exempts small businesses of 50 and fewer employees.
  This is simple good sense. It says that a substance abuse problem or 
mental health issue should be treated under the same rules for getting 
your bill paid by your insurance company as a knee operation would be. 
Mental illness and substance abuse reaches across racial lines, class 
lines, religious lines, and geographic lines. It reaches into many, 
many families, including families represented in this institution.
  This is a reform that is long overdue. It is why it is a reform that 
has support from both Republicans and Democrats. I would urge my 
colleagues on both sides of the aisle to take a commonsense step 
towards helping families across this country and vote ``yes'' on this 
much-needed piece of legislation.
  The SPEAKER pro tempore. The gentleman from California (Mr. McKeon) 
is recognized for 20 minutes.
  Mr. McKEON. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in opposition to H.R. 1424. Today we are 
attempting to enact legislation that achieves ``parity'' in the 
treatment of employer-sponsored coverage for mental and behavioral 
illnesses. However, although the House bill is well-intentioned, it 
does not accomplish the goal of providing parity. Instead, it creates 
new mandates so onerous that they could do far more harm than good, 
potentially squeezing employers out of the voluntary health care system 
altogether or eliminating the very mental health benefits we are trying 
to provide.
  First, this bill would give preferential treatment in our health care 
system to mental health benefits, affording mental illness a special 
status that is not given to other similarly severe medical illnesses.
  For example, under the House bill we are considering today, virtually 
every mental illness defined by the mental health profession would be 
required to be covered by private plans. This, despite the fact that 
most States currently do not mandate this type of coverage. Also, H.R. 
1424 does not place a similar requirement on private health plans to 
cover other types of medical benefits, including hospital services, 
physician services, drug benefits, or any other category of benefits. 
What this bill really accomplishes is not ``parity'' between mental 
health coverage and the medical and surgical benefits that are offered 
by plans; it is quite simply preferential treatment for mental health 
benefits over and above all other categories of medical benefits. The 
changes that have been made to the floor version of H.R. 1424 fail to 
address these serious concerns.
  Second, we have heard the bill's supporters say that this is a 
balanced bill. Respectfully, it is not. The bill fails to adequately 
and explicitly protect the ability of private plans to apply 
commonsense medical management practices currently being used to help 
ensure the delivery of high-quality medical care and ensure that 
coverage for working men and women remains affordable.

                              {time}  1730

  Under this bill, plans would likely have to pay a mental health 
provider's bill without question, which would make it very difficult to 
control costs.
  Third, this bill unnecessarily weakens the preemption requirements in 
the ERISA law. As a result, States would be free to enact standards 
greater than the Federal standard. Although the majority may argue that 
ERISA preemption is maintained, their language,

[[Page H1292]]

at a minimum, raises serious questions about the ability of States to 
enact laws and remedies that preempt ERISA and impact group health 
plans that currently operate under Federal law.
  Litigation to determine the meaning of this provision will result and 
group health plans could be subjected to possibly 50 different State 
laws on mental health benefits, making it harder to provide one set of 
rules that apply to all plans. This violates a fundamental rule of 
ERISA, which creates efficiencies by preventing plans from having to 
comply with 50 or more different sets of laws. One set of rules, 
applied equally to all ERISA plans, makes high-quality coverage 
affordable and available to millions of Americans. If the majority were 
truly interested in preserving ERISA, they would have adopted the 
noncontroversial language contained in the competing Senate mental 
health parity bill.
  Fourth, the bill mandates out-of-network coverage if any other 
benefit is operated on an out-of-network basis. This mandate will 
prevent plans from coordinating medical care, which will reduce quality 
and increase the cost of coverage.
  Lastly, this bill will increase litigation against ERISA plans by 
permitting application of State remedies to federally mandated 
benefits. There will be absolutely no consistency in State court 
rulings, and litigation costs could skyrocket.
  Mr. Speaker, while the broad issue of mental health parity enjoys 
widespread support, this bill does not. It is not a negotiated 
compromise between all parties that have a stake in this debate and, 
therefore, it is not in the best interest of the country as a whole.
  However, a viable alternative to the House bill with broad mainstream 
support already exists and has passed the Senate. The Senate's 
bipartisan bill has extensive support from mental health advocates, 
health care providers and business groups representing virtually all 
sides of this debate. The Senate bill is the product of years of 
bipartisan negotiations which accomplishes exactly what it sets out to 
do, provide parity for mental health benefits. It clearly reflects a 
more balanced and viable solution, and has a much better chance of 
becoming law if it were considered and passed by the House. Sadly, the 
majority has refused to consider that legislation, and instead offers 
the bill we are debating today, which gives preferential treatment to 
one particular class of medical benefits and has little or no chance of 
becoming law. Unfortunately, passage of the House bill will likely make 
it much more difficult to pass meaningful parity legislation this year.
  For the reasons stated, I must oppose this bill and encourage my 
colleagues to do the same.
  Mr. Speaker, I reserve the balance of my time.
  The SPEAKER pro tempore. Without objection, the gentleman from New 
Jersey will control the time of the gentleman from California.
  There was no objection.
  Mr. ANDREWS. Mr. Speaker, at this time I would like to yield 30 
seconds to the author of the bill, the gentleman from Rhode Island (Mr. 
Kennedy).
  Mr. KENNEDY. I just want to take issue with the point that this is 
giving some kind of preferential treatment to mental health benefits. 
If the gentleman would yield for a second on the point, we're having to 
state that mental health benefits need to be in the bill because no one 
questions when you get a broken arm, that it's automatically covered. 
But if it's a mental illness, it's discriminated against. Why we have 
to put this in the bill is because if we don't, it gets discriminated 
against. It's as simple as that. That's why we're on the floor today 
because we have to put it into civil rights law so it's not 
discriminated against. That's why we're on the floor today. That's not 
preferential treatment.
  Mr. ANDREWS. Mr. Speaker, I am pleased at this time to yield 2 
minutes to the gentleman from Iowa (Mr. Loebsack) who has been a 
vigorous advocate for mental health issues since his arrival here.
  Mr. LOEBSACK. Mr. Speaker, I rise today in strong support of the Paul 
Wellstone Mental Health and Addiction Equity Act. This bipartisan bill 
is the product of many months and even years of thoughtful negotiation, 
and I congratulate the authors of this legislation, Congressman Kennedy 
and Congressman Ramstad, on their work to move this bill forward. And I 
might add that I did know Paul Wellstone, and I knew Sheila very well, 
too, and I know the both of them were strong advocates on this issue.
  I, like many others, have personally felt the effects of mental 
illness in my family. My mother struggled with mental health issues for 
as long as I can remember, and I know firsthand how difficult and 
draining her struggle was.
  We have all heard the statistics. One in every five people in our 
country will experience a mental illness this year. Many of these 
individuals will seek treatment, and without this legislation many 
would be denied. This is unacceptable.
  I hope today this House will understand the importance of equal 
access to treatment for those suffering from mental illness. I was 
elected to this House to do the right thing for the people of the 
Second District of Iowa and the right thing for the people of America. 
This is the right thing to do, and I urge my colleagues to support this 
bill.
  Mr. McKEON. Mr. Speaker, I yield 5 minutes to the gentlelady from 
Oklahoma (Ms. Fallin).
  Ms. FALLIN. Mr. Speaker, I'm here today to speak in opposition of 
H.R. 1424. This bill, although well intended, comes with a long series 
of unintended consequences. And while I fully support the bipartisan 
efforts to bring parity between mental health and medical benefits and 
employer-sponsored health care plans, I cannot support this bill as it 
is currently written. In fact, in my mind, this legislation will 
diminish care for patients, will increase costs, will restrict access 
to care, will restrict access to specific hospitals and doctors, along 
with hurting the financial investments made personally by doctors and 
specialty hospitals.
  Oklahoma has one of the highest concentrations of specialty hospitals 
in the Nation, and I've had the opportunity to visit a large percentage 
of them. These specialty hospitals offer very good quality care with 
physicians who are trained specifically in areas of expertise to 
deliver to their patients.
  These facilities offer specialties anywhere from hip and bone 
replacement to gynecology, to cardiology, to heart hospitals, spine 
hospitals, and they do provide some of the best medical care possible 
in the whole Nation. In fact, some of our hospitals have grown by leaps 
and bounds because they have people coming from all over the Nation, 
and they've even been rated as some of the top hospitals in the Nation.
  By interfering with the ability of physicians to refer their patients 
to specialty hospitals, this bill will throw up a legal barrier to good 
medical treatment. I personally believe that competition is good in a 
marketplace. It improves the delivery of services. It improves the 
quality of services and delivery of care. It also offers greater 
transparency of pricing. We talk a lot in this Congress about patients 
knowing the price of medical care. It also offers greater transparency 
in the quality of care, the outcomes of the care so patients can make 
better choices about their treatment and become more informed about 
their treatment.
  Specialty hospitals and medical specialties also allow doctors new 
ways for innovation and treatments, new techniques. They bring new 
techniques and innovations to the marketplace that might not always be 
there in our regular hospitals. And they've also shown in many cases to 
have better health outcomes because their doctors specialize in these 
particular medical practices.
  This legislation would restrict patient choice to not be able to 
choose doctors who would specialize in a heart procedure and a hip 
replacement or maybe even delivery of babies.
  Specialty-owned hospitals have also documented that they can have 
shorter stays, that they have lower infection rates, sometimes up to 50 
percent lower infection rates, lower infection rates of staph infection 
and lower risk of illness. When you take a person who is going in for a 
hip replacement and you put them in a hospital with someone who has the 
flu, you put that person at risk of getting another illness. And when 
you have a specialty and they're going in for a hip replacement and 
that's their illness, there's less risk of another illness coming upon 
that patient.

[[Page H1293]]

  We also find that a large portion of our medical specialty hospitals 
take big portions of Medicare patients. I know that that's been a big 
concern. They are Medicare certified. In fact, many of the hospitals 
take up to 65 to 70 percent Medicare patients in their facilities. And 
many of them are required to have the emergency rooms. McBride 
Hospital, for instance, in Oklahoma City is the third largest hospital 
in the whole Nation for hip and bone replacement, and people come, as I 
mentioned, from all over.
  They're also required to meet all the procedure requirements of a 
full-blown hospital. We find that the other hospitals in our community 
often refer their patient to our specialty hospitals.
  If you look at other systems that have rated specialty hospitals and 
these practices, HHS, MedPac, GAO have studied physician-owned 
hospitals, specialty hospitals, and found no negative impact on general 
hospitals. In fact, I heard one speaker say today that 3 percent of our 
Nation's hospitals are specialty hospitals.
  It also has found that there's no evidence of increased utilization 
by physicians in facilities in which they own, which they have 
ownership.
  And, of course, specialty hospitals have created jobs and investment 
in our community and have some of the best rated services in our whole 
Nation.
  So today, Mr. Speaker, as we are considering this mental health 
parity bill, which is an important subject, I find language that I 
believe will be a disservice to patient choice, patient quality of care 
in our Nation.
  Mr. ANDREWS. Mr. Speaker, may I inquire how much time is remaining on 
each side.
  The SPEAKER pro tempore. The gentleman from New Jersey controls 12\1/
2\ minutes. The gentleman from California has 9\1/2\ minutes remaining.
  Mr. ANDREWS. Mr. Speaker, at this time I am pleased to yield 2 
minutes to a gentleman who has become expert on both the military and 
civilian health care system, my friend and neighbor from Pennsylvania 
(Mr. Sestak).
  Mr. SESTAK. Mr. Speaker, I rise in support of H.R. 1424 for three 
simple reasons based upon my experience in the U.S. military:
  First, today we're seeing 17 percent of those who wear the cloth of 
our Nation in Iraq and Afghanistan returning with post-traumatic stress 
disorder. And over one-third are returning with a mental disorder from 
anxiety to depression. They will feed into our society. How can we not 
give them the same parity as we do to those who are double amputees and 
we give prosthetics?
  Second, again in the military we put money in in order to prevent a 
greater crisis. We were the insurance for this Nation. Presently, we 
spend up to three times the cost, indirect cost of mental illness as it 
would take for the treatment. How can we not pursue this, both for the 
good of the individual and the cost-benefit for our society?
  And the third simple reason is, I honestly do believe in the ideals 
that Hubert Humphrey said. The moral test of our government is how well 
it takes care of those in the dawn of life, the children, those in the 
twilight of life, the elderly, and those in the shadows of life, the 
sick, the disabled, the handicapped. I'm sure he would have included in 
that the mentally disabled, the largest disability in America.
  Mr. McKEON. Mr. Speaker, I'm happy to yield now 4 minutes to the 
gentleman from Georgia (Mr. Broun).
  Mr. BROUN of Georgia. Mr. Speaker, I spoke earlier today about my 
grave concerns about this bill. I noted that I did my very best to 
offer amendments to this bill that would mitigate some of the damages 
that this bill will cause, which will include increased health care 
cost, and an actual decrease of mental health coverage for many 
Americans.
  What my very sincere but misguided colleagues on the other side of 
the aisle repeatedly forget is that actions have consequences. When 
Congress chooses to impose billions of Federal Government mandates on 
the private sector, they somehow seem to believe that the money that it 
will take to pay for those mandates will just somehow drop out of the 
sky or grow on trees. I'm here to remind them that it doesn't. Someone 
must pay for it.
  There's a great thing that we call the free market in America. I'm an 
ardent capitalist, and I believe that the marketplace, unencumbered by 
government regulation, is the best way to control quality, quantity and 
cost of all goods and services, including health care.
  The reality is when government steps in and tries to improve the 
marketplace, they impede and harm the efficient delivery of goods and 
services, and this definitely includes mental health care.

                              {time}  1745

  Please understand me. I'm in complete agreement that mental health is 
an extremely important issue, but we have over 200 years of 
capitalistic experience in America that proves beyond a shadow of a 
doubt that heavy-handed government regulations just simply do not work, 
no matter how well-meaning they are.
  We in Congress will harm Americans if this bill passes. We are 
trampling on the private sector, punishing employers that already offer 
a mental health coverage to their employees. We're harming Americans 
that desperately need mental health coverage, and we're trampling on 
the Constitution which does not give us the right to impose these 
restrictions and mandates on the American people and American 
businesses.
  It is an undeniable fact that this bill includes private sector 
mandates in billions of dollars. It's also a fact that one thing this 
bill does not mandate is that employers provide mental health coverage, 
but for any employer that does provide that coverage, and many do and 
they're commended for doing so, Congress is now going to greatly 
increase their costs and put regulations on them in their doing so.
  And in turn, what will they do? Just grin and bear it? Well, some 
likely will, possibly cutting costs in other areas, but there will be 
undoubtedly many businesses that cannot afford these burdens and will 
simply drop mental health coverage. That will be a shame, and it will 
be Congress' fault.
  The real solution to health care costs, and that's all our health 
care costs, and the coverage is to stop these mandates and get the 
regulatory burden off of the health care system, including providing 
mental health care.
  Mr. ANDREWS. Mr. Speaker, at this time I'm pleased to yield 1\1/2\ 
minutes to a very powerful voice for the voiceless, the gentlelady from 
New Hampshire (Ms. Shea-Porter).
  Ms. SHEA-PORTER. Mr. Speaker, I rise this afternoon to voice my 
strong support of this bipartisan legislation. I became an original 
cosponsor of the Paul Wellstone Mental Health and Addiction Equity Act 
of 2007 because I recognize the inequities in our health insurance 
system.
  As a social worker and administrator, I saw firsthand that insurance 
companies did not cover mental illnesses the same way they covered 
other illnesses. This created extra strain on patients, families, and 
health care providers in the communities they live in. Requiring higher 
deductibles and copayments also blocked access to health care for many.
  H.R. 1424 remedies these problems by requiring mental health parity. 
There should be no difference between a pain in one's abdomen and 
mental pain or the pain of addiction, but these patients and their 
families do not receive the same support and help to stabilize their 
condition and walk the road to recovery. This is wrong and it's time to 
remedy this discrimination.
  I urge my colleagues to vote ``yes.''
  Mr. McKEON. May I inquire as to the amount of time remaining.
  The SPEAKER pro tempore. The gentleman from California (Mr. McKeon) 
has 6 minutes remaining. The gentleman from New Jersey (Mr. Andrews) 
has 10 minutes remaining.
  Mr. McKEON. I'm going to be our last speaker.
  Mr. ANDREWS. I have others I can yield to.
  Mr. McKEON. I'll reserve.
  Mr. ANDREWS. Mr. Speaker, I'm pleased to yield 2 minutes at this time 
to a gentleman who really understands the interface of insurance and 
health care law, the gentleman from Connecticut (Mr. Courtney).
  Mr. COURTNEY. Mr. Speaker, I rise in strong support of the Wellstone 
Parity Act. This legislation will move our country forward to a more 
intelligent,

[[Page H1294]]

humane, and cost-effective health care system.
  Intelligent because it recognizes a scientific fact, that mental 
illness and disease can be diagnosed and treated like any physical 
illness and disease.
  Humane because it will provide relief and care for millions who 
suffer needlessly.
  And cost-effective because providing access to primary mental health 
treatment saves much more expensive catastrophic health care costs and 
increases productivity of workers suffering from illnesses such as 
depression and alcoholism.
  This is not just a theoretical claim, Mr. Speaker. States like the 
State of Connecticut, which I come from, have had an operational parity 
bill for a number of years. It is precisely because of that fact that 
the carefully crafted language surrounding ERISA by the Education and 
Labor Committee was designed to protect existing parity laws for State-
regulated health care plans. We did not want to have a bill that 
resulted in States ending up going backwards rather than forwards, and 
commissioners from States like Wisconsin and Connecticut weighed in and 
advised our committee to, again, make sure that we design the ERISA 
language carefully to protect State-regulated plans.
  Finally, this legislation adheres to fiscally sound PAYGO rules. And 
on that note, I would again salute the work that's been done and will 
work to make sure that these policies in the bill will not stifle 
research and development for new medical cures and treatments to help 
those suffering from mental health and addiction problems.
  Again, I urge passage of this strong, bipartisan legislation. It is 
long overdue that our country move in this direction.
  Mr. ANDREWS. Mr. Speaker, I'm pleased to yield 2 minutes to my friend 
and neighbor from the State of New Jersey, Mr. Holt.
  Mr. HOLT. Mr. Speaker, I thank my friend, Mr. Andrews.
  Mr. Speaker, it will be a landmark day when we realize that health is 
not just about fixing broken bones. It's about having a healthy, 
complete individual from head to toe.
  Today the House takes an important step to require mental health 
parity in insurance, and I particularly want to thank and recognize 
Patrick Kennedy and Jim Ramstad, and the late Paul and Sheila 
Wellstone.
  Mr. Speaker, millions of Americans suffer from mental illness of some 
form. Few Americans are untouched and no one is immune.
  Some of my colleagues have expressed their concern about the cost of 
providing mental health parity; yet an analysis of the bill indicates 
that it would result in an increase of less than 1 percent in premiums 
and would reduce out-of-pocket costs by about 18 percent. Further, 
according to a recent article in the Journal of the American Medical 
Association, employers who actively encourage their employees to use 
mental health services actually experience better health outcomes and, 
I want to emphasize this, increases in hours worked and productivity 
gained.
  I include in the Record an editorial from the Journal of the American 
Medical Association from last September of 2007 dealing with the 
treatment of depression.

 Reducing the Burden of Depression--Building Villages for Coordinated 
                                  Care

                 (Kenneth B. Wells and Jeanne Miranda)

       In this issue of JAMA, Wang et al provide evidence that 
     implementing depression care programs through employer-
     sponsored managed behavioral health can improve clinical 
     outcomes, job retention, and effective hours worked compared 
     with usual care. The programs encouraged depressed workers to 
     learn about and use evidence-based depression treatments, 
     supported clinicians in following practice guidelines, and 
     offered telephone counseling and self-help workbooks. The 
     monetary value of the increased work time under the program 
     exceeded the direct intervention costs and likely exceeded or 
     was within the range of cost increases due to greater mental 
     health specialty use under the intervention. While formal 
     estimates of cost-effectiveness and employer return on 
     investment are pending, it appears to be in the business 
     interests of many employers to implement such programs to 
     protect their investments in the retention and productivity 
     of workers they have hired and trained.
       These findings should be evaluated within the context of 
     the simple but startling facts about depression. Clinical 
     depressive disorders are among the most prevalent of major 
     medical conditions, affecting about 16% of adults in their 
     lifetime. Owing to high prevalence, early age at onset 
     (unlike other debilitating disorders that occur past the age 
     of parenting and work responsibilities), and strong impact on 
     functional status, depressive disorders are leading 
     contributors to disability worldwide. Depressive disorders 
     are highly treatable yet often remain unrecognized and 
     untreated. While a number of effective programs promote 
     higher use of treatments in service delivery settings, 
     particularly primary care practices, these programs are not 
     yet widely implemented. Thus, technology is available to 
     treat this disabling condition, but US health care systems 
     have failed to take full advantage of the technology to 
     reduce personal or societal consequences of depression.
       The intervention approach in the study by Wang et al can be 
     characterized as ``building a village'' of health plans, 
     clinicians, and resources that ``surround'' depressed persons 
     with opportunities to learn about and engage in evidence-
     based care, attending to a careful fit of intervention 
     requirements and context-specific implementation options. 
     This approach has generally proven effective in primary care, 
     and the substantial outreach efforts mirror those in the WE 
     Care study demonstrating that depression treatments are 
     effective for low-income and minority women. In the study by 
     Wang et al telephone managers from the behavioral health 
     company offered counseling and communicated recommendations 
     to clinicians, an extension of their usual role. In the 
     Partners in Care study, primary care nurses expanded their 
     disease management skills to include assessment, education, 
     and follow-up concerning depression. In both studies, 
     patients and clinicians were free to use or not use study 
     resources according to their preferences. Such interventions 
     have the advantage of preserving the naturalistic context of 
     the delivery systems, potentially facilitating the 
     translation of findings into change by example. Interventions 
     in both studies achieved roughly similar outcomes: a 10 
     percentage-point gain in use of appropriate treatment and in 
     recovery from depression over a year, as well as roughly 2 
     more weeks of days worked in a year in the study by Wang et 
     al and a month more of days worked over 2 years in Partners 
     in Care.
       Depression interventions have many advantages for 
     individuals, their family and friends, employers and society, 
     over and above relief of individual symptoms. As mothers' 
     depression improves following care, for example, their 
     children also enjoy improvements in mental health. The study 
     by Wang et al demonstrates that treatment of depression 
     increases productivity and may reduce economic losses due to 
     depression for employees and employers. If such gains exceed 
     costs of providing the interventions and treatments, there is 
     ``money on the table'' across stakeholders that could be used 
     to pay for interventions. Why then do many individuals with 
     depression endure their illness without care?
       One barrier to care is that depression affects motivation 
     and cognition, making it difficult for many individuals with 
     depression to realize they have a need and obtain care 
     without the outreach provided by nurse/care managers. Family 
     members also may fail to identify depression or have 
     knowledge about appropriate care. This suggests that 
     opportunities to improve access to depression care should be 
     embedded within an infrastructure available to potentially 
     depressed persons, such as primary care settings. However, an 
     awareness of the effects of treatment on social costs such as 
     productivity may not provide a strong incentive for 
     clinicians and health plans to improve care, as they do not 
     necessarily face immediate financial consequences from 
     patients' changes in productivity or may not track this 
     outcome. Yet most private health care in the United States is 
     financed through employer-sponsored insurance. Direct 
     contributions to the bottom line of employers offers them an 
     incentive to promote depression care, independent of policy 
     mandates or other motives such as responding to employee 
     demand.
       Other stakeholders, including policy makers and the public, 
     may benefit from improved depression care through an 
     increased tax base from employees who work more or an overall 
     improved economy. Yet it is challenging in the US policy 
     environment to use economic gains from one policy sector such 
     as the labor market as leverage to support improved health 
     care, However some policy changes could be implemented to 
     better align the incentives to implement depression care 
     programs across diverse stakeholders and to avoid undermining 
     the goals of such programs, for example by excluding 
     depression treatment from health insurance coverage when 
     changing jobs or insurance based on a recent history of 
     depression treatment in an employer-based depression program. 
     Under such an ill-advised policy, the risk of losing coverage 
     would serve as a major deterrent to seeking care.
       The need to coordinate program implementation and policy 
     suggests an expanded concept of ``a village,'' that includes 
     not only wrap-around interventions but coordinated efforts 
     across affected stakeholders. It may be trite that the 
     stakeholder with the most power to influence services 
     delivery for most Americans is the employer, but broader and 
     deeper change in access to depression care may yet require a 
     concerted effort among affected parties to yield prograns 
     that address public and self-stigma and to provide access to 
     depression treatments under policies that

[[Page H1295]]

     facilitate use of such programs and do not penalize 
     individuals for using them. Studies such as that by Wang et 
     al strongly support such integrated solutions.
       Exactly how programs to improve depression care are 
     implemented may affect the distribution of benefits--an 
     important issue given evidence of disparities in quality of 
     depression care and the potential for practice-based programs 
     to overcome disparities in depression outcomes. Developers of 
     interventions and policies should consider implications of 
     their design for inclusion of underserved groups who may not 
     seek behavioral health care. Despite the extensive efforts by 
     Wang et al to reach general employees, the majority of 
     persons had already inquired about outpatient care. Learning 
     how to optimize personal and societal gains by improving 
     access to quality depression care across diverse communities 
     through employer, practice, and community-based programs and 
     policy changes is a next agenda for evidence-based action. As 
     a community participant in the Witness for Wellness program 
     recently stated: ``Depression is everybody's business.''

  Now, ultimately, despite the economic arguments in favor of parity, 
it is not a debate about dollars and cents but about lives saved and 
people restored. Let's work to ensure that those who need access to 
mental health will get it.
  Mr. ANDREWS. Mr. Speaker, it is my privilege at this time to yield 2 
minutes to the gentleman from Chicago (Mr. Davis), a member of the 
committee.
  Mr. DAVIS of Illinois. Mr. Speaker, I'm convinced that the most 
widespread and most impactful health issue and problem which we face 
today is in the area of mental health and mental illness. The numbers 
of individuals affected are so great until it is more than difficult to 
get a handle on them, and that is one of the reasons that I rise in 
support of H.R. 1424, the Paul Wellstone Mental Health and Addiction 
Equity Act of 2007.
  Mr. Speaker, I commend Representatives Kennedy and Ramstad for their 
leadership in introducing this legislation and shepherding it to the 
floor.
  When we consider the numbers of people who suffer from drug 
addiction, whose lives are filled with anxiety, depression, fear, and 
uncertainty, we can readily see that more attention must be paid to our 
mental health needs. When we see the numbers of people living in 
shelters, halfway houses, and in many instances under viaducts, 
abandoned cars, and in the streets, when we see the numbers of people 
who make up the criminally ill, who hurt, injure, maim and sometimes 
kill other people because they've never been able to shake their demons 
who disrupt and plague their lives because they've had no mental health 
attention or treatment, Mr. Speaker, it is clear to me that this is an 
idea whose time has come.
  I urge passage of this legislation.
  Mr. McKEON. Mr. Speaker, we do have another speaker.
  Mr. ANDREWS. I would reserve my time.
  Mr. McKEON. Mr. Speaker, I'm happy to yield at this time to the 
gentlelady from Oklahoma (Ms. Fallin) 2 minutes.
  Ms. FALLIN. Mr. Speaker, I support bipartisan efforts to bring parity 
between mental health and medical benefits, but I have a concern, and 
it's come to my attention, about the mental health parity bill, H.R. 
1424.
  A Supreme Court decision, Doe v. Bolton, lists mental health as a 
reason that abortion is allowed for health exceptions.
  This bill, as currently written, could be construed to mandate health 
care coverage for an abortion as part of treatment for a mental health 
issue such as depression.
  As defined by the Court, in their words, ``health of the mother 
includes all factors, physical, emotional, physiological, familial, and 
a woman's age, relevant to the well-being of the patient. All these 
factors may relate to health.''
  And furthermore, in testimony by Dr. James McMahon before the House 
Judiciary Committee in June 1995, he cited 39 partial birth abortions 
that were performed because of a mother's depression.
  Because this issue is unclear, H.R. 1424 lacks a conscious clause 
applied to this legislation, and there appears to be no protection for 
an employer to reject health care coverage for such a procedure if they 
choose to extend mental health coverage to its employees.
  Mr. ANDREWS. Mr. Speaker, I yield myself 15 seconds.
  I would say that the manuals referred to in this bill make no 
reference whatsoever to any abortion services as a covered benefit.
  At this time, I'd be pleased to demonstrate bipartisan support for 
this bill and yield 1 minute to the gentleman, my friend from 
Connecticut, Mr. Shays.
  Mr. McKEON. Mr. Speaker, I will add 1\1/2\ minutes to demonstrate 
also bipartisanship.
  Mr. SHAYS. Mr. Speaker, I rise in support of the Paul Wellstone 
Mental Health and Addiction Equity Act. It is reported 50 million 
adults, 25 percent of the U.S. adult population, suffer from mental 
disorders or substance abuse disorders; yet, despite the prevalence of 
mental illness, there continues to be widespread misinformation and 
ignorance surrounding the condition.
  We need to work to destigmatize this illness and ensure those who 
need treatment have access to care. At the same time, we need to 
increase biomedical research into the causes of, and treatments for, 
mental illness.
  It is estimated 98 percent of private health insurance plans 
discriminate against patients seeking treatment for mental illness by 
requiring higher copayments, allowing fewer doctor visits or days in 
the hospital, or requiring larger deductibles than imposed on other 
medical illnesses.
  The National Institutes of Mental Health estimates the annual health 
care costs of untreated mental illness is $70 billion, and data has 
shown that instituting equal coverage for treatment of mental illness 
will result in lower overall health care costs.
  By requiring insurers who cover mental illnesses to do so at parity 
with physical illnesses, we will knock down a tremendous barrier to 
getting the assistance these individuals require.
  While I support the underlying bill, I believe we should temporarily 
hold off for now increasing the Medicaid drug rebate provisions 
intended to raise revenue to pay for this legislation. Because the 
Centers for Medicare and Medicaid Services are in the process of 
developing new regulations based on the Deficit Reduction Act, it's 
entirely possible Medicaid rebates will be increased administratively. 
Since this provision was not in the Senate bill, I'm hopeful we will be 
able to enact mental health parity legislation without this provision.
  With this one reservation, I'm particularly pleased to support this 
legislation, urge its adoption, and congratulate Congressmen Ramstad 
and Kennedy for all their efforts to help the mentally ill.
  Mr. ANDREWS. Mr. Speaker, if I could inquire of my friend from 
California if he has any further speakers.
  Mr. McKEON. I'm the last speaker.
  Mr. ANDREWS. At this point, Mr. Speaker, I would yield to the 
gentlelady from California who has worked on this issue for many years 
on the committee, Mrs. Davis, for 2 minutes.
  Mrs. DAVIS of California. Mr. Speaker, I worked as a social worker 
before my career in public office, and I've seen firsthand the results 
when mental illnesses go untreated. Those who develop a severe mental 
illness can go from having a career and a family to losing everything.
  About half our States now have implemented full mental health parity 
requirements, and these States have learned a very valuable lesson. 
They've learned that the benefits of ensuring parity are worthwhile.

                              {time}  1800

  Far too many people's illnesses, mental illnesses, linger without 
treatment, triggering physical complications that only result in more 
costs. So, proper diagnosis and treatment greatly offset these costs 
and save health care dollars over the long term.
  This bill will also help our servicemembers fighting in Iraq and 
Afghanistan as they transition to civilian life because national 
barriers to mental health care ripple out to everyone. Post-traumatic 
stress disorder and other combat-related conditions can take months, if 
not years, to develop after discharge. Many of these veterans will not 
have access to VA health facilities and will rely upon private health 
insurance to obtain treatment.
  Finally, and most importantly, this legislation also addresses the 
stigma

[[Page H1296]]

attached to mental health care. It loudly communicates that mental 
health care is on an equal footing with physical health care.
  Mr. Speaker, I give my enthusiastic support to the Paul Wellstone 
Mental Health and Addiction Equity Act. I thank the sponsors and 
encourage my colleagues to join me in voting for it today.
  Mr. ANDREWS. Mr. Speaker, I would just represent that I am the last 
speaker on our side for this portion of the debate.
  Mr. McKEON. Mr. Speaker, I yield myself the balance of my time.
  I agree with much of what has been said here, because achieving 
parity between mental health and medical/surgical benefits is a goal 
that enjoys widespread support, and I support that. Had this bill been 
negotiated in an inclusive, cooperative fashion, I believe a parity law 
could quickly be enacted this year, ensuring access to coverage for 
those who need it.
  There was a road map that would have allowed us to forge a consensus 
bill. On the other side of the Capitol, stakeholders were brought 
together and given the opportunity to find agreement on these difficult 
issues. There was give and take by everyone involved, which is how the 
Senate was able to produce a bill that achieves parity without undue 
burden on our employer-based health care system. Unfortunately, we're 
not following that road map. Instead, we're considering a bill that 
overreaches and in the process puts at risk many fundamental elements 
of private health insurance plans.
  The majority argues that the latest variation of their proposal 
addresses key concerns. I wish that were true. Unfortunately, the bill 
we're considering today contains only modest changes that fail to fully 
resolve concerns about ERISA preemption, costly litigation, coverage 
mandates, and a host of other concerns.
  By giving preferential treatment to mental health benefits over other 
types of medical coverage, the bill creates a lopsided system that may 
actually be biased against mental health coverage because some 
employers may choose to drop their mental health coverage or, worse, 
all health coverage rather than comply with more burdensome mandates.
  Moreover, the list of conditions that would receive mandatory 
coverage under this bill would be laughable were it not posing such a 
serious risk to health care coverage for hardworking families. At a 
time when health care costs are rising, this bill threatens key 
management tools that have helped keep costs down. And by weakening 
ERISA preemption, the bill opens the door to increased litigation and a 
patchwork of confusing requirements and inefficiencies.
  Mr. Speaker, there is a better way to provide parity for mental 
health benefits. The bill that passed the Senate provides a thoughtful, 
reasonable and a balanced approach that reflects the deliberations of 
all relevant stakeholders. Representatives Heather Wilson, John Kline 
and Dave Camp sought to offer that proposal today in the hopes that we 
would move quickly on a consensus proposal that could be signed into 
law. Their amendment also used a noncontroversial payment offset, 
unlike H.R. 1424. Unfortunately, as has become the hallmark of the 
110th Congress, we were shut out of meaningful debate, and that 
amendment, along with a number of other improvements to the bill, will 
not be considered.
  I support a balanced approach to mental health parity and, therefore, 
I cannot support this bill in its current form. I urge my colleagues to 
vote ``no'' on this bill so that we can take up the consensus 
legislation that enjoys community and other key stakeholders' support, 
those who share our commitment to provide equitable benefits that 
support mental health without jeopardizing our health care system as a 
whole. I urge a ``no'' vote.
  Mr. Speaker, I yield back the balance of my time.
  Mr. ANDREWS. Mr. Speaker, I yield myself the balance of the Education 
and Labor Committee's time.
  My friend from California says that mental health parity is a goal 
that he lauds. Well, it's a goal that we should achieve right here, 
right now, today, by passing this bill.
  We've heard the argument that the bill establishes preferential 
treatment for people with mental health and substance abuse issues, 
exactly the opposite of the truth. The bill establishes parity and 
equal treatment between mental health and substance abuse and physical 
and surgical benefits.
  We've heard the concern that medical management practices that 
control costs have been taken out of the bill. What is also true, 
however, is that nothing in present law, nothing in the status quo 
precludes medical management practices that are useful in offsetting 
costs. There is nothing that prohibits that.
  Finally, we hear that there is a concern that employers confronted 
with the defined benefit package, with the guaranteed rights of the 
insured under this will drop coverage. In States that have similar 
provisions, there is not a shred of empirical evidence that that is the 
case. Where State laws extend robust protections to mental health and 
substance abuse benefits, employers have not dropped mental health 
coverage; in fact, it has expanded.
  This is the right time for the right bill. Its cost is minimal, its 
benefit is great, its support is bipartisan, and its time for passage 
is now.
  I would urge each of our colleagues, Republican and Democrat, to join 
this bipartisan coalition and vote ``yes'' on the legislation offered 
by Mr. Kennedy and Mr. Ramstad.
  Mr. Speaker, I yield back the balance of the Education and Labor 
Committee's time.
  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
California.
  Mr. STARK. Mr. Speaker, I yield myself 2 minutes.
  It's an important day, and we've been working to achieve mental 
health parity for decades. We finally have a bill before us to achieve 
that goal for more than 160 million Americans. And as my colleagues 
know, this bill is named for one of its chief proponents, the late 
Senator Paul Wellstone of Minnesota, a true champion for all people, 
especially those suffering from mental illness and addiction disorders.
  I would like to recognize the efforts of Paul's son, David Wellstone, 
who has been commuting from California to lobby Members of Congress to 
help get this bill enacted. His dad would be proud. Wellstone Action is 
one of the hundreds of groups supporting this legislation.
  Here in the House, our colleague from Minnesota, Jim Ramstad, and our 
colleague from Rhode Island, Patrick Kennedy, have been lead advocates. 
They've done a stunning job getting 273 cosponsors, including 41 
Republicans, a real bipartisan feat in this day and age.
  Enough of the accolades. The real reason we're bringing forth this 
bill is to end discrimination in health insurance for people with 
mental illnesses and addiction disorders. It's not a new concept. We 
took a baby step back in '96, but it wasn't enough.
  This bill does for our constituents what we already receive through 
the Federal Employees Health Benefit Plan. We also passed the 
Children's Health and Medicare Protection Act last summer which would 
extend mental health parity to Medicare beneficiaries. That bill is 
still pending in the Senate.
  Last year, this legislation went through multiple hearings, five 
markups in three major committees, and the issues are straightforward. 
Those who oppose true parity may engage in scare tactics or offer red 
herrings to distract from the underlying issues, but one thing is 
clear, the bill is better for patients than the Senate bill, yet the 
cost is almost exactly the same.
  The passage of the Paul Wellstone Mental Health and Addiction Equity 
Act simply finishes the work we have begun. I look forward to 
negotiating with the Senate so we can get a bill to the President's 
desk soon. Tens of millions of Americans are counting on us.
  I urge support for this overdue legislation.
  Mr. CAMP of Michigan. Mr. Speaker, I yield myself such time as I may 
consume.
  We all support the goal of improving patients' access to treatment 
for mental illnesses. However, this bill represents a flawed approach 
that will ultimately do more harm for these patients by driving up 
costs and resulting in few employers actually offering any health care 
coverage to their employees.

[[Page H1297]]

  This bill will place an unprecedented number of mandates on insurers 
and employers, which will increase the costs of health insurance for 
working Americans. Whether large or small, these costs get passed along 
to the purchasers of health insurance, employers and employees alike.
  Dramatic increases in health care costs have already forced many 
employers to drop or limit health care coverage. This in turn makes it 
more difficult for their employees to obtain any health insurance, let 
alone mental health and substance abuse benefits. The mandates in this 
bill will only make the situation worse, making health insurance 
unaffordable for increasing numbers of Americans. This is why employer 
groups like the Chamber of Commerce, the National Restaurant 
Association and the National Retail Federation are all strongly opposed 
to the bill before us today.
  There is a better way to achieve the goals of protecting patients and 
ensuring they get access to the mental health care they need. Senators 
Domenici and Kennedy have crafted a bipartisan bill that is supported 
by mental health advocates, employers and insurers, and if that bill 
were on the floor today, I would vote for it. The Senate bill adopts a 
more targeted approach to defining covered conditions.
  The bill also allows plans to determine the network of providers 
while maintaining parity for treatment limits and cost sharing. The 
Senate approach may significantly reduce the potential cost that could 
be imposed upon employers while still achieving the goal of mental 
health parity.
  The Senate has worked with the mental health community to balance the 
needs of patients with the ability to provide quality, affordable and 
accessible health insurance. These compromises led the Senate to 
unanimously pass their legislation last September. Unfortunately, in 
order to pay for the costs associated with this bill the majority has 
also decided to shift costs to every American by increasing Medicaid 
rebates from pharmaceutical companies and limiting physician ownership 
in hospitals. Both of these proposals represent the view that 
bureaucrats, rather than markets, can better govern health care. At the 
end of the day, price controls and more government regulation increase 
health care spending and deny patients access to high-quality care.
  Whether they want to admit it or not, the majority is increasing 
health care on every American twice under this bill. As more and more 
Americans are having difficulty affording health care, we should be 
looking to expand affordable health care options, not placing more 
mandates on employers.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, at this time, I am proud to yield 2 minutes 
to the distinguished gentleman from Pennsylvania (Mr. Carney).
  Mr. CARNEY. Mr. Speaker, I rise today in strong support of H.R. 1424, 
the Paul Wellstone Mental Health and Addiction Equity Act.
  In recent years, many brave Americans serving in the National Guard 
and Reserves returned home after fighting for our freedom in Iraq and 
Afghanistan. They return to their civilian jobs and are subject to 
their private health insurance. The all-too-common tale, however, is 
that our veterans have witnessed horrors that many cannot even imagine. 
One in six of these veterans will experience symptoms of post-traumatic 
stress disorder, or PTSD, that can impair them for many years beyond 
their homecoming.
  Many of these veterans choose to seek treatment at their local VA 
hospital or clinic. But for some of our veterans in rural areas of our 
country, like mine, it is far easier to use their private insurance and 
seek treatment from their local private doctor. Unfortunately, some of 
these veterans quickly find that PTSD is not covered in their health 
insurance plan.
  Our veterans shouldn't have to travel for hours simply to meet with a 
qualified mental health professional. H.R. 1424 fixes this injustice 
and ensures that our veterans have the choice to seek treatment for 
PTSD through their private insurance plan.
  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 5 minutes to 
the distinguished gentleman from Minnesota (Mr. Ramstad), a 
distinguished member of the Health Subcommittee.
  Mr. RAMSTAD. I thank my friend for yielding.
  Mr. Speaker, the issue before us is not just another public policy 
issue, it's a matter of life or death for 54 million Americans 
suffering the ravages of mental health and for 22 million Americans 
suffering from chemical addiction.
  Last year alone, 300,000 people were denied access to addiction 
treatment, most had health insurance, and 33,000 people committed 
suicide from untreated depression. Over 150,000 of our fellow Americans 
died as a direct result of chemical addiction.
  On top of the tragic loss of lives, Mr. Speaker, untreated addiction 
and mental illness cost our economy over $550 billion last year. 
According to the Wall Street Journal, untreated depression alone cost 
our businesses $70 billion in lost productivity last year.
  So it's ludicrous for the opponents to come here and argue that 
parity will cost businesses $1.5 billion, as my friend from Washington, 
member of the Rules Committee, did. If you don't believe the Wall 
Street Journal, certainly those on our side of the aisle, what do you 
believe? Cost businesses $70 billion, just depression, untreated 
depression alone.
  Mr. Speaker, all the empirical data, including all the actuarial 
studies, show that equity for mental health and addiction treatment 
will save literally billions of dollars nationally. At the same time, 
it will not raise premiums more than two-tenths of 1 percent, according 
to the Congressional Budget Office. That's our own CBO numbers. So, I 
don't know where these people are getting these numbers, these inflated 
cost figures. Pulling them out of thin air is the only thing I can 
surmise.
  The CBO says it will not raise premiums more than two-tenths of 1 
percent. In other words, for the price of a cheap cup of coffee per 
month, several million Americans in health plans can receive treatment 
for chemical addiction and mental illness. And it's unfortunate, Mr. 
Speaker, that some opponents of this legislation have misrepresented 
the costs of enacting parity.

                              {time}  1815

  Mr. Speaker, I'm alive and sober today only because of the access I 
had to treatment back on July 31, 1981, when I woke up in a jail cell 
in Sioux Falls, South Dakota. I'm living proof that treatment works and 
recovery is real.
  But far too many people in our country don't have the same access to 
treatment that I had and other Members of Congress have also had. A 
major barrier for thousands of Americans is insurance discrimination 
against people in health plans who need treatment for mental illness or 
chemical addiction.
  The legislation that my friend from Rhode Island, Patrick Kennedy, 
who has worked tirelessly on this legislation, who arranged for all 14 
field hearings, who has been a real champion, this legislation that we 
have authored will end the discrimination by prohibiting health 
insurers from placing discriminatory restrictions on treatment for 
people with mental illness or addiction. In other words, no more 
inflatable deductibles or copayments that don't apply to physical 
diseases. No more limited treatment stays that don't apply to physical 
diseases. No more discrimination against people with mental illness or 
chemical addiction.
  The Paul Wellstone Mental Health and Addiction Equity Act simply 
provides equal treatment for diseases of the brain and the body. This 
legislation provides people in health plans with the same exact 
coverage that we as Members of Congress have and other Federal 
employees as well.
  By the way, some of the exaggeration, some of the red herrings as to 
the use of the Diagnostic and Statistical Manual IV are just beyond 
belief. The red herrings presented by opponents, caffeine addiction, 
sibling rivalry, jet lag, would not be subject to treatment because 
insurance plans can use ``medical necessity'' requirements. So let's 
not use bogus red herring arguments. Let's come with intellectually 
honest arguments if you're against this legislation.
  Also, the DSM-IV is used for Medicare, Medicaid, and veterans health 
care. I wonder how many of you can go home and say, look, it's good 
enough

[[Page H1298]]

for Members of Congress but it's not good enough for you, constituents. 
I don't think anybody in this body would dare do that nor should we. If 
it's good enough for Members of Congress, it's good enough for the 
American people.
  Mr. Speaker, Patrick Kennedy and I have traveled the country from one 
end to the other, holding 14 field hearings. We've heard literally 
hundreds of stories of human suffering, broken families, tragic deaths, 
shattered dreams all because of insurance companies not providing 
access to adequate treatment for mental illness and addiction. I don't 
have time, Mr. Speaker, to recite some of these horror stories, but 
Patrick and I could share hundreds and hundreds of horror stories 
caused by discrimination in treatment for mentally ill and addicted 
people that we heard in these 14 States.
  Mr. Speaker, it's time to end the discrimination against people who 
need treatment for mental illness and addiction. It's time to prohibit 
health insurers from placing discriminatory barriers to treatment. It's 
time to pass the Paul Wellstone Mental Health and Addiction Equity Act. 
The American people, Mr. Speaker, cannot wait any longer.
  Mr. STARK. Mr. Speaker, I am pleased to yield 2\1/2\ minutes to the 
distinguished gentleman from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Mr. Speaker, this day has been many years in the 
making. This mental health parity will be a signature jewel in the 
crown of the 110th Congress. This legislation reflects our deepest 
values as Americans.
  I want to thank Congressman Kennedy and Congressman Ramstad for your 
long labors in making real mental health parity a reality. Families all 
over America will be forever indebted to you.
  I have long been a supporter of affordable, accessible, quality 
health care for every American for both physical and mental illnesses. 
As a member of the Jersey legislature, I worked for parity legislation 
that finally came to fruition in 1999. Like the 1996 Federal parity 
law, the coverage was not complete. Advocates in Jersey continue the 
fight to ensure real and complete coverage parity.
  Today, at long last, this House will take one step closer to making 
that a reality by passing H.R. 1424, the Mental Health and Addiction 
Equity Act. Thank you, both of you.
  For the first time, this legislation will eliminate inequitable 
treatment limits and end the imposition of financial requirements on 
mental health benefits which are not similarly imposed on comparable 
physical ailments. These two policies are considered to be essential 
steps toward ending coverage discrimination against individuals with 
mental illness.
  To be clear, this legislation does not mandate insurers or group 
health plans to provide any mental health coverage at all. This 
legislation will ensure coverage of the same mental illnesses and 
addiction disorders available to Members of Congress and 8.5 million 
other Federal employees. Isn't that a breakthrough.
  While opponents of this insist that parity will bankrupt the health 
care system, research has shown that there's no significant cost 
increase whatsoever. The Congressional Budget Office has estimated a 
minuscule impact on premiums for the mental health parity bill, just 
two-tenths of 1 percent.
  This must be passed, both sides of the aisle, and America will 
benefit.
  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 4 minutes to 
the distinguished gentleman from Texas (Mr. Sam Johnson), a member of 
the Ways and Means Committee and the Health Subcommittee.
  (Mr. SAM JOHNSON of Texas asked and was given permission to revise 
and extend his remarks.)
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I come to the floor today 
proud to say I've been looking to the issue of mental health parity 
since 2002. In March of that year, I chaired the subcommittee that held 
the very first House hearing on that topic. I heard back then and have 
continued to hear over the years the concerns from mental health 
advocates, employers, and benefit managers about what effect parity may 
have on everyone's goal of providing quality health care to more 
Americans. So I come to the floor today disappointed that we are 
debating a bill that I cannot support.
  Unfortunately, the majority has decided that politics should trump 
policy; that instead of bringing a bill to the floor that has the 
support of all the stakeholders in this debate, a bill the President 
has said he would sign into law, and a bill the Senate passed by 
unanimous consent, we're debating a bill that will only delay action on 
this very important issue.
  There are real problems with the bill before us today. The first is 
the heavy-handed list of mandates. This bill would say to employers and 
insurance companies, if you decide to include mental health benefits in 
your health insurance package, you are forced to cover anything and 
everything related to mental health.
  This is a requirement that doesn't exist in any other sector of the 
insurance industry, and I believe it would have the unintended 
consequence, in spite of what our opposition says, of forcing employers 
and companies to decide not to offer mental health benefits at all. 
This, of course, is not the goal we're striving to achieve today.
  This bill also pays for mental health parity with a provision that 
would have a devastating effect on communities across the Nation. This 
provision would hurt every physician-owned hospital in this country, 
and that includes specialty hospitals, long-term acute care facilities, 
physician-owned full service hospitals, and patient rehabilitation 
facilities and others.
  Physician-owned hospitals serve as an integral part of the health 
care system in this country. They deliver efficient, high-quality care 
to their patients and are a benefit to any community. These facilities 
across the country routinely are recognized nationally for their 
superior care.
  In fact, just last month a hospital in my district, Baylor Health 
Care System, received the National Quality Award from the National 
Quality Forum. This award recognizes exemplary health care 
organizations who are role models for achieving meaningful and 
sustainable quality improvement in health care.
  However, if this provision becomes law, this exemplary hospital would 
be forced to suffer serious consequences, like reducing patient care.
  We all support the goal of equal access to mental health benefits; 
however, it should not be paid for by sacrificing facilities that bring 
quality health care to more Americans. Physician-owned hospitals are on 
the front lines of reforming our health care system, and they shouldn't 
be punished for the inroads they are making.
  This provision will prohibit any new facility from being built as 
well as deny Medicare provider numbers to any facility currently under 
construction. It also caps the percentage of physician ownership in 
existing hospitals. No one facility can have more than 40 percent 
physician ownership, and no one doctor can own more than 2 percent of a 
facility. It puts the Federal Government in charge of deciding whether 
or not these facilities need to expand and help respond to the needs of 
the community.
  There have been a number of studies that have shown specialty 
hospitals have an overall positive effect over general acute care 
hospitals.
  Today is the day to stand up for innovation and stop taking the 
funding from the specialty hospitals, Mr. Stark.
  Mr. STARK. Mr. Speaker, at this time I am pleased to yield 1 minute 
to the distinguished gentleman from Minnesota (Mr. Walz).
  Mr. WALZ of Minnesota. I thank the chairman for yielding.
  Mr. Speaker, I rise in strong support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act.
  I'd like to thank and recognize my two colleagues and friends who 
have led this fight with tenaciousness and with integrity for so many 
years, Congressman Kennedy, and my friend and fellow Minnesotan, 
Congressman Ramstad. The two of you represent the best that this 
institution has to offer, and I thank you. You carried on the fight 
that was started so many years ago by our late Senator from Minnesota, 
Paul Wellstone, and you've done so in such an admirable fashion. I 
can't tell you how proud I am to see this come to the floor.
  One of Senator Wellstone's qualities was one that you've exemplified. 
He

[[Page H1299]]

stood up and he fought for what he believed in. It didn't matter what 
the political implications were. It didn't matter what others said. He 
steadfastly believed that discrimination against people because of 
mental illness or addiction was absolutely wrong and the antithesis of 
what America stood for.
  Senator Wellstone represented our State of Minnesota, and due to his 
work, Congressman Ramstad's work, Congressman Kennedy's work, Minnesota 
has one of the strongest parity acts in the Nation, and it works. If we 
can do it there, we can do it in this Congress.
  I would urge my colleagues to vote for this bill, not accept anything 
less, not the Senate version, not something from the White House, not a 
motion to recommit, not a smokescreen. This is the time to get this 
right the first time. Do the right thing. Pass this piece of 
legislation. This country will be better for it.

                              {time}  1830

  Mr. CAMP of Michigan. At this time I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, at this time I am happy to yield 2 minutes to 
the distinguished gentleman from Connecticut (Mr. Larson).
  Mr. LARSON of Connecticut. Mr. Speaker, I thank the distinguished 
Chair, and rise to associate myself with his remarks.
  What a remarkable afternoon this has been. What a remarkable journey 
of two of our colleagues. I rise today to support them for what they 
have done in the old-fashioned democratic way, reaching out across this 
country, holding hearings, and bringing back to this body a piece of 
legislation long overdue. I commend Representative Ramstad and 
Representative Kennedy. Their work has been extraordinary.
  President Kennedy once said that communities reveal an awful lot 
about themselves in the memorials they create, the people that they 
honor. This body is about to reveal an awful lot about itself on the 
legislation we are about to vote on. Two of our colleagues revealed so 
much about themselves in an effort to bring forth the plight of others 
less fortunate than they, and unable to be here on this floor to speak. 
That is the crowning glory of this great democracy that we all 
participate in.
  Patrick Kennedy had it right. This is a certain right. This is a 
civil right. This is something that goes beyond parity and speaks to 
the very essence of equality in what we stand for. And two of our 
colleagues have demonstrated the way to do that beyond the Chambers, 
beyond the Beltway, and out to the people where it really matters. 
Thank you so much for bringing their cause here today.
  Mr. CAMP of Michigan. I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, at this time I am pleased to yield 2 minutes 
to the distinguished gentleman from Georgia (Mr. Lewis).
  Mr. LEWIS of Georgia. Mr. Speaker, I want to thank my friend, 
Chairman Stark, for yielding.
  Mr. Speaker, I rise today to give my full support to H.R. 1424, the 
Paul Wellstone Mental Health Parity Act. I want to thank my colleagues, 
my very good friends, Mr. Kennedy and Mr. Ramstad, for their leadership 
on this important issue, for having the courage to stand up, to speak 
up, to speak out to take the leadership and bring this bill before us 
today.
  Today, we win a battle in the ongoing struggle against 
discrimination. Discrimination against mental illness and addiction is 
wrong. It is dead wrong. Today, we end that discrimination in health 
insurance. I believe that health care is a right and not a privilege. 
Until we can provide real and meaningful health coverage to all 
Americans, we must take each step as it comes to expand coverage. So, 
today we take an important step, a necessary step in that direction by 
requiring parity in insurance coverage.
  I have fought long and hard to end discrimination in this Nation, and 
we have made some real progress. But people suffering from mental 
illness and addiction have been left out and left behind, and it's time 
for us to do what is right when they are told that their illness is not 
covered by their insurance. That discrimination must end, and it must 
end now.
  Mental health parity is a matter of fairness, of equality, and it is 
the right thing to do. The time is always right to do right.
  Mr. CAMP of Michigan. I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, could I find out how much time remains on 
both sides.
  The SPEAKER pro tempore. Both sides have 8\1/2\ minutes remaining.
  Mr. STARK. Mr. Speaker, at this time I am happy to recognize the 
distinguished gentleman from Maryland (Mr. Van Hollen) for 2 minutes, a 
member of the Ways and Means Committee.
  Mr. VAN HOLLEN. I thank my colleague.
  Mr. Speaker, I rise in strong support of this long overdue bipartisan 
legislation, and I want to commend and thank our colleagues, Patrick 
Kennedy and Jim Ramstad, for their leadership, their passion, and their 
perseverance on this very important issue that is so important to 
millions of Americans around this country.
  Last year, they traveled across this great land, holding a series of 
field hearings, listening to Americans in communities across the 
Nation, people from every walk of life. I had the privilege of hosting 
one of those hearings in my congressional district. The message from 
that hearing, as with the other hearings from around the country, was 
very clear, Congress needs to end insurance discrimination in mental 
health care. Both common sense and simple fairness require that mental 
health diseases be treated on an equal footing with other health 
conditions.
  According to the National Institute of Mental Health, an estimated 26 
percent of Americans suffer from a diagnosable mental disorder in any 
given year, and approximately 6 percent of our fellow Americans suffer 
from serious mental illness. Mental disorders are the leading cause of 
disability for individuals between the ages of 15 and 44. The good news 
is the science tells us that treatment works. The sad truth is that, 
for most Americans, health insurance coverage does not now cover the 
full range of their needs.
  We know that for years, for years, employer-provided health care set 
stricter treatment limits and imposed higher out-of-pocket costs for 
mental health care. Congress took an important step in 1996 to correct 
that inequity through the Mental Health Parity Act. But problems 
remain, and that is the reason we have this very important legislation 
before us, because insurance companies were setting rigid, arbitrary 
caps on how they cover mental health. This legislation will finally 
stop those practices.
  Mr. Speaker, Members of Congress have good health care coverage and 
mental health coverage. Let's give the same thing to the American 
people.
  Mr. CAMP of Michigan. Mr. Speaker, I yield 2 minutes to the 
distinguished gentleman from California (Mr. Herger), a member of the 
Ways and Means Committee.
  Mr. HERGER. Mr. Speaker, I would like to encourage every Member of 
Congress to ask their constituents one simple question: Are your health 
insurance premiums high enough yet? Because this bill will make them 
even higher. We all want to improve access to mental health treatment. 
But the legislation before us could force some employers to drop mental 
health benefits altogether. Under this bill, plans are actually 
prohibited from covering treatment for depression, or potentially even 
a program to help someone quit smoking, unless they agree to cover 
literally everything in the book.
  I am especially concerned by the offset that effectively bans 
physician investment in hospitals. I am concerned that this provision 
could have a devastating impact on access to high quality health care. 
For example, there are just two hospitals in the city of Redding, 
California, in my northern California district. One of them nearly shut 
down a few years ago. It was bought by a company that specializes in 
turning around failing hospitals.
  Part of their strategy was to give the physicians who work at the 
hospital a partial ownership stake. They were successful. As a result, 
a vital community hospital is still open in a largely underserved area. 
This so-called ``offset'' would subject it to crippling new 
regulations, and it could doom other struggling hospitals to closure.
  Vote ``no'' on this legislation.

[[Page H1300]]

  Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from 
Illinois (Mr. Emanuel). Pending that, I yield myself 15 seconds to 
remind the distinguished gentleman from California that the hospital 
that closed in Redding was the one that killed 167 people by 
unnecessary cardiac procedures, and we were glad to be rid of it.
  Mr. EMANUEL. I thank my friend from California for the time.
  When I worked in the White House in 1996, we took two important steps 
on dealing with mental health parity. The first was signing the mental 
health parity legislation in 1996. That was referred to earlier. The 
second was also signing the executive order that ensured that 
government workers, Members of Congress and their staff, as well as 
other government workers, also had mental health parity in their health 
care. Some would think we are a little crazy for being in this job, but 
now we have got health care coverage for it.
  The fact of what this legislation does is provide for the taxpayers 
in America and make sure that they have the same access to the same 
type of health care that we have. It's that simple. When we did the 
first bill, the same people that were opposed to this bill, the 
insurance companies, said it would ruin the health care system. It 
didn't happen. The same insurance companies that are in the Federal 
employee system said they couldn't do what the executive order told 
them they had to do. They did it.
  Every time you try to make a little more reform to have a little more 
coverage, the insurance companies tell you that you can't do it. We 
accomplished it, and we accomplished it by doing right by the American 
people.
  The prior speaker mentioned that everybody is for covering mental 
health coverage, or for having mental health coverage, except for when 
it comes to covering mental health coverage. You can't be for it and 
then against it. Everybody was for an increase in the minimum wage, 
except for when you wanted to vote for it, they weren't voting for it. 
Everybody thought it was a good idea to increase Pell Grants, except 
for when it came to vote to increase Pell Grants.
  Well, here we are going to do this. You can't just say you're for 
mental health parity and then vote against it. This is the legislation. 
It builds on what we did in 1996 and 1999, and brings the type of 
reforms that are necessary. This is an illness, and these illnesses 
affect everybody's families, everybody's families, and it makes sure 
that there is one set of rules to the road when it comes to health care 
coverage.
  I appreciate the time, and it's time that we have this type of 
legislation on the floor.
  Mr. CAMP of Michigan. At this time we have no further speakers, so I 
reserve my time, except to close.
  Mr. STARK. Mr. Speaker, at this time I am happy to yield 1 minute to 
the distinguished gentleman from Pennsylvania (Mr. Patrick J. Murphy).
  Mr. PATRICK J. MURPHY of Pennsylvania. I thank my colleagues for 
taking the fight and leading the fight here.
  Mr. Speaker, I rise today on behalf of a teenager from Bensalem, 
Pennsylvania, for whom mental health care came too late. I rise in 
favor of a health care system that works for those in need. This 
legislation not only promotes fairness for those with mental illness, 
it also will not preempt stronger State laws, laws such as 
Pennsylvania's Act 106, which has saved countless lives.
  I stand with the Republican State Representative from my district, 
Gene DiGirolamo, as we fight together to preserve these critical laws 
in conference. Mr. DiGirolamo of Bensalem is a leading advocate for 
mental health parity, and has worked tirelessly for health care laws 
that are fair and just.
  Mr. Speaker, this bill is bipartisan and long overdue. I urge my 
colleagues to join us in voting for it.
  Mr. CAMP of Michigan. I continue to reserve.
  Mr. STARK. Mr. Speaker, do I have the right to close this section?
  Then I would reserve the balance of my time.
  The SPEAKER pro tempore. Mr. Pallone had reserved 2 minutes, and he 
will be the final speaker. But in this section, the gentleman from 
California has the right to close.
  Mr. CAMP of Michigan. I will be our final speaker on this side, Mr. 
Speaker.
  This debate is not really about who's for or against mental health 
parity, it's about doing mental health parity in the right way. The 
Senate unanimously passed a mental health parity bill last year, and 
there, Senators Kennedy, Domenici and Enzi worked in a bipartisan way 
and brought all affected parties together to reach a compromise that 
mental health groups, employers and health plans fully support.
  What has really not been answered in the debate today, and I don't 
fully understand, is why put the entire DSM-IV manual in statute. It's 
a diagnostic code. It's not for coverage decisions on health benefits. 
That question has never really been fully answered.
  Let's do the sensible thing. Let's vote this bill down and adopt the 
Senate bill. We can have a mental health parity bill on the President's 
desk by the end of the month if we followed this procedure. So I urge 
my colleagues to vote ``no'' on this bill.
  I yield back the balance of my time.

                              {time}  1845

  Mr. STARK. Mr. Speaker, I yield myself the balance of my time just to 
suggest that while costs have been an issue, basically the Senate bill, 
as I understand it, would be the preferred vehicle for the opposition 
to this bill, and I would like to just remind my colleagues that the 
Senate bill and the House bill cost the taxpayers the same amount of 
money. There is no cost difference between the Senate bill and the 
House bill.
  We are talking about a cost to employers, if they pay the entire cost 
of insurance, of 2 cents out of every $10, hardly a phenomenal cost 
when you think that the savings in productivity, human lives, and the 
billions of dollars that we would save in lost time and additional 
costs from the results of addiction and mental illness would be a bonus 
for which we don't get scored under our scoring procedures.
  This is a bill that was first introduced in the Ways and Means 
Committee, as I recall, almost 20 years ago. I wasn't able to do much 
with it in 20 years, but my distinguished friends Patrick Kennedy and 
Jim Ramstad have been able to do it, and I just want to repeat how 
proud I am of their tireless work.
  I hope that we will end the day today for the under-65 population of 
this country with mental health parity, and that we could come back 
again later this year or next year to finish this for us older guys in 
Medicare, so that we can also extend parity for the rest of the 
Americans.
  I want to thank all the staffs who have worked so hard, my colleagues 
on the Health Subcommittee of Ways and Means, my colleagues on Energy 
and Commerce, my colleagues on Education and Labor. This went through 
three committees, a feat in itself in this Congress. I think it is a 
bill that the time has come. We can set aside what minor differences 
there are, go and negotiate with the Senate for the final bill, and I 
look forward to its passage.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The gentleman from New Jersey, Mr. Pallone, 
controls the remaining 2 minutes.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just want to also thank the two sponsors of this 
legislation, Mr. Kennedy and Mr. Ramstad. If any of you had been in 
Trenton, New Jersey, the day when Mr. Kennedy held a hearing, to see 
the compassion that he brought to the hearing, to hear him tell his 
personal story, to see those who are advocates for the bill in my State 
to show up and basically explain why the type of discrimination that 
exists now with regard to mental health coverage should not continue.
  I think Mr. Kennedy said on the floor today that this is a civil 
rights issue, and that is true. People may doubt that a lot of 
discrimination continues to exist about mental illness, and certainly 
we have come a long way, there is no question about that, but the fact 
of the matter is that the discrimination continues. And although we 
have made some progress in terms of the Federal law, and even different 
States have passed legislation that is somewhat similar to this, the 
bottom line is

[[Page H1301]]

that we don't have absolute equality or equity at this point, and we 
need to make sure that if there is going to be mental health coverage, 
it covers all types of mental health illnesses as well as substance 
addiction. In addition to that, we want to make sure that the same is 
true, whether you are in or out of the health care network.
  These two gentlemen, my colleagues Mr. Ramstad and Mr. Kennedy, have 
been working on this bill for such a long time, and it really is a 
tribute to them and to Paul Wellstone that we are about to pass this 
bill. We commit, myself and the other chairmen of our respective 
committees, that we will not only pass this, but we will make sure that 
we do a bill that we can conference between the two Houses and get it 
to the President and hopefully get him to sign it before the end of 
this session.
  Mr. ELLSWORTH. Mr. Speaker, I rise in support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act. The passage of this 
bill today is an important step forward in the effort to ensure every 
American has access to quality mental health care services.
  Access to quality, affordable mental health care is just as important 
as access to traditional health care for Americans struggling with 
psychological problems. For decades, America has led the world in 
developing and implementing mental health diagnosis and treatment 
methods. Unfortunately, while American hospitals, doctors, and 
counselors provide the best mental health care in the world, many 
Americans are left without access to the benefits of that system. Too 
often, cost prohibits people from obtaining adequate coverage and 
seeking care when they need it.
  This bill makes important advances in addressing this problem for 
Americans with private health insurance. H.R. 1424 will expand access 
to mental health care and services for Americans with private health 
insurance, requiring plans to make mental health copayments, 
deductibles, and other benefits equal to benefits offered for 
traditional, physical health care. I believe this bill is an important 
step in breaking down the barrier to treatment many Americans with 
mental health problems face when they try to improve their lives, and I 
urge my colleagues to support it.
  While I am a strong supporter of the underlying legislation, I would 
like to express my concern with one of the offsets used to pay for the 
bill's costs. The Medicaid prescription drug rebate has proven to be an 
important tool in ensuring access to the best pharmaceutical drugs for 
low-income Americans. Currently, prescription drug producers already 
pay a significant rebate in order to participate in Medicaid, and this 
bill would increase that rebate by almost one third. I am concerned 
that further expanding this rebate could have a negative impact on 
research and development of the next generation of treatments. Congress 
needs to ensure it provides increased access to mental health services 
without jeopardizing future pharmaceutical breakthroughs.
  I will continue to support this bill and encourage my colleagues to 
do the same. However, as this bill advances to conference with the 
Senate, I hope that the final product we send to the President will not 
contain an overly burdensome increase in the Medicaid rebate.
  MR. BACA. Mr. Speaker, I rise today in strong support of civil rights 
and the passage of H.R. 1484, the Paul Wellstone Mental Health and 
Addiction Equity Act of 2007.
  This bill is aimed at eliminating discriminatory provisions in mental 
health. With this bill addiction treatments are provided on par with 
treatment for other medical illnesses and conditions, such as diabetes, 
asthma and high blood pressure.
  Currently, many families are facing hurdles and obstacles in 
obtaining quality care for mental illness and addiction disorders.
  Over 57 million Americans suffer from a form of a mental health 
disorder and more than 26 million from a chemical addition. Our early 
intervention services for mental health and addiction are behind other 
medical conditions.
  This is discrimination; this is not the American way.
  In my District alone, we are facing an alarming methamphetamine-use 
crisis, these patients often require professional help.
  Mental health must be recognized as equal to other health conditions 
and illnesses. The stigma must be removed so more people will be able 
to seek professional help and our loved ones will be able to live 
healthy and productive lives.
  These are real diseases, and those affected by them deserve coverage. 
We are living in different times now and we need to pay closer 
attention to the mental health needs of our families.
  For example, the recent school shootings are evidence of where 
counseling and treatment may have prevented these tragedies, yet stigma 
and lack affordability of mental health services stood in the way.
  I urge my colleagues to support mental health parity and vote in 
favor of H.R. 1424.
  Mr. UDALL of Colorado. Mr. Speaker, I rise today in support of H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007. This bill moves forward the important principles that mental 
health deserves fair and equal recognition in our health care financing 
system and that individuals afflicted with mental health disorders 
deserve no less a chance at recovery than those afflicted with physical 
disorders.
  These principles do not exist for their own sake, and there are 
plenty of practical reasons that mental health coverage should be equal 
to that of other types of health coverage. For example, the Journal of 
the American Medical Association estimates that employers lose as much 
as $31 billion per year in productivity costs associated with having 
depressed workers. The story is much the same for alcohol-related 
illnesses and certainly for suicide. Even if these economic realities 
did not exist, there remains no scientific justification for treating 
mental health as separate and inferior to physical health.
  Many attribute the historical disparities between the treatment of 
mental health and physical health to stigmas about the realness of 
mental health disorders and the credibility of those who claim to have 
them. If this is true, surely our scientific and health care 
communities have moved us beyond those stigmas and shown that mental 
health not only exists, but is as important to one's day to day life as 
any physical condition. It is time that our laws and our health care 
financing system caught up to our scientific knowledge in this 
important respect.
  H.R. 1424 will move us in that direction. If passed, it will bring 
this aspect of our private health insurance system in line with what 
has worked for Medicare, Medicaid, the Veterans Administration, and the 
Federal Employees Health Benefits Program--the very same health program 
available to members of Congress. This is not a mandate. Employer-based 
health care plans will not be required to offer mental health benefits, 
but those group plans with 51 or more employees who do offer mental 
health benefits will be required to provide coverage that is no less 
substantial than the coverage provided for physical health. This is 
sound policy, and ensures that those afflicted with mental health 
disorders can afford the care they need to lead productive, happy, 
healthy lives.
  I am aware that there are some differences between this bill and the 
similar bill that passed the Senate last year. Some opponents of the 
House version, I think, have legitimate concerns about the effects of 
basing coverage on the Diagnostic and Statistical Manual of Mental 
Disorders (DSM-IV). The instances in which plans and states have 
adhered to the DSM-IV have not yielded the problems with overuse and 
treatment for the ``worried well'' that opponents predict, but the 
possibility that these problems could occur, I think, is strong enough 
that these differences should be addressed before the bill becomes law. 
I am hopeful that ongoing discussions between the House and the Senate 
will produce a bill that addresses these concerns and finds a suitable 
compromise.
  I will vote for this bill because I believe that moving it forward in 
the legislative process is one more important step toward the final 
goal of instituting equity between physical and mental health coverage, 
a goal I hope can be achieved this year.
  Mr. HULSHOF. Mr. Speaker, I am very glad that we are taking up mental 
health parity today. I support mental health and substance abuse 
parity, as does most of this body. But there are a few details of this 
bill I would like to change to ensure that true parity be the final 
result of the legislation before us.
  But because this is brought up under a closed rule, these vital 
changes cannot be made, thus I will oppose this bill.
  Let me add at the outset that I have only the utmost respect for my 
friend and fellow Health Subcommittee member Jim Ramstad. He is a 
champion on this issue, and the tenants of mental health parity that 
most here support are in no-small-part thanks to his intelligent, 
passionate advocacy. I thank the gentleman for that example and his 
service to this institution.
  September 18, the Senate voice voted S. 558, legislation that was the 
product of input and agreement between mental health advocates, policy 
experts, health providers, employers, and authoring legislators.
  I am concerned that in passing the language in this bill, this House 
will be marginalizing itself--that in passing a bill with no real hopes 
of adoption by the other body this body will be seen as out-of-touch, a 
secondary player, and at worst could hold up much needed mental health 
legislation.
  I would like to highlight two key differences between the House and 
Senate bills, using the

[[Page H1302]]

language from the Senate compromise bill--the codification of the DSM-
IV, Diagnostic Statistical Manual, and protection of Medical 
Management.


                                  DSM

  I proposed two amendments at the Ways and Means Committee that would 
have won my vote there and here on the floor and would move this bill 
more quickly through a House-Senate conference and to the President's 
desk for signing.
  The first issue, this legislation creates a broad new mandate by 
codifying usage of the DSM-4 (DSM-IV).
  H.R. 1424 imposes a broad mandate to cover all mental illnesses 
listed in the DSM-IV Manual. DSM is the Diagnostic Statistical Manual 
that provides diagnostic criteria and codes for billing health plans.
  Health Plans will be required to provide coverage for all the 
conditions listed in DSM-IV--conditions such as caffeine withdrawal and 
jet lag are included, as other speakers have and will discuss. This is 
simply a benefits mandate.
  The bill exceeds the stated objective of achieving ``parity'' by 
requiring coverage of all conditions in the diagnostic manual for 
mental health and substance abuse disorders if a plan decides to cover 
any mental health or substance abuse conditions at all. No similar 
Federal requirement applies to any other category of benefits.
  Currently, there is no Federal definition of the scope of medical/
surgical benefits that plans must offer. Therefore, this is NOT true 
parity.


                           Medical Management

  The House bill contains no provision to protect medical management 
practices. These can include such things as coordinated disease 
management, care management initiatives, health coaching, and patient 
support tools to improve the quality and accessibility of mental health 
benefits.
  The use of medical management allows plans to provide the right 
course of treatment and avoid expending resources on ineffective or 
unproven treatments.
  The Senate bill would protect plans ability to manage mental health 
benefits in this way, even if such management is more intensive than 
the management of other types of medical services.
  The reason FEHB plans have been able to keep their costs down is 
because they are allowed to offer medical management programs to 
determine whether a treatment is medically necessary or not.
  In fact, the principal investigator who evaluated parity for Federal 
employees stated in his testimony to the Energy and Commerce Committee 
that ``these findings suggest that parity of coverage of mental health 
and substance abuse services, when coupled with management of care, is 
feasible . . .''
  If enacted, H.R. 1424 will limit the ability of group health plans to 
apply a full range of medical management tools--including the use of 
provider networks and contracting--tools essential in controlling costs 
and ensuring quality.


               Genetic Information Non-Discrimination Act

  I would like to make one other point on the attachment of the Genetic 
Information Non-Discrimination Act to H.R. 1424, legislation I 
supported out of Committee.
  But at Ways and Means we fixed language protecting those who donate 
their time and selves for clinical research, but this final language is 
not comprehensive.
  I am concerned with the definitions of genetic testing/services, that 
they fully include protection for those going into clinical research. 
An example: John's employer learns that John is signing up for clinical 
research and fires him or his insurer drops his policy. The bill now 
says ``genetic services received pursuant to clinical research.'' So, 
John isn't protected because he has not had a genetic test or service, 
he's only signed up to do it. Or maybe the employer discovered that 
John is interested in participating and fires him.
  The services themselves are protected, which is good. However, the 
definition is missing the protection of the ability to participate in 
clinical research. The Ways and Means Committee passed language 
protecting this, and I hope that this language can be perfected at 
conference with the Senate to protect all clinical research 
participants.
  Mr. SMITH of Texas. Mr. Speaker, I support better health care being 
made available for the mentally ill. Americans should have the freedom 
to choose health care plans that offer mental health benefits.
  I also support the passage of H.R. 1424, the ``Paul Wellstone Mental 
Health and Addiction Equity Act of 2007,'' because this legislation 
represents a step forward in the mental health care debate.
  However, I believe the House bill goes too far by limiting 
physicians' ability to refer patients to physician-owned hospitals. 
Physician-owned hospitals play an important role in providing high 
quality care to patients. These facilities should not be penalized for 
offering accessible health care to so many individuals.
  In addition, this legislation requires any plan that provides mental 
health or substance-related disorder benefits to offer coverage for all 
disorders listed in the Diagnostic and Statistical Manual of Mental 
Disorders (DSM-IV). The list of disorders encompassed by this 
legislation is too broad and could be used by some individuals to take 
advantage of the health care system.
  H.R. 1424 also will not allow employers to have discretion over the 
benefit coverage decisions for their employees. It instead imposes a 
mandate that requires employers to cover all conditions listed in the 
DSM-IV. This mandate likely will increase health insurance costs.
  I am hopeful that if this legislation goes to a Conference Committee, 
the House will adopt much of the language contained in the Senate 
version of the bill, S. 558, the ``Mental Health Parity Act.'' The 
Senate bill represents a compromise between the mental health and 
business communities.
  The Senate legislation provides employer discretion by allowing 
employers to determine which mental health conditions should be covered 
under their plan and does not include language that penalizes 
physician-owned hospitals.
  I look forward to continuing to work with my colleagues on this 
important issue and to making sure we have an improved bill at the end 
of the process.
  Mrs. BACHMANN. Mr. Speaker, today we are debating a bill which 
addresses an issue that is near and dear to my heart: helping those 
with mental health disorders.
  As the wife of a clinical therapist, I have seen the many challenges 
that people who have mental health disorders face day after day.
  These are very real impairments--but through counseling and 
appropriate treatments, real breakthroughs can be made.
  We can help those individuals who suffer, as well as their families 
and our overall society.
  But I have serious concerns about the scope of this legislation and 
the impact it will have on the affordability of health insurance for 
all Americans.
  By mandating that group health plans offer the same financial benefit 
structure for both mental and physical disorders, the cost of insurance 
will increase across the board--and with accessibility of health care 
services and the affordability of health care coverage so paramount a 
concern for families across the country.
  The Congressional Budget Office has estimated that the cost of these 
mandates in the private insurance market will total $3 billion annually 
by 2012.
  This will inevitably set up a cycle of increasing costs on employers 
offering health insurance and thus increasing costs for employees 
seeking to obtain coverage.
  These mandates may even have an adverse affect on access to mental 
health coverage at all.
  My colleagues in support of the bill have stressed that it does 
nothing to require employers to offer coverage of mental health 
services--it only mandates what this coverage must include on those who 
choose to offer mental health coverage.
  But it is not hard to imagine that many employers who are frustrated 
with the increased costs the bill will impose on them will simply drop 
mental health coverage altogether.
  That, of course, would be counterproductive to the intent of the 
bill.
  In fact, it would hurt the very people the bill purports to help.
  Mr. Speaker, the cost of health care is at perhaps an all time high.
  Between 2000 and 2006, premiums for family coverage have increased by 
87 percent, making the average premium families' paid last year 
$12,106.
  This is not the time to make coverage less affordable.
  Though I appreciate my colleagues' good intentions, the negative 
impact this bill would have on our overall health care market is too 
serious to ignore and I must oppose it.
  Mr. CONYERS. Mr. Speaker, I rise to voice my strong support for H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007, which requires equity in the provision of mental health and 
substance-related disorder benefits under group health plans. This much 
needed legislation would finally provide for true mental health 
insurance parity, offering mental health and substance-abuse benefits 
on par with medical and surgical benefits, ending discrimination 
against patients seeking treatment for psychiatric disorders.
  Mental illnesses have a devastating affect on our nation. According 
to a 2005 Harvard study, over 35 million Americans suffer from a 
moderate or serious mental disorder in any given year. Societal costs, 
such as loss of productivity and the burden on family caregivers, total 
$113 billion annually. As well, the President's New Freedom Commission 
on Mental Health reported in 2003 that mental illnesses constitute the 
leading cause of disability in the United States; the Commission noted 
that half

[[Page H1303]]

of those who need mental health treatment in this country do not 
receive it.
  The treatment of mental illness works. Unfortunately, only those who 
are able to access care can benefit from it. Most mental disorders are 
chronic, ongoing illnesses that require consistent and persistent 
treatment in order to achieve remission. It would seem unconscionable 
to limit the number of times a cancer patient sees their oncologist for 
treatment; those suffering from severe psychiatric illness should not 
be held to a lesser standard of care.
  Despite disinformation put forth by some of my colleagues today, the 
concept of mental health insurance parity is not a new one. In fact, as 
members of Congress, we all enjoy the benefits of mental health parity 
that our constituents are deprived of. The Federal Employees Health 
Benefits (FEHB) Program has offered mental health and substance-abuse 
benefits on a par with general medical benefits since 2001. A 
convincing study of the FEHB program published by the New England 
Journal of Medicine in 2006 proves that the implementation of parity in 
insurance benefits for behavioral health care can improve insurance 
protection without increasing total costs.
  Mr. Speaker, the inequity of coverage with regard to mental health 
and substance abuse treatment benefits is tantamount to discrimination 
against the mentally ill, and it reinforces the strategy of insurance 
companies to deny care rather than provide care. It is our duty to end 
this intolerable discrimination against the mentally ill, and pass H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007.
  Mr. HOLT. Mr. Speaker, it will be a landmark day when we realize that 
health is not just about fixing broken bones. It's about having a 
healthy, complete individual from head to toe. Millions of Americans 
suffer from mental illness of some form, conditions that disrupt a 
person's thinking, feeling, mood, ability to relate to others, and 
daily functioning. Mental illnesses strain families and can contribute 
to lost productivity, unemployment, substance abuse, homelessness, or 
suicide. Few Americans are untouched by it. No one is immune.
  Prompt and comprehensive treatment can reduce enormously these 
effects, but insurance companies--including government plans like 
Medicare, Medicaid, and the State Children's Health Insurance Program 
(SCHIP)--frequently impose limits on coverage for mental health that 
are not imposed on traditional medical and surgical care. Already this 
year, Congress has worked to address these inequalities in the federal 
health programs.
  Today, the House of Representatives is taking a significant step 
toward finally ending the insurance discrimination that has existed for 
decades against people with mental illness.
  Representative Patrick Kennedy and Representative Jim Ramstad deserve 
credit for their strong leadership on the Paul Wellstone Mental Health 
and Addiction Equity Act, H.R. 1424, which I am proud to cosponsor 
along with more than 270 of my colleagues. This much needed legislation 
would require insurance companies to provide benefits for mental health 
and substance abuse treatment equal to those provided for physical 
medical treatment.
  The Paul Wellstone Mental Health and Addiction Equity Act would 
require that all Diagnostic and Statistical Manual of Mental Disorders, 
DSM-IV, illnesses be covered, rather than letting insurance companies 
determine their own scope of coverage. This is the same coverage 
requirements that we as Members of Congress receive under our federal 
employee health plan, and our constituents deserve no less coverage.
  The American Psychological Association, which publishes DSM-IV, 
reports that lack of insurance coverage (87 percent) and cost (81 
percent) are the leading factors for individuals not seeking mental 
health services. The Paul Wellstone Mental Health and Addiction Equity 
Act would solve both of these problems.
  Additionally, unlike the bill working through the Senate, H.R. 1424 
would not preempt state law. This is very important for the residents 
of my home state of New Jersey and others who already have mental 
health parity laws on the books. For good reason these states worry 
that they might be forced to reduce their coverage requirements.
  We know that mental illness is treatable, yet because one third of 
the people affected do not receive needed treatments, mental illness 
remains a leading cause of disability and premature death. According to 
the World Health Organization, the costs related to untreated mental 
illness are $147 billion each year in the United States. Those who 
oppose the legislation thinking it is too expensive should note this 
cost.
  Yet, an analysis of the Paul Wellstone Mental Health and Addiction 
Equity Act indicates it would result in an increase of less than one 
percent premiums and would reduce out-of-pocket costs by 18 percent. 
Further, a recent article in the Journal of American Medical 
Association, JAMA, indicates that employers who actively encourage 
their employees to use mental health services actually experienced an 
increase in hours worked and productivity gains.
  Ultimately, despite the economic arguments in favor of parity, it is 
not a debate about dollars and cents, but about lives saved and people 
restored. I recently received a letter from a constituent who is a 
corporate human resource director. She did not write me in that 
capacity, however. Instead, she wrote me ``as the sister of a beloved 
brother who committed suicide one day after his in-patient mental 
health care benefit `ran-out'.'' She understood and related to me not 
only the human resources concerns, but also and especially, the true 
cost of mental health and the failure to enact mental health parity. 
Let's work to ensure that those who need access to mental health care, 
get it.
  Mr. TERRY. Mr. Speaker, today the House is considering H.R. 1424, the 
Paul Wellstone Mental Health and Addiction Equity Act. I strongly 
support the mental health community and believe that millions of 
Americans living with mental health illness and addiction need access 
to treatment. Screening and early treatment remains an important and 
cost-effective way of combating mental health illness and addiction.
  Unfortunately, the bill before us today seeks to extend mental health 
treatment by stifling innovation, increasing health insurance cost to 
employers and employees and mandates that ALL diagnoses, such as `jet 
lag' and `caffeine intoxication' listed in the DSM-IV be covered.
  A provision in H.R. 1424 also seeks to limit physician ownership in 
hospitals, regardless of whether those hospitals are in rural or small 
communities. Physician owned hospitals strive to eliminate preventable 
complications and errors in order to improve patient care. Specialty 
care hospitals are an integral part of our community in Nebraska. They 
provide quality care and help keep costs down. A February article in 
Forbes highlighted a University of Iowa study which found that tens of 
thousands of Medicare patients' complication rates for hip and knee 
surgeries were 40 percent lower at specialty hospitals than at other 
hospitals.
  Mr. Speaker, unlike the Senate bill which requires that insurance 
companies consider all mental ailments listed in the Diagnostic and 
Statistical Manual of Mental Disorders, the legislation before us goes 
one step further by requiring groups which offer mental health benefits 
to cover all diagnoses under the DSM-IV, this includes disorders such 
as `jet lag' and `caffeine intoxication.' Furthermore, groups would be 
required to extend current mental health benefits regardless of 
religious or moral objections they may have to paying for the treatment 
of psycho-sexual disorders or dubious complaints of less serious 
problems.
  Finally, the bill would increase health insurance costs. The CBO 
estimates that by 2012, H.R. 1424 would cost $3 billion annually, a 
cost which would be passed on to employers and employees.
  I am concerned that the government mandate currently proposed by H.R. 
1424, though well-intentioned, could actually reduce access to mental 
health care. Many health plans are already responding to customer 
demand by gradually implementing greater coverage of mental health 
treatments. Mandating that such coverage would be immediately equal 
with medical and surgical benefits could force some plans to drop 
mental health benefits altogether leaving Americans in need of coverage 
with none at all.
  Mr. Speaker, I wanted to come to this floor and vote for a Mental 
Health Parity bill like the one I supported in the Energy and Commerce 
Committee last fall. Unfortunately, this is not the same legislation, 
and therefore I must reluctantly oppose it.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in support of 
H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, 
introduced by my distinguished colleague from Rhode Island, 
Representative Patrick J. Kennedy, but ask for a closer at Section 6, 
and its effect on physician-owned general hospitals.
  I have opposed H. Res. 1014, the rule which provided for 
consideration of H.R. 1424; however, I am in support of the bill 
itself.
  This bill permanently reauthorizes and expands the Mental Health 
Parity Act of 1996 to provide for equity in the coverage of mental 
health and substance disorders as compared to medical and surgical 
disorders. This legislation ensures that group health plans do not 
charge higher co-payments, coinsurance, deductibles, and impose maximum 
out-of-pocket limits and lower day and visit limits on mental health 
and addiction care than for medical and surgical benefits.
  Although this legislation does not mandate group health plans, if a 
plan does offer mental health coverage, then this legislation would 
require it to offer equity in its: (1) financial requirements applied 
to mental health and substance-related disorders, (2) equity in 
treatment limitations, (3) prohibit discrimination by diagnosis, and 
(4) equality in out-of-network coverage.

[[Page H1304]]

  This legislation provides for greater transparency in medical 
management, and strict enforcement by the Internal Revenue Service, 
something we all want to see more of in the health care industry.
  Over the past several decades, America's health care system has been 
a leader in innovation. This innovation has given patients 
unprecedented access to specialized care in all different fields of 
medicine. Whether it's in cancer centers, children's hospitals, or 
ambulatory surgical centers, patients now have the ability to receive 
quality care in a hospital of their choice.
  Unfortunately, this bill stifles the very innovation and choice that 
has laid the groundwork to real transformation in our health care 
system. A provision in H.R. 1424 would severely restrict the ability 
and capacity of physician owned hospitals to provide quality healthcare 
to their patients. It does not matter if the hospital is rural, inner 
city, big or small this legislation will punish these hospitals, the 
doctors and the nurses that serve their community every day by 
restricting them from providing high quality care to their patients. 
Physician owned hospitals serve as an integral part in the future of 
patient care and should not be dismissed just because they have 
physician investment.

  In Texas, we have inpatient rehabilitation hospitals, long-term acute 
care hospitals, general care hospitals, and community hospitals that 
are nationally recognized as the best in the industry and each and 
every one of them has physician investment. Patients across the great 
state of Texas have greatly benefited from the safety, quality, and 
innovation that physician owned hospitals bring.
  In an era when hospital deaths from infections, medical errors, and 
other problems approach 100,000 a year, physician owned hospitals have 
placed a very large emphasis on eliminating preventable complications 
and errors in order to improve patient care.
  Just this month in a Forbes article, a University of Iowa study found 
that tens of thousands of Medicare patients' complication rates for hip 
and knee surgeries were 40 percent lower at specialty hospitals than at 
other hospitals. These hospitals provide a needed service and they must 
be allowed to continue their good work now and in the future.
  Before Senator Paul Wellstone's untimely death and that of his wife 
and daughter, I had the opportunity to meet with him and work with him 
on these very issues. His dedication to creating affordable healthcare 
for all Americans is what is at the root of this legislation. Having a 
provision that actually seeks to restrict physicians and hospitals 
seems to obliterate the bipartisanship and purpose of this bill.
  We all support the goal of equal access to mental health benefits. 
However, we should not believe that it should be paid for by 
sacrificing facilities that bring quality, efficient and accessible 
healthcare to all patients.
  I urge my colleagues to take a closer look at the effect this 
legislation will have on physician-owned hospitals. Despite my 
reservations regarding the disproportionate impact on physician-owned 
hospitals, ultimately patients benefit from this legislation and 
therefore I ask each of you to join me in supporting H.R. 1424.
  Mr. CONYERS. Mr. Speaker, I rise to voice my strong support for H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007, which requires equity in the provision of mental health and 
substance-related disorder benefits under group health plans. This much 
needed legislation would finally provide for true mental health 
insurance parity, offering mental health and substance-abuse benefits 
on par with medical and surgical benefits, ending discrimination 
against patients seeking treatment for psychiatric disorders.
  Mental illnesses have a devastating effect on our nation. According 
to a 2005 Harvard study, over 35 million Americans suffer from a 
moderate or serious mental disorder in any given year. Societal costs, 
such as loss of productivity and the burden on family caregivers, total 
$113 billion annually. As well, the President's New Freedom Commission 
on Mental Health reported in 2003 that mental illnesses constitute the 
leading cause of disability in the United States; the Commission noted 
that half of those who need mental health treatment in this country do 
not receive it.
  The treatment of mental illness works. Unfortunately, only those who 
are able to access care can benefit from it. Most mental disorders are 
chronic, ongoing illnesses that require consistent and persistent 
treatment in order to achieve remission. It would seem unconscionable 
to limit the number of times a cancer patient sees their oncologist for 
treatment; those suffering from severe psychiatric illness should not 
be held to a lesser standard of care.
  Despite disinformation put forth by some of my colleagues today, the 
concept of mental health insurance parity is not a new one. In fact, as 
members of Congress, we all enjoy the benefits of mental health parity 
that our constituents are deprived of. The Federal Employees Health 
Benefits (FEHB) Program has offered mental health and substance-abuse 
benefits on a par with general medical benefits since 2001. A 
convincing study of the FEHB program published by the New England 
Journal of Medicine in 2006 proves that the implementation of parity in 
insurance benefits for behavioral health care can improve insurance 
protection without increasing total costs.
  Mr. Speaker, the inequity of coverage with regard to mental health 
and substance abuse treatment benefits is tantamount to discrimination 
against the mentally ill, and it reinforces the strategy of insurance 
companies to deny care rather than provide care. It is our duty to end 
this intolerable discrimination against the mentally ill, and pass H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007.
  Mr. SHULER. Mr. Speaker, I rise in support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act. The passage of this 
bill is an important step for those suffering from mental health 
problems in this country.
  I believe it should not be an uphill battle to get treatment for 
millions of Americans living with mental illness and addiction. Thanks 
to my colleagues Mr. Kennedy and Mr. Ramstad we are moving towards 
achieving parity between mental and physical conditions.
  While I support the underlying legislation, I oppose the closed rule 
under which it is being introduced, because it does not provide for an 
opportunity to address the revenue raisers included in the bill. I am 
particularly concerned with the offset used to pay for the legislation, 
specifically the Medicaid prescription drug rebate.
  Increasing these rebate rates could have a chilling effect on 
pharmaceutical research and development for the next generation of 
treatments, including those that aid patients with mental health 
conditions that we are attempting to help today.
  I urge the passage of this bill. However, as this bill advances to 
conference, I hope that the final product that returns to the House 
will not contain an increased Medicaid rebate or any other provision 
that will deter the innovation of new treatments for the diseases that 
affect American families.
  Mr. ETHERIDGE. Mr. Speaker, I rise today in support of H.R. 1424, the 
Paul Wellstone Mental Health and Addiction Equity Act. As a cosponsor 
of this important legislation, I applaud your leadership in bringing 
this bill to the floor and addressing the issue of mental health panty.
  According to the National Institute of Mental Health (NIMH), 
approximately 26.2 percent of Americans ages 18 and older--about one in 
four adults--suffer from a diagnosable mental disorder. Unfortunately, 
the U.S. Surgeon General reports that only one in three of these people 
receive treatment for their disabilities. A significant reason that 
people fail to seek medical help for debilitating mental health issues 
is the lack of insurance.
  The Paul Wellstone Mental Health and Addiction Equity Act would help 
address this problem. By requiring health plans to consider mental 
health issues on an equal basis with other health problems, this bill 
ensures that those in need can get the treatment that is medically 
necessary. We must expand access to mental health to ensure a strong 
and productive America that provides for its most vulnerable citizens.
  Untreated and mistreated mental illness costs the United States $105 
billion in lost productivity, a figure that has been increasing every 
year. According to a study funded by NIMH, treating mental health in 
the workplace significantly improves employee health and productivity, 
likely leading to overall lower costs for the employer. Mental health 
also has a high cost to society--for example, 20 percent of youths in 
juvenile justice facilities have a serious emotional disturbance and 
most have a diagnosable mental disorder. This bill will improve our 
economy and ensure those in need get the help they need before their 
illness turns into something worse.
  My home state of North Carolina was one of the first states to adopt 
a mental health parity law back in 1991, and last year the State 
Legislature expanded and strengthened its mental health parity 
provisions. I support the efforts of North Carolina's mental health 
professionals in bringing this issue to the forefront of our State's 
agenda.
  Mr. Speaker, while I strongly support this bill, I disagree with part 
of the bill's funding mechanism. We must be fiscally responsible, but 
we should not allow cost offsets to undermine the basic goals of this 
bill. I am concerned that the large increase in the Medicaid 
prescription drug rebate will reduce the ability of patients, including 
those with mental health conditions, to get the prescription medicines 
they need.
  H.R. 1424 calls for a 33 percent increase in the rebate that brand 
pharmaceutical companies pay to the Medicaid program. Innovator drug 
companies already provide deep discounts to Federal and State 
Governments for

[[Page H1305]]

the prescription drugs covered by the Medicaid program. I am concerned 
that a huge increase in costs will have a chilling effect on 
pharmaceutical research and development for the next generation of 
treatments, including those that aid the very patients with mental 
health conditions that we are attempting to help today. Mr. Speaker, I 
hope that you and the House conferees will work to address this issue 
in conference negotiations with the Senate.
  After careful consideration, I urge my colleagues to join me in 
voting for H.R. 1424.
  Mr. LANGEVIN. Mr. Speaker, I rise in strong support of the Paul 
Wellstone Mental Health and Addiction Equity Act of 2007, which I am 
proud to cosponsor. I know many people have worked hard to bring this 
important measure to the floor, including my friend from Minnesota, the 
co-chair of the Bipartisan Disabilities Caucus, Mr. Ramstad. Most of 
all, I would like to recognize the commitment and perseverance of my 
good friend and colleague from Rhode Island, Patrick Kennedy. Patrick 
has been my good friend for many years, and I have watched him harness 
his passion and his knowledge to address the challenges faced by those 
with mental illness. He has raised awareness about a topic that had 
previously been considered taboo by the American people, using his own 
personal experiences to humanize the issue of mental health. I know 
that the people of Rhode Island admire his leadership, and I thank him 
for his tireless efforts.
  Mental illnesses and substance abuse problems are at epidemic levels 
in this country. According to recent estimates, more than 35 million 
Americans experience the disabling symptoms of mental illness. 
Depression alone costs employers over $35 billion dollars a year in 
lost productivity, and that figure does not even factor in the 
multitude of other behavioral and psychological disorders that 
challenge our society on a daily basis. Substance abuse also directly 
affects an estimated 25 million Americans. An additional 40 million are 
indirectly affected once family members of abusers and the injured 
victims of intoxicated drivers are considered. Put simply, the social 
and monetary costs of these problems are astounding.
  This bipartisan legislation makes tremendous strides in ending the 
inherent discrimination in our insurance system against patients 
seeking treatment for these illnesses. It permanently reauthorizes and 
expands the Mental Health Parity Act of 1996 to provide for equity in 
the coverage of mental health and substance-related disorders. It does 
not achieve equity by mandating that group health plans provide mental 
health coverage. However, if a plan chooses to offer coverage--as it 
rightfully should--then the coverage it offers must be no more 
restrictive in the financial requirements or treatment limits that are 
provided for medical or surgical disorders. This will mean equity in 
deductibles and co-pays, as well as in the frequency and number of 
visits. It will also establish parity for out-of-network coverage. In 
short, it will vastly expand coverage and access for those seeking 
treatment for their mental health.
  Mental health parity is already available to members of Congress and 
over 8 million Federal employees under the Federal Employee Health 
Benefits Program, FEHBP, at minimal additional cost to the program. It 
is time that we extend this benefit to all Americans, and this 
legislation takes us considerably closer to that goal. I strongly urge 
my colleagues to vote in favor of this bill.
  Mr. McDERMOTT. Mr. Speaker, today is an historic day. Along with 
others, I have labored for a very long time to produce a comprehensive 
mental health parity bill. Without a doubt, our actions today will 
benefit real people in real ways. Many times we come to the floor to 
debate and vote on legislation that many Americans may wonder what is 
the relevance or the purpose? No one who has suffered a mental illness 
or has watched a family member suffer a mental illness will ask what is 
the relevance?
  As a doctor and psychiatrist, I want to emphasize to my colleagues 
that this bill will make a genuine difference in the lives of the 
American people we serve. I know the suffering of mental illness. Not 
only do many patients still face the stigma of mental illness, but they 
also face discrimination in coverage.
  Most Americans would be outraged if they heard that health plans 
charged higher co-payments for cancer treatments or limited hospitals 
stays for those with heart diseases or denied care for diabetes. We 
would all be outraged. But, that is what we allow for mental illness.
  We have heard a great deal about the costs of requiring mental health 
parity. What we hear very little about is the cost of not providing 
mental health parity. Many untreated mental illnesses can metastasize 
into serious physical and costly illnesses. Untreated depressions can 
result in heart disease. An untreated eating disorder can result in 
kidney failure. Yet, had we treated the mental illness we could have 
saved millions of dollars in costly care.
  The issue of increasing costs of insurance is simply and 
categorically false. We know from the FEHBP experience that mental 
health parity has not resulted in significant costs. In fact, CBO has 
reported that H.R. 1424 would increase premiums by just two tenths of 
one percent. I would argue the longer term savings would offset any 
increase in premiums and that we will see a savings.
  Access to mental health is simply access to quality primary care. 
It's key to preventing disease and improving outcomes. It simply makes 
no sense to treat the brain differently than the kidney or lungs or 
heart.
  We have also heard a great deal about the use of the DSM-IV and scope 
of coverage. The use of DSM-IV is a tool for diagnosing mental illness 
and ensures that doctors, not insurance companies, define a mental 
illness. Some of my colleagues have argued that the use of DSM-IV will 
mean that plans must cover jet lag. These are not DSM diagnoses and 
refer to V Codes and not developed for the DSM.
  My colleagues also argue that the use of the DSM-IV will prohibit 
plans from medical management. Again, my colleagues are wrong. As a 
practitioner, let me assure you that diagnosing and treating illness 
are very different things. Treatments can and will still be subject to 
medical necessity, like any other illness.
  I think it is important for me to correct the record. Many of the 
speakers who addressed the House today are not health care 
professionals and have little understanding of mental illness. Yet, 
they claim to be experts on diagnosing and treating mental illness.
  Finally, let me say a few words about the physician ownership offset. 
Just a couple of weeks ago, the administration sent to the Congress the 
Medicare 45 percent trigger recommendations. We have heard over and 
over again that Medicare spending is not sustainable and we need 
radical reforms. Yet, when we offer a small reform measure that will 
save more than $2 billion over 10 years, and protect patients from 
unnecessary care, some Members come to the floor to oppose. In fact, 
they argue that this physician ownership issue reduces choice or 
access. Who chooses to spend $2 billion more?
  I understand that there may be some clinics that are providing 
quality care and we need to work to ensure that Medicare beneficiaries 
are not denied access. But, let's remember what we are doing. This is 
about closing a loophole to limit physician ownership of medical 
facilities to reduce over utilization and protect full service 
community hospitals. Many of these physician owned facilities do not 
staff an emergency department or an ICU. This is about protecting the 
integrity of the Medicare program. This is about controlling Medicare 
spending.
  I strongly support H.R. 1424. Let's end this inhumane practice of 
discriminating against those with a mental illness. Let's make sure 
that when families pay premiums for health insurance coverage that they 
have the right to medically necessary coverage.
   Mr. KIND. Mr. Speaker, I rise today in strong support of long 
overdue legislation that would equalize care for the millions of 
Americans suffering from mental health and substance-related disorders. 
More than 10 years after passing the Mental Health Parity Act, Congress 
now has the chance to finish the job it began and ensure that no 
Americans face discrimination in insurance coverage of mental health 
care.
   Patients throughout the country struggle with the enormous financial 
costs of mental health and substance abuse treatments not covered by 
insurance. Many go without treatment, creating a burden on families, 
communities, and even our economy. Over 1.3 billion work days are lost 
annually due to mental disorders, more than stroke, heart attack, and 
cancer combined. In addition, employers face $135 billion in lost 
productivity each year due to untreated alcoholism and $31 billion due 
to untreated depression.
   Enacting H.R. 1424 is important not only as a way to remove barriers 
to mental health and substance abuse care, however, but also as a way 
to remove the stigma long associated with these disorders. Equalizing 
care would send a strong message that the 57 million Americans 
suffering from mental health disorders and 26 million from chemical 
addiction should be treated no differently than individuals suffering 
from other medical conditions. I applaud the leadership and work of 
Representatives Kennedy and Ramstad for their tireless efforts to bring 
this important legislation forward, and I am proud to give them my 
strong support.
   In moving forward, it is my hope that the House and Senate can work 
together to find common ground so that mental health parity can be 
enacted. as part of this process, I would encourage negotiators to 
review the offsets used to pay for H.R. 1424, particularly the increase 
in the base Medicaid drug rebate level. I encourage Congress to 
consider the

[[Page H1306]]

effect this increase would have on small businesses that provide drugs 
and biologics to the Medicaid program, as well as possible 
disincentives this increase could create for companies to innovate and 
develop important new medicines. Although I am not opposed to raising 
the base rebate amount on principle, I am concerned that it may not be 
a prudent step to take without a thoughtful and complete review of its 
possible impacts.
   Ms. BALDWIN. Mr. Speaker, I rise in strong support of H.R. 1424, the 
Paul Wellstone Mental Health and Addiction Equity Act.
   All Americans deserve access to affordable, comprehensive health 
care--to meet both their physical and mental needs. I believe that 
Americans should be provided comprehensive coverage for mental health 
services. Mental illness and substance abuse are real and treatable 
health problems--just like hypertension, cancer and heart disease; yet 
millions of hardworking men and women still find that their health 
plans place strict limits on coverage for mental health benefits.
   I am proud to be an original cosponsor of H.R. 1424. This bill will 
finally provide for equity in coverage of mental health and substance-
related disorders.
   We know all too well the inequities that currently exist for those 
seeking mental health care and substance-related care. They are 
subjected to higher co-payments, higher deductibles, and more 
restrictive treatment limits.
   I have heard hundreds of heart-wrenching stories from my 
constituents in Wisconsin about the effects that these inequities have 
had on their families.
   One woman's story was especially poignant about the inequities of 
the current system. In the same year, both her husband and her daughter 
required major medical care because of life-threatening conditions. One 
had a disease of the kidneys, and one suffered from severe clinical 
depression. Both patients required emergency visits and extended 
treatment. Both patients were compliant and followed their doctor's 
treatment instructions. Both patients were covered under the same 
family policy.
   But the insurance paid for twice as much of the costs associated 
with the kidney disease than they did for the severe depression, 
because depression is a mental illness.
   And while her husband underwent multiple treatments for his kidney 
disease, her daughter was told after a few psychiatric visits that her 
insurance would not pay anything toward further visits because she had 
used up her allotted number of visits for the year.
   These higher patient costs and treatment limits are unconscionable. 
I am delighted that H.R. 1424 will require equity in financial 
commitments and equity in treatment limits for mental health and 
substance-related disorders as compared to medical and surgical 
benefits. In addition, it will prohibit discrimination by diagnosis and 
provide Americans with the same mental health coverage that Members of 
Congress have.
   Mr. Speaker, I urge my colleagues to join me in voting in favor of 
H.R. 1424.
  Mr. BUTTERFIELD. Mr. Speaker, I rise today in strong support of the 
H.R. 1424--Paul Wellstone Mental Health and Addiction Equity Act of 
2007. This legislation is a great step in ensuring that group health 
plans are discouraged from charging higher co-payments, coinsurance, 
deductibles, and imposing the maximum out-of-pocket limits on mental 
health and addiction care than those imposed for medical and surgical 
benefits.
  Although I fully support the intent of this measure, Mr. Speaker, I 
have slight reservation over one of the offsets used to pay for the 
legislation, specifically the large increase in the Medical 
prescription drug rebate.
  Innovative drug companies already provide deep discounts to Federal 
and state governments for prescription drugs covered by the Medicaid 
program. H.R. 1424 calls for a 33 percent increase in the rebate that 
brand pharmaceutical companies pay to the Medicaid program at a time 
when many drug companies are facing big financial challenges.
  As a member of the North Carolina delegation, I realize the economic 
impact that this innovative industry has on my State, employing over 
25,000 North Carolinians with many coming from my congressional 
district. I also understand the threat that this rebate poses to 
research, development, and access to drugs for the Medicaid 
beneficiaries of my poverty stricken district. We need these companies 
to continue investing in the United States, creating good jobs, and 
developing the new drugs our patients need.
  Mr. Speaker, it is my hope that the House will come together and 
support this progressive piece of legislation. I am pleased that we did 
not give up on this bill and have moved forward despite the President's 
veto of the Children's Health and Medicare Protection Act of 2007. 
Further, I would also like to encourage my colleagues who will be 
engaged in the conference negotiations to bring to us a final product 
that will not deter innovation of new treatments for the diseases and 
ailments that affect American families.
  Mr. SESSIONS. Mr. Speaker, today on the floor of the House of 
Representatives we are considering the issue of mental health parity. 
Unfortunately, some of my colleagues have clouded this important issue 
with extensive and over-burdensome regulations. As a supporter of 
mental health parity it is regrettable that I can not support the bill 
at hand. With over 50 million adults suffering from mental disorders it 
is necessary that there is access to mental health services. The Senate 
has passed legislation on parity that will allow access to these needed 
services, and I applaud and support their efforts.
  As a long time supporter of the Genetic Information Non-
Discrimination Act, it is disappointing that this legislation was 
coupled in with the over regulated mental health parity bill. Congress 
has taken great strides over the last few years towards adequately 
protecting an individual's genetic information an encouraging 
lifesaving genetic testing. Attaching this legislation to the flawed 
parity bill puts those efforts to shame. Congress should take up the 
Genetic Information Nondiscrimination Act on its own and allow those, 
like myself, to vote in favor of the bill.
  Mrs. BEAN. Mr. Speaker, I rise in support of H.R. 1424, the Paul 
Wellstone Mental Health and Addiction Equity Act. The passage of this 
bill is an important step for those suffering from mental health and 
substance-related disorders in this country.
  I believe it should not be an uphill battle for the millions of 
Americans living with mental illness and addiction to receive quality 
care. Thanks to my colleagues, Mr. Kennedy and Mr. Ramstad, we are 
taking strides to achieve parity between mental and medical conditions.
  While I support achieving mental health parity, I am concerned about 
using the Medicaid prescription drug rebate as an offset to pay for 
this legislation.
  Innovator drug companies already pay significant rebates to Federal 
and state governments for their prescription drugs to be covered by the 
Medicaid program. As a result of this ``best price'' policy, Medicaid 
programs already obtain drugs at a below-market price. I am concerned 
that further increasing this rebate will have a chilling effect on 
pharmaceutical research and development for the next generation of 
treatments, including those that aid the patients with mental health 
conditions we are helping today.
  As the economy weakens and our manufacturers are courted with large 
subsidies to move their operations and jobs overseas, we must not 
stifle innovation. We need our pharmaceutical companies to continue 
investing in the United States, creating good jobs, and inventing new 
drugs our patients need.
  I urge the passage of H.R. 1424. However, as this bill advances to 
conference, I hope the final product that returns to the House will not 
contain an increased Medicaid rebate, or any other provision that will 
deter the innovation of new treatments for the diseases that affect 
American families.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, as a psychiatric 
nurse with 15 years of hands-on patient care experience, I strongly 
support mental health parity. All health insurers should provide 
coverage for mental and behavioral care.
  An overwhelming body of evidence links mental- and emotional well-
being to physical well-being. Simply put, the two go hand-in-hand.
  For too long, too many health insurance companies have cut corners, 
when it comes to providing mental health benefits. Left to the ``free 
market system,'' many insurers have opted not to cover mental health 
care, claiming that it is not medically necessary, or simply ignoring 
the issue and forcing patients to absorb the costs.
  For too long, patients have suffered unfair expenses or delayed 
getting care, and the economic impact to our society has been large. 
Suicides, missed work due to depression, and other mental health issues 
have been the result of private industry's refusal to offer mental 
health benefits.
  It is time that we put this harmful practice to a stop. I want to 
commend Representatives Patrick Kennedy, Jim Ramstad, and Senators Ted 
Kennedy and Pete Domenici for their tireless work to develop this 
legislation.
  While I strongly support mental health parity, I believe that the 
Senate bill has been better tested by the stakeholder and business 
communities. The House version contains a provision, intended to help 
pay for the mental health benefit, that would result in reduced 
spending for physician-owned hospitals.
  Baylor cardiovascular hospital, in my district in Dallas, would be 
affected by the provision. In order to collect future Medicaid 
reimbursements, the hospital would need to reduce its percentage of 
physician ownership; and growth of the hospital could be severely 
restricted.
  It is my belief that Dallas residents are best served with as many 
options of affordable

[[Page H1307]]

health care as possible--including mental health care. I hope that the 
House and Senate can resolve differences in the final legislation that 
will not harm local hospitals, yet pay for the benefits without 
increasing the Federal deficit.
  For me, the bottom line is this: mental health parity should have 
existed from the onset of our modern health insurance system. Mental 
wellness is just as important as physical wellness. The two are the 
foundation for a life of wholeness and satisfaction.
  Again, I thank my colleagues, stakeholder groups, and members of the 
Other Body for their hard work on such a critical issue.
  Mr. TANNER. Mr. Speaker, I rise today to express my concern with one 
of the proposals being used to fund this legislation. I agree that 
improving coverage of mental health services is a laudable goal, and 
long over due, I might add. However, the proposal to help fund this 
increased coverage through increasing the Medicaid drug rebate is 
troubling to me. Drug companies already provide deep discounts to 
Federal and State governments for the prescription drugs covered by the 
Medicaid program. This legislation calls for a 33 percent increase in 
that rebate. I hope that a substantial increase in the rebate will not 
have a chilling effect on research and development for the next 
generation of treatments for those very patients with mental health 
conditions we are trying to help today.
  As everyone knows, I am a strong supporter of pay go provisions. So I 
want to commend our leadership for their efforts to continue to address 
these funding issues. The other funding provision being used for the 
improved coverage in this bill is designed to ensure that any potential 
conflict of interest created by physician ownership interests in 
specialty hospitals is limited. I think this provision goes a long way 
toward creating a more equitable situation for all hospitals.
  I plan to support final passage of this legislation. However, I hope 
that we can work together as this process goes forward to negotiate a 
conference agreement that offers a more balanced approach.
  Mr. DINGELL. Mr. Speaker, today we are voting on the passage of H.R. 
1424, the ``Paul Wellstone Mental Health and Addiction Equity Act of 
2007'', which will permanently reauthorize and improve the Mental 
Health Parity Act of 1996. I commend my distinguished colleagues, 
Representatives Kennedy and Ramstad, for their efforts in crafting this 
important piece of legislation.
  H.R. 1424 will create true parity of coverage for mental health and 
substance abuse disorders. It will ensure that healthcare plans that 
provide mental health coverage do not charge higher co-payments, 
coinsurance, or deductibles for mental health or substance abuse care. 
It will also ensure that care for mental health and addiction disorders 
is no more restrictive than medical or surgical care.
  Mental illness and addiction disorders have long been recognized by 
the healthcare community as actual and legitimate health afflictions 
which may have a significant affect on an individual's life and well-
being. It has long been accepted that these afflictions deserve 
treatment by professionally trained healthcare providers.
  As I think of all of the different diseases and afflictions 
recognized by our scientific and healthcare communities, I struggle to 
find a reason why someone who has healthcare coverage should confront 
discriminatory barriers to treatment simply because of the nature of 
the disease. Mental health and addiction disorders can be just as 
painful and debilitating as medical and surgical disorders. The strains 
of these illnesses affect individuals, families, and society as a 
whole.
  I urge my colleagues to vote to pass H.R. 1424 to achieve 
comprehensive mental health and substance abuse parity.
  Mrs. JONES of Ohio. Mr. Speaker, today I rise in support of H.R. 
1424, the Paul Wellstone Mental Health and Addiction Equity Act of 
2007. I am honored to support one of the many noble causes of the late 
Senator Paul Wellstone and strongly believe that this bill will address 
and improve our Nation's need for enhanced mental health services.
  The plight of families suffering from mental illness is immense due 
to an absence of adequate social services and the unwarranted stigma 
surrounding mental health issues. Due to the unwarranted social stigma 
and a systemic failure to ensure health care coverage, over two-thirds 
of the people who suffer from mental illness go untreated according to 
the Department of Health and Human Services. Within minority 
communities, even greater needs exist for mental health services.
  According to the National Institute on Mental Health, 20 percent of 
our children and 26.2 percent of American adults suffer from a 
diagnosable mental disorder in a given year. As the leading cause of 
disability in the U.S., many people suffer from more than one mental 
disorder at a given time. Thus, the need for mental health services is 
immense, and we cannot allow discriminatory practices by insurance 
companies to be an impediment to accessing available services.
  Last year, I introduced H. Con. Res. 86 to express the sense of 
Congress that an appropriate month should be recognized as Bebe Moore 
Campbell National Minority Mental Health Awareness Month. Bebe Moore 
Campbell was a premier journalist who, before her untimely death, 
authored a children's book titled, Sometimes My Mommy Gets Angry, 
winner of the National Alliance for the Mentally Ill Outstanding 
Literature Award. Through this story of how a little girl copes with 
being reared by her mentally ill mother, Moore Campbell was able to 
raise public awareness of mental health issues and heighten the 
consciousness of this topic within minority communities.
  In conclusion, I would like to affirm my support for H.R. 1424. This 
legislation is necessary to assist families who are struggling through 
the effects of mental illness and will contribute greatly to our 
Nation's overall wellness.
  Mr. MORAN of Virginia. Mr. Speaker, I rise today in strong support of 
H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act. I 
want to congratulate Congressmen Kennedy and Ramstad for their 
excellent work on this bill. Their effort to secure parity for all 
Americans suffering from mental heath conditions has truly been an 
historic one, and I am proud to stand here today and support the 
House's comprehensive mental health parity bill.
  Mental health conditions are the leading cause of disability for 
Americans aged 15-44, and are implicated in 90 percent of the more than 
30,000 suicides that occur here annually. Productivity loss due to 
depression costs employers an additional $31 billion per year before 
disability claims are even taken into account. Every day, patients 
suffering from these debilitating conditions are denied treatment by 
insurers who do not provide mental health coverage--patients who could 
be treated safely and effectively thanks to new advances in medicine.
  Mental illness is, according to nearly all medical experts, a 
biologically-based illness just like getting cancer, or diabetes, or 
the flu. But in addition to the horrendous costs that untreated and 
unchecked mental illness imposes on patients and society as a whole, 
failure to provide parity in coverage for mental illness stigmatizes 
patients suffering from mental health conditions and decreases the 
likelihood that they will seek treatment that could aid their suffering 
and enable them to be more productive members of society. This unjust 
stigmatization has no biological or medical basis, and yet it threatens 
promising American lives every day. We do not blame cancer patients for 
having cancer--why should we treat patients suffering from mental 
health conditions any differently?
  H.R. 1424 is a comprehensive mental health parity bill that will 
ensure access to vitally needed treatment for countless Americans 
currently suffering from mental health conditions. Again, I applaud my 
good friends on their efforts on this bill, and I am proud to support 
this historic legislation here today.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired. Pursuant to 
House Resolution 1014, the previous question is ordered.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


               Motion to Recommit Offered by Mr. Hoekstra

  Mr. HOEKSTRA. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. HOEKSTRA. Yes, in its present form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  Mr. PALLONE. Mr. Speaker, I reserve a point of order.
  The SPEAKER pro tempore. A point of order is reserved.
  The Clerk will report the motion to recommit.
  The Clerk read as follows:

       Mr. Hoekstra of Michigan moves to recommit the bill, H.R. 
     1424, to the Committee on Energy and Commerce with 
     instructions to report the same back to the House forthwith 
     with the following amendment:
       Strike all after the enacting clause and insert the text of 
     the bill H.R. 3773 as passed by the Senate on February 12, 
     2008.

  The SPEAKER pro tempore. Does the gentleman from New Jersey continue 
to reserve his point of order?
  Mr. PALLONE. Yes, I continue to reserve my point of order.
  The SPEAKER pro tempore. The gentleman from Michigan is recognized 
for 5 minutes to speak in support of his motion.

[[Page H1308]]

  Mr. HOEKSTRA. Mr. Speaker, this bill is intended to ensure the mental 
health of Americans; yet, no American's health can be fully secured if 
they are under attack by a terrorist or facing the potential threat of 
terrorist attack.
  It has now been 18 days since the Protect America Act expired, taking 
with it the full array of enhanced tools for the intelligence community 
to aggressively investigate potential attacks and detect and prevent 
potential terrorist attacks. This motion to recommit would ensure the 
health of Americans by inserting the text of the Senate bill to 
modernize FISA.
  Eighteen days is long enough; yet, the leadership of the House still 
has done nothing to appoint conferees on the Senate bill to modernize 
FISA.
  The SPEAKER pro tempore. The gentleman will suspend.
  Mr. PALLONE. Mr. Speaker, I insist on my point of order. The 
gentleman is not confining his remarks to the point of order.
  The SPEAKER pro tempore. The point of order was reserved and the 
gentleman from Michigan was recognized on his motion to recommit.
  Mr. HOEKSTRA. Thank you, Mr. Speaker. May I continue?
  The SPEAKER pro tempore. The gentleman from Michigan may continue.
  Mr. HOEKSTRA. As I said, as we deal with this bill, 18 days is a long 
time, yet the leadership of this House still has done nothing to 
appoint conferees on the Senate bill to modernize the Foreign 
Intelligence Surveillance Act, which passed the Senate with 
overwhelming bipartisan support and is supported by a majority of the 
House. The Democratic leadership continues to block this bill, even 
though a number of responsible Democrats support it and the bill will 
pass if brought to the floor.
  It was 18 days ago, it was 3 weeks ago that it was brought to the 
floor to have a 3-week extension, on top of a 2-week extension, on top 
of a 6-month extension. It is time to move this bill forward and to 
again give our intelligence community the tools that they need, the 
enhanced tools that many recognized after 9/11 that the intelligence 
community needed to keep America safe. It is time to bring up the 
Senate-passed FISA bill.
  In the 18 days since the expiration of the Protect America Act, we 
have already seen multiple examples where our country's ability to 
follow up on potential threats has been significantly impaired.
  In Tampa, the Transportation Security Administration stopped a man 
trying to board a plane with a box cutter in his backpack. Officers 
also found books in the backpack titled ``Muhammad in the Bible,'' 
``The Prophet's Prayer,'' and ``The Noble Qur'an.'' There may be 
instances in that situation where there may be intelligence clues that 
we would want to follow up. We want to know whether there are any 
connections to foreign terrorists and whether at that very moment there 
may be other people in other airports trying to board planes with box 
cutters.
  We don't want our intelligence officials to have to wait for lawyers 
to fill out voluminous paperwork in order to obtain permission from a 
Federal judge to follow up on those leads. Precious time could have 
been lost while an attack was in progress.
  Last Friday, authorities found toxic ricin, or perhaps toxic ricin, 
in a hotel room in Las Vegas. Absent any evidence in the hotel room to 
prove probable cause that the ricin was tied to international 
terrorists, it may have been impossible for the intelligence community 
to follow up on any evidence that may have pointed to a suspected tie 
with foreign terrorists.
  These are the things that happen in the United States. When you take 
a look at other things that are happening around the world, our troops 
in harm's way in both Iraq and Afghanistan, our brave men and women who 
are serving in the embassies in the Foreign Service around the world 
today, it is important that our intelligence community be given the 
tools and the techniques to keep Americans, our servicemen, our 
embassies, and our foreign personnel safe.
  It has now been 18 days. The majority promised us that they could 
deal with this issue, first they said in 6 months, then they said in 2 
weeks, then they said in 3 weeks. It has clearly been much more time 
than that, and every day that we delay, we lose a little bit of our 
capability to track the threats that face this country.
  The chairman of the Senate Intelligence Committee has said the same 
thing. The Director of National Intelligence has said the same thing. 
So now for 18 days our capabilities have slowly been eroding, but each 
day piles on to the loss that we had from the day before.
  There are real threats out there. There are real threats to 
Americans, to our troops, and to other individuals serving overseas. It 
is time to make sure that our intelligence community has all of the 
tools that it needs to keep America safe. We need to join with the 
Senate. We need to join with the 68 in the other body who 
overwhelmingly passed a bipartisan FISA modernization bill that gives 
the intelligence community the tools that they need to keep America 
safe.
  I call on my colleagues and the leadership on the other side of the 
aisle to support this motion to recommit, to send a clear signal, and 
then to move forward on an overall bill. Because if this passes today, 
what it will do is send a clear signal.


                             point of order

  Mr. PALLONE. Mr. Speaker, I insist on my point of order.
  I raise a point of order that the motion to recommit contains 
nongermane instructions in violation of clause 7 of Rule XVI. The 
instructions in the motion to recommit address an unrelated matter 
within the jurisdiction of a committee not represented in the 
underlying bill.
  The SPEAKER pro tempore. Does any other Member wish to be heard on 
the point of order?


                        parliamentary inquiries

  Mr. HOEKSTRA. Yes, I do.
  Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state it.
  Mr. HOEKSTRA. Under the rule, the text of H.R. 493, as passed by the 
House, is added at the end of this bill. H.R. 493 deals with genetic 
information discrimination. The title of the bill is ``genetic 
information'' and not mental health.
  Mr. Speaker, how is it that a genetic information discrimination bill 
can be added to a mental health bill but the FISA bill to protect us 
from terrorist attack cannot?
  The SPEAKER pro tempore. That additional text will be added by 
operation of House Resolution 1014 upon passage of the bill.
  Mr. HOEKSTRA. Mr. Speaker, further parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his inquiry.
  Mr. HOEKSTRA. If I understand the Speaker and if you have just 
answered my question correctly, the majority has the tools at its 
disposal to include the FISA bill in any legislation that passes the 
House but is refusing to do so?
  The SPEAKER pro tempore. That is not an appropriate parliamentary 
inquiry.
  Does any Member wish to speak further on the point of order? If not, 
the Chair is prepared to rule.
  The Chair will rely on the precedents of February 26 and February 27, 
2008. The instructions in the motion to recommit address foreign 
intelligence surveillance, a matter unrelated to issues of health and 
mental health and within the jurisdiction of committees not represented 
in the underlying bill. The instructions are therefore not germane and 
the point of order is sustained. The motion is not in order.
  Mr. HOEKSTRA. Mr. Speaker, I appeal the ruling of the Chair.
  The SPEAKER pro tempore. The question is, Shall the decision of the 
Chair stand as the judgment of the House?


                 Motion to Table Offered by Mr. Pallone

  Mr. PALLONE. Mr. Speaker, I move to table the appeal.
  The SPEAKER pro tempore. The question is on the motion to table.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. HOEKSTRA. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.

[[Page H1309]]

  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 223, 
nays 186, answered ``present'' 1, not voting 18, as follows:

                             [Roll No. 99]

                               YEAS--223

     Abercrombie
     Ackerman
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Castor
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis, Lincoln
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Frank (MA)
     Giffords
     Gilchrest
     Gillibrand
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth Sandlin
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     Klein (FL)
     Kucinich
     LaHood
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Perlmutter
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Ramstad
     Reyes
     Richardson
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Sherman
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Tsongas
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (OH)
     Wu
     Yarmuth

                               NAYS--186

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Bonner
     Bono Mack
     Boozman
     Boustany
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Buchanan
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Cubin
     Culberson
     Davis (KY)
     Davis, David
     Davis, Tom
     Deal (GA)
     Dent
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Duncan
     Ehlers
     Emerson
     English (PA)
     Everett
     Fallin
     Feeney
     Ferguson
     Flake
     Forbes
     Fortenberry
     Fossella
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Graves
     Hall (TX)
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hulshof
     Hunter
     Inglis (SC)
     Issa
     Johnson, Sam
     Jones (NC)
     Jordan
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     Lamborn
     Lampson
     Latham
     LaTourette
     Latta
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McHugh
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Moran (KS)
     Murphy, Tim
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Radanovich
     Regula
     Rehberg
     Reichert
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Roskam
     Royce
     Ryan (WI)
     Sali
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shays
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Tancredo
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walberg
     Walden (OR)
     Walsh (NY)
     Wamp
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield (KY)
     Wilson (NM)
     Wilson (SC)
     Wittman (VA)
     Wolf
     Young (AK)
     Young (FL)

                        ANSWERED ``PRESENT''--1

       
     Johnson (IL)
       

                             NOT VOTING--18

     Blunt
     Boehner
     Brown-Waite, Ginny
     Conyers
     Cuellar
     DeFazio
     Diaz-Balart, L.
     Gerlach
     Gonzalez
     Johnson, E. B.
     Keller
     Poe
     Rangel
     Renzi
     Rush
     Saxton
     Woolsey
     Wynn


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). Members are advised 2 
minutes remain in the vote.

                              {time}  1922

  Messrs. JORDAN of Ohio, HALL of Texas, McCOTTER, and PLATTS changed 
their vote from ``yea'' to ``nay.''
  Mr. LYNCH changed his vote from ``nay'' to ``yea.''
  So the motion to table was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________