Congressional Record, Volume 154 Issue 37 (Wednesday, March 5, 2008)

[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.

[[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:

[[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:

(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.

[[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.''.

[[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:

(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--

``(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:

(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--

``(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.

____________________