[Congressional Record (Bound Edition), Volume 145 (1999), Part 12]
[Extensions of Remarks]
[Page 17588]
[From the U.S. Government Publishing Office, www.gpo.gov]



               NATIONAL MENTAL HEALTH PARITY ACT OF 1999

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, July 22, 1999

  Mr. STARK. Mr. Speaker, I am proud to join with my colleagues to 
introduce the National Mental Health Parity Act of 1999. The goal of 
this legislation is to provide parity in insurance coverage of mental 
illness and improve mental health services available to Medicare 
beneficiaries. This legislation will end the systematic discrimination 
against those with mental illness and reflect the many improvements in 
mental health treatment.
  My legislation would prohibit health plans from imposing treatment 
limitations or financial requirements on coverage of mental illness, if 
they do not have similar limitations or requirements for the coverage 
of other health conditions. The bill also expands Medicare mental 
health and substance abuse benefits to include a wider array of 
settings in which services may be delivered. Specifically, the 
legislation would eliminate the current bias in the law toward 
delivering services in general hospitals by allowing patients to 
receive treatment in a variety of residential and community-based 
settings. This transition saves money for the simple reason that 
community-based services are far less expensive than hospital services. 
In addition, community-based providers can better meet the patient's 
personal needs.
  Providing access to mental health treatment offers many benefits 
because of the significant social costs resulting from mental health 
and substance abuse disorders. Treatable mental and addictive disorders 
exact enormous social and economic costs, individual suffering, breakup 
of families, suicide, crime, violence, homelessness, impaired 
performance at work and partial or total disability. Recent estimates 
indicate that mental and addictive disorders cost the economy well over 
$300 billion annually. This includes productivity losses of $150 
billion, health care costs of $70 billion and other costs (e.g. 
criminal justice) of $80 billion.
  Two to three percent of the population experience severe mental 
illness disorders. As many as 25 percent suffer from milder forms of 
mental illness, and approximately one out of ten Americans suffers from 
alcohol abuse. One out of thirty Americans suffer from drug abuse.
  Alcohol and drug dependence is not the result of a weak will or a 
poor character. In many cases, the dependence results from chemical 
abnormalities in the person's brain that makes them prone to 
dependence. In other cases, the dependence represents a reaction to 
unhealthy social and environmental conditions that perpetuate abuse of 
alcohol and drugs. Regardless of the cause of the abuse, alcohol and 
drug abuse can be treated and allow the person to live a normal and 
productive life.
  Mental health disorders are like other health disorders. With 
appropriate treatment, some mental health problems can be resolved. 
Other mental health conditions, like physical health conditions can 
persist for decades. Indeed, there are those who battle mental illness 
their entire life just as there are those who suffer from diabetes, 
congenital birth defects, or long-term conditions like multiple 
sclerosis. Whereas insurance policies cover the chronic health 
problems, they do not offer the same support for mental health 
conditions.

  During the last 104th Congressional session, parity in the treatment 
of mental illness was a widely and hotly debated issue. Although parity 
legislation was finally developed, insurance carriers found gaping 
loopholes and created mental health insurance policies that provide 
less access to mental health services. Furthermore, the current parity 
legislation includes many exemptions in coverage requirements for small 
employers. if an employer has at least 2 but not more than 50 
employees, they can be exempt from the coverage requirement. Finally, 
if a group health plan experiences an increase in costs of at least 1 
percent, they can be exempted in subsequent years. We can and must do 
more for our constituents.
  My proposed legislation addresses two fundamental problems in both 
public and private health care coverage of mental illness. First, 
despite the prevalence and cost of untreated mental illness, we still 
lack full parity for treatment. The availability of treatment, as well 
as the limits imposed, are linked to coverage for all medical and 
surgical benefits. Whatever limitations exist for those benefits will 
also apply to mental health benefits.
  Let us not forget the small employers either. If a company qualifies 
for the small employer exemption, the insurance companies will be able 
to set different, lower limits on the scope and duration of care for 
mental illness compared to other illnesses. This means that people 
suffering from depression may get less care and coverage than those 
suffering a heart attack. This disparity is indefensible.
  Access to equitable mental health treatment is essential and can be 
offered at a reasonable price. Recent estimates indicate that true 
parity for mental health services will increase insurance rates by a 
mere one percent, a trivial price to pay for the well being of all 
Americans.
  Second, the diagnoses and treatment of mental illness and substance 
abuse has changed dramatically since the start of Medicare. Treatment 
options are no longer limited to large public psychiatric hospitals. 
The great majority of people receive treatment on an outpatient basis, 
recover quickly, and return to productive lives. Even those who once 
would have been banished to the back wards of large institutions can 
now live successfully in the community. Unfortunately, the current 
Medicare benefit package does not reflect the many changes that have 
occurred in mental health care. This bill would permit Medicare to pay 
for a number of intensive community-based services. These services are 
far less expensive than inpatient hospitalization.
  For those who cannot be treated while living in their own homes, this 
bill would make several residential treatment alternatives available. 
These alternatives include residential detoxification centers, crisis 
residential programs, therapeutic family or group treatment homes and 
residential centers for substance abuse. Clinicians will no longer be 
limited to sending their patients to inpatient hospitals. Treatment can 
be provided in the specialized setting best suited to addressing the 
person's specific problem.
  Currently there is a 190-day lifetime limit for psychiatric hospital 
treatment. This limit was originally established primarily in order to 
contain costs. in fact, CBO estimates that under modern treatment 
methods, only about 1.6% of Medicare enrollees hospitalized for mental 
disorders or substance abuse used more than 190 days of service over a 
five year period.
  Under the provisions of this bill, beneficiaries who need inpatient 
hospitalization would be admitted to the type of hospital that can best 
provide treatment for his or her needs.
  Inpatient hospitalization would be covered for up to 60 days per 
year. The average length of hospital stay for mental illness in 1995 
for all populations was 11.5 days. Adolescents averaged 12.2 days; 14.6 
for children; 16.6 days for older adolescents; 8.6 days for the aged 
and disabled; 9.9 days for adults. A stay of 30 days or fewer is found 
in 93.5% of the cases. The 60-day limit, therefore, would adequately 
cover inpatient hospitalization for the vast majority of Medicare 
beneficiaries, while still providing some modest cost containment. 
Restructuring the benefit in this manner will level the playing field 
for psychiatric and general hospitals.
  In summary, my legislation is an important step toward providing 
comprehensive coverage for mental health. Further leveling the health 
care coverage playing field to include mental illness and timely 
treatment in appropriate settings will lessen health care costs in the 
long run. These provisions will also lessen the social costs of crime, 
welfare, and lost productivity to society. This bill will assure that 
the mental health needs of all Americans are no longer ignored. I urge 
my colleagues to join me in support of this bill.

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