[Congressional Record (Bound Edition), Volume 148 (2002), Part 1]
[Senate]
[Pages 729-730]
[From the U.S. Government Publishing Office, www.gpo.gov]




                             MENTAL HEALTH

  Mr. DURBIN. Madam President, I submit for the Record an article that 
ran in The Washington Post yesterday about the discrimination that 
individuals with a history of mental illness face in our current health 
insurance market. The story documents the dilemma of Michelle Witte who 
was denied health insurance coverage because she was successfully 
treated for depression during her adolescence. In fact, more than 50 
million Americans each year suffer from mental illness. About 19 
percent of the Nation's adults and 21 percent of the youths aged 9 to 
17 have a mental disorder at some time during a one-year period.
  Last Congress I introduced legislation to address the barriers faced 
by Michelle Witte and thousands like her who have been treated for a 
mental condition. I plan to reintroduce this legislation this spring, 
and I urge my colleagues to join me in this effort.
  The Mental Health Patients' Rights Act limits the ability of health 
plans to redline individuals with a preexisting mental health 
condition. I undertook this initiative when I learned that some of my 
constituents were being turned away from health plans in the private 
non-group market due solely to a past history of treatment for mental 
conditions. Unfortunately, under the current system of care in the 
United States, individuals who are undergoing treatment or have a 
history of treatment for mental illness may find it difficult to obtain 
private health insurance, especially if they must purchase it on their 
own and do not have an employer-sponsored group plan available to them. 
In part this is because while the Health Insurance Portability and 
Accountability Act, HIPAA, protects millions of Americans in the group 
health insurance market, it affords few protections for individuals who 
apply for private non-group insurance. While the majority of Americans 
under age 65 have employer-sponsored group coverage, a significant 
minority, approximately 12.6 million individuals, rely on private, 
individual health insurance.
  The Mental Health Patients' Rights Act closes this loophole by 
limiting any preexisting condition exclusion relating to a mental 
health condition to not more than 12 months and reducing this exclusion 
period by the total amount of previous continuous coverage. It 
prohibits any health insurer that offers health coverage in the 
individual insurance market from imposing a preexisting condition 
exclusion relating to a mental health condition unless a diagnosis, 
medical advice or treatment was recommended or received within the 6 
months prior to the enrollment date. And it prohibits health plans in 
the individual market from charging higher premiums to individuals 
based solely on the determination that the individual has had a 
preexisting mental health condition. These provisions apply to all 
health plans in the individual market, regardless of whether a state 
has enacted an alternative mechanism, such as a risk pool, to cover 
individuals with preexisting health conditions.
  The Mental Health Patients' Rights Act complements ongoing efforts to 
enhance parity between mental health services and other health 
benefits. This is because parity alone will not help individuals who do 
not have access to any affordable health insurance due to preexisting 
mental illness discrimination. The Patients' Rights Act does not 
mandate that insurers provide mental health services if they are not 
already offering such coverage. It simply prohibits plans in the 
private non-group market from redlining individuals who apply for 
general health insurance based solely on a past history of treatment 
for a mental condition.
  I have also asked the General Accounting Office to examine the types 
of mental health conditions for which individual health insurers 
typically underwrite; the degree to which there is an actuarial basis 
for these carrier practices; the prevalence of medical underwriting for 
mental health conditions that results in denying coverage or raising 
premiums; and the extent of state laws that prevent or constrain 
insurers from denying coverage or raising premiums due to a history of 
mental health conditions, including consumer protections such as 
appeals procedures and access to information. This report is due out 
next month.
  It simply does not make sense that a person is rendered uninsurable 
for all health needs simply because he or she seeks treatment for 
mental illness. I invite my colleagues to enlist in this important 
initiative to ensure that such individuals are not discriminated 
against when applying for health insurance coverage.
  I ask unanimous consent that the article be printed in the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                [From the Washington Post, Feb. 5, 2002]

               Second Opinion: The Perils of Doing Right

                         (By Abigail Trafford)

       Michelle Witte did everything right. She graduated from the 
     University of Maryland last June with a degree in English. 
     She got a job she loves with a Washington communications firm 
     that is too small to qualify for a group health plan. But her 
     employer will pay for an an individual policy, so she applied 
     to CareFirst BlueCross BlueShield. In answer to questions on 
     the form, she stated that she has chronic asthma and had been 
     prescribed antidepressant medication for a short period when 
     she was in high school.
       The health plan rejected her.
       ``Upon review of the Individual Health Evaluation 
     Questionnaire, you have documented that you have been or are 
     currently being treated for depressive disorder,'' stated the 
     letter from the health plan. ``Based upon our medical 
     underwriting criteria, we are unable to approve this coverage 
     for you.''
       ``I just think it's shocking,'' said Witte, 23. CareFirst 
     has refused to comment on the case. But in its official reply 
     to her application, the plan expressed no concern over her 
     ongoing problem of asthma. It was one episode of successfully 
     treated depression in adolescence that turned Witte into a 
     health plan pariah. ``It didn't occur to me that it could be 
     such a liability,'' she said.
       This is how discrimination works against people with mental 
     diseases. For all the rhetoric about removing the stigma of 
     mental illness and treating disorders of the brain

[[Page 730]]

     the same way as disorders of the body, the bias persists. A 
     physical disease like asthma is okay; a mental disorder like 
     depression is not.
       If anything, Witte ought to be a prized health plan client. 
     She has demonstrated that she knows how to take care of 
     herself. Six years ago, when she was in high school, she 
     developed anorexia, an eating disorder. Her parents promptly 
     took her to a psychiatrist at Children's National Medical 
     Center who diagnosed depression and prescribed a six-month 
     course of the antidepressant Zoloft. Witte responded well. 
     She overcame her eating problems. She has had no problems 
     with depression since that time.
       How many teenage girls try to keep their destructive eating 
     habits secret? How many go for years without proper 
     treatment? They can end up needing hospitalization and may 
     suffer long-term complications. In the end, that is much more 
     expensive to a health plan than covering outpatient 
     psychotherapy and medications for six months.
       In short, Witte and her parents--her father works for the 
     federal government, her mother for a health maintenance 
     organization--did everything right in getting prompt 
     treatment. ``It was a success story,'' said Witte. ``I'm a 
     proponent of drugs when they're used properly. They can 
     really help.''
       Why should she be penalized for being a success story?
       It's legal for health insurers to consider a person's 
     health status when they offer individual policies. Otherwise 
     some people might not buy insurance until they were diagnosed 
     with a major medical problem and needed coverage to get care.
       But this is obviously not the case with Witte, a healthy 
     young woman who runs regularly and likes to take day-long 
     hikes. As a health insurance reject, she is eligible for 
     programs designed for high-risk individuals, but the costs of 
     coverage are generally higher and the benefits more limited 
     compared to a regular plan. That's a steep price to pay for 
     having had a six-month prescription for Zoloft.
       In many parts of the country, the infrastructure of mental 
     health services is unraveling. Headlines have rightly focused 
     on the collapse of public programs for people who need 
     government-funded treatment.
       But a much larger population with mental disorders remains 
     in the private sector. They are holding jobs and raising 
     families. They rely on private insurance and private 
     therapists for treatment. Support for them is eroding, too, 
     as insurance agencies stint on payment for mental health 
     services, managed care plans place limits on benefits, and 
     the burden of co-payments and other out-of-pocket expenses 
     continues to increase.
       Even people with good jobs and supposedly good health 
     coverage are hurting. One man who works for the federal 
     government has been treated for major depression since his 
     first episode at age 38. He has seen the same psychiatrist, 
     who monitors his medications and provides psychotherapy, 
     every week for 15 years.
       This year his insurance plan has eliminated the more 
     generous high-option policy that covered 50 visits to the 
     doctor. His current plan, with a premium that is a few 
     dollars cheaper every month, covers only 25 sessions. His 
     psychiatrist charges $165 an hour; the plan now covers about 
     half the hourly fee, and only half the time. Bottom line: His 
     doctor bills come to $8,250 a year. His plan pays $1,800; he 
     pays the rest.
       ``It's not fair,'' he said, ``it has to cost us so much 
     money when there's supposed to be parity'' in coverage of 
     mental and physical illnesses. ``Parity keeps slipping 
     away.''
       The president last week came out in favor of patients' 
     rights. That ought to include the millions of Americans with 
     mental illness.

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