[Congressional Record (Bound Edition), Volume 154 (2008), Part 15]
[House]
[Pages 20223-20236]
[From the U.S. Government Publishing Office, www.gpo.gov]




  PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION 
                           EQUITY ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 6983) 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 for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6983

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Paul Wellstone and Pete 
     Domenici Mental Health Parity and Addiction Equity Act of 
     2008''.

     SEC. 2. MENTAL HEALTH PARITY.

       (a) Amendments to ERISA.--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:
       ``(3) Financial requirements and treatment limitations.--
       ``(A) In general.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides both medical and surgical benefits and 
     mental health or substance use disorder benefits, such plan 
     or coverage shall ensure that--
       ``(i) the financial requirements applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant financial requirements 
     applied to substantially all medical and surgical benefits 
     covered by the plan (or coverage), and there are no separate 
     cost sharing requirements that are applicable only with 
     respect to mental health or substance use disorder benefits; 
     and
       ``(ii) the treatment limitations applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant treatment limitations 
     applied to substantially all medical and surgical benefits 
     covered by the plan (or coverage) and there are no separate 
     treatment limitations that are applicable only with respect 
     to mental health or substance use disorder benefits.
       ``(B) Definitions.--In this paragraph:
       ``(i) Financial requirement.--The term `financial 
     requirement' includes deductibles, copayments, coinsurance, 
     and out-of-pocket expenses, but excludes an aggregate 
     lifetime limit and an annual limit subject to paragraphs (1) 
     and (2).
       ``(ii) Predominant.--A financial requirement or treatment 
     limit is considered to be predominant if it is the most 
     common or frequent of such type of limit or requirement.
       ``(iii) Treatment limitation.--The term `treatment 
     limitation' includes limits on the frequency of treatment, 
     number of visits, days of coverage, or other similar limits 
     on the scope or duration of treatment.
       ``(4) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health or substance use 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 or substance use 
     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.
       ``(5) Out-of-network providers.--In the case of a plan or 
     coverage that provides both medical and surgical benefits and 
     mental health or substance use disorder benefits, if the plan 
     or coverage provides coverage for medical or surgical 
     benefits provided by out-of-network providers, the plan or 
     coverage shall provide coverage for mental health or 
     substance use disorder benefits provided by out-of-network 
     providers in a manner that is consistent with the 
     requirements of this section.'';
       (2) in subsection (b), by amending paragraph (2) to read as 
     follows:
       ``(2) in the case of a group health plan (or health 
     insurance coverage offered in connection with such a plan) 
     that provides mental health or substance use disorder 
     benefits, as affecting the terms and conditions of the plan 
     or coverage relating to such benefits under the plan or 
     coverage, except as provided in subsection (a).'';
       (3) in subsection (c)--
       (A) in paragraph (1)(B)--
       (i) 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 
     that such appears; and
       (ii) by striking ``and who employs at least 2 employees on 
     the first day of the plan year''; and
       (B) by striking paragraph (2) and inserting the following:
       ``(2) 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

[[Page 20224]]

     year involved of the actual total costs of coverage with 
     respect to medical and surgical benefits and mental health 
     and substance use 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. An 
     employer may elect to continue to apply mental health and 
     substance use disorder parity pursuant to this section with 
     respect to the group health plan (or coverage) involved 
     regardless of any increase in total costs.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     subparagraph shall be--
       ``(i) 2 percent in the case of the first plan year in which 
     this section is applied; 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 section shall be made and certified by a 
     qualified and licensed actuary who is a member in good 
     standing of the American Academy of Actuaries. All such 
     determinations shall be in a written report prepared by the 
     actuary. The report, and all underlying documentation relied 
     upon by the actuary, shall be maintained by the group health 
     plan or health insurance issuer for a period of 6 years 
     following the notification made under subparagraph (E).
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     a group health 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.--
       ``(i) In general.--A group health plan (or a health 
     insurance issuer offering coverage in connection with a group 
     health plan) that, based upon a certification described under 
     subparagraph (C), qualifies for an exemption under this 
     paragraph, and elects to implement the exemption, shall 
     promptly notify the Secretary, the appropriate State 
     agencies, and participants and beneficiaries in the plan of 
     such election.
       ``(ii) Requirement.--A notification to the Secretary 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 use 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 use 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification to the Secretary 
     under clause (i) shall be confidential. The Secretary shall 
     make available, upon request 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 type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(F) Audits by appropriate agencies.--To determine 
     compliance with this paragraph, the Secretary may audit the 
     books and records of a group health plan or health insurance 
     issuer relating to an exemption, including any actuarial 
     reports prepared pursuant to subparagraph (C), during the 6-
     year period following the notification of such exemption 
     under subparagraph (E). A State agency receiving a 
     notification under subparagraph (E) may also conduct such an 
     audit with respect to an exemption covered by such 
     notification.'';
       (4) in subsection (e), by striking paragraph (4) and 
     inserting the following:
       ``(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 Federal and State law.
       ``(5) Substance use disorder benefits.--The term `substance 
     use disorder benefits' means benefits with respect to 
     services for substance use disorders, as defined under the 
     terms of the plan and in accordance with applicable Federal 
     and State law.'';
       (5) by striking subsection (f);
       (6) by inserting after subsection (e) the following:
       ``(f) Secretary Report.--The Secretary shall, by January 1, 
     2012, and every two years thereafter, submit to the 
     appropriate committees of Congress a report on compliance of 
     group health plans (and health insurance coverage offered in 
     connection with such plans) with the requirements of this 
     section. Such report shall include the results of any surveys 
     or audits on compliance of group health plans (and health 
     insurance coverage offered in connection with such plans) 
     with such requirements and an analysis of the reasons for any 
     failures to comply.
       ``(g) Notice and Assistance.--The Secretary, in cooperation 
     with the Secretaries of Health and Human Services and 
     Treasury, as appropriate, shall publish and widely 
     disseminate guidance and information for group health plans, 
     participants and beneficiaries, applicable State and local 
     regulatory bodies, and the National Association of Insurance 
     Commissioners concerning the requirements of this section and 
     shall provide assistance concerning such requirements and the 
     continued operation of applicable State law. Such guidance 
     and information shall inform participants and beneficiaries 
     of how they may obtain assistance under this section, 
     including, where appropriate, assistance from State consumer 
     and insurance agencies.'';
       (7) by striking ``mental health benefits'' and inserting 
     ``mental health and substance use disorder benefits'' each 
     place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
     (a)(2)(B)(i), and (a)(2)(C); and
       (8) by striking ``mental health benefits'' and inserting 
     ``mental health or substance use disorder benefits'' each 
     place it appears (other than in any provision amended by the 
     previous paragraph).
       (b) Amendments to Public Health Service Act.--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:
       ``(3) Financial requirements and treatment limitations.--
       ``(A) In general.--In the case of a group health plan (or 
     health insurance coverage offered in connection with such a 
     plan) that provides both medical and surgical benefits and 
     mental health or substance use disorder benefits, such plan 
     or coverage shall ensure that--
       ``(i) the financial requirements applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant financial requirements 
     applied to substantially all medical and surgical benefits 
     covered by the plan (or coverage), and there are no separate 
     cost sharing requirements that are applicable only with 
     respect to mental health or substance use disorder benefits; 
     and
       ``(ii) the treatment limitations applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant treatment limitations 
     applied to substantially all medical and surgical benefits 
     covered by the plan (or coverage) and there are no separate 
     treatment limitations that are applicable only with respect 
     to mental health or substance use disorder benefits.
       ``(B) Definitions.--In this paragraph:
       ``(i) Financial requirement.--The term `financial 
     requirement' includes deductibles, copayments, coinsurance, 
     and out-of-pocket expenses, but excludes an aggregate 
     lifetime limit and an annual limit subject to paragraphs (1) 
     and (2),
       ``(ii) Predominant.--A financial requirement or treatment 
     limit is considered to be predominant if it is the most 
     common or frequent of such type of limit or requirement.
       ``(iii) Treatment limitation.--The term `treatment 
     limitation' includes limits on the frequency of treatment, 
     number of visits, days of coverage, or other similar limits 
     on the scope or duration of treatment.
       ``(4) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health or substance use 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 or substance use 
     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.
       ``(5) Out-of-network providers.--In the case of a plan or 
     coverage that provides both medical and surgical benefits and 
     mental health or substance use disorder benefits, if the plan 
     or coverage provides coverage for medical or surgical 
     benefits provided by out-of-network providers, the plan or 
     coverage shall provide coverage for mental health or 
     substance use disorder benefits provided by out-of-network 
     providers in a manner that is consistent with the 
     requirements of this section.'';
       (2) in subsection (b), by amending paragraph (2) to read as 
     follows:
       ``(2) in the case of a group health plan (or health 
     insurance coverage offered in connection with such a plan) 
     that provides mental health or substance use disorder 
     benefits, as affecting the terms and conditions of the plan 
     or coverage relating to such benefits under the plan or 
     coverage, except as provided in subsection (a).'';

[[Page 20225]]

       (3) in subsection (c)--
       (A) in paragraph (1), by inserting before the period the 
     following: ``(as defined in section 2791(e)(4), except that 
     for purposes of this paragraph such term shall include 
     employers with 1 employee in the case of an employer residing 
     in a State that permits small groups to include a single 
     individual)''; and
       (B) by striking paragraph (2) and inserting the following:
       ``(2) 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 use 
     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. An employer may elect to continue 
     to apply mental health and substance use disorder parity 
     pursuant to this section with respect to the group health 
     plan (or coverage) involved regardless of any increase in 
     total costs.
       ``(B) Applicable percentage.--With respect to a plan (or 
     coverage), the applicable percentage described in this 
     subparagraph shall be--
       ``(i) 2 percent in the case of the first plan year in which 
     this section is applied; 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 section shall be made and certified by a 
     qualified and licensed actuary who is a member in good 
     standing of the American Academy of Actuaries. All such 
     determinations shall be in a written report prepared by the 
     actuary. The report, and all underlying documentation relied 
     upon by the actuary, shall be maintained by the group health 
     plan or health insurance issuer for a period of 6 years 
     following the notification made under subparagraph (E).
       ``(D) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connection with 
     a group health 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.--
       ``(i) In general.--A group health plan (or a health 
     insurance issuer offering coverage in connection with a group 
     health plan) that, based upon a certification described under 
     subparagraph (C), qualifies for an exemption under this 
     paragraph, and elects to implement the exemption, shall 
     promptly notify the Secretary, the appropriate State 
     agencies, and participants and beneficiaries in the plan of 
     such election.
       ``(ii) Requirement.--A notification to the Secretary 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 use 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 use 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification to the Secretary 
     under clause (i) shall be confidential. The Secretary shall 
     make available, upon request 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 type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(F) Audits by appropriate agencies.--To determine 
     compliance with this paragraph, the Secretary may audit the 
     books and records of a group health plan or health insurance 
     issuer relating to an exemption, including any actuarial 
     reports prepared pursuant to subparagraph (C), during the 6-
     year period following the notification of such exemption 
     under subparagraph (E). A State agency receiving a 
     notification under subparagraph (E) may also conduct such an 
     audit with respect to an exemption covered by such 
     notification.'';
       (4) in subsection (e), by striking paragraph (4) and 
     inserting the following:
       ``(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 Federal and State law.
       ``(5) Substance use disorder benefits.--The term `substance 
     use disorder benefits' means benefits with respect to 
     services for substance use disorders, as defined under the 
     terms of the plan and in accordance with applicable Federal 
     and State law.'';
       (5) by striking subsection (f);
       (6) by striking ``mental health benefits'' and inserting 
     ``mental health and substance use disorder benefits'' each 
     place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
     (a)(2)(B)(i), and (a)(2)(C); and
       (7) by striking ``mental health benefits'' and inserting 
     ``mental health or substance use disorder benefits'' each 
     place it appears (other than in any provision amended by the 
     previous paragraph).
       (c) Amendments to Internal Revenue Code.--Section 9812 of 
     the Internal Revenue Code of 1986 is amended--
       (1) in subsection (a), by adding at the end the following:
       ``(3) Financial requirements and treatment limitations.--
       ``(A) In general.--In the case of a group health plan that 
     provides both medical and surgical benefits and mental health 
     or substance use disorder benefits, such plan shall ensure 
     that--
       ``(i) the financial requirements applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant financial requirements 
     applied to substantially all medical and surgical benefits 
     covered by the plan, and there are no separate cost sharing 
     requirements that are applicable only with respect to mental 
     health or substance use disorder benefits; and
       ``(ii) the treatment limitations applicable to such mental 
     health or substance use disorder benefits are no more 
     restrictive than the predominant treatment limitations 
     applied to substantially all medical and surgical benefits 
     covered by the plan and there are no separate treatment 
     limitations that are applicable only with respect to mental 
     health or substance use disorder benefits.
       ``(B) Definitions.--In this paragraph:
       ``(i) Financial requirement.--The term `financial 
     requirement' includes deductibles, copayments, coinsurance, 
     and out-of-pocket expenses, but excludes an aggregate 
     lifetime limit and an annual limit subject to paragraphs (1) 
     and (2),
       ``(ii) Predominant.--A financial requirement or treatment 
     limit is considered to be predominant if it is the most 
     common or frequent of such type of limit or requirement.
       ``(iii) Treatment limitation.--The term `treatment 
     limitation' includes limits on the frequency of treatment, 
     number of visits, days of coverage, or other similar limits 
     on the scope or duration of treatment.
       ``(4) Availability of plan information.--The criteria for 
     medical necessity determinations made under the plan with 
     respect to mental health or substance use 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 or substance use 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.
       ``(5) Out-of-network providers.--In the case of a plan that 
     provides both medical and surgical benefits and mental health 
     or substance use disorder benefits, if the plan provides 
     coverage for medical or surgical benefits provided by out-of-
     network providers, the plan shall provide coverage for mental 
     health or substance use disorder benefits provided by out-of-
     network providers in a manner that is consistent with the 
     requirements of this section.'';
       (2) in subsection (b), by amending paragraph (2) to read as 
     follows:
       ``(2) in the case of a group health plan that provides 
     mental health or substance use disorder benefits, as 
     affecting the terms and conditions of the plan relating to 
     such benefits under the plan, except as provided in 
     subsection (a).'';
       (3) in subsection (c)--
       (A) by amending paragraph (1) 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.''; and
       (B) by striking paragraph (2) and inserting the following:
       ``(2) Cost exemption.--
       ``(A) In general.--With respect to a group health plan, if 
     the application of this section

[[Page 20226]]

     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 use 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. An employer may elect to continue to apply mental 
     health and substance use disorder parity pursuant to this 
     section with respect to the group health plan involved 
     regardless of any increase in total costs.
       ``(B) Applicable percentage.--With respect to a plan, the 
     applicable percentage described in this subparagraph shall 
     be--
       ``(i) 2 percent in the case of the first plan year in which 
     this section is applied; 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 
     section shall be made and certified by a qualified and 
     licensed actuary who is a member in good standing of the 
     American Academy of Actuaries. All such determinations shall 
     be in a written report prepared by the actuary. The report, 
     and all underlying documentation relied upon by the actuary, 
     shall be maintained by the group health plan for a period of 
     6 years following the notification made under subparagraph 
     (E).
       ``(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.--
       ``(i) In general.--A group health plan that, based upon a 
     certification described under subparagraph (C), qualifies for 
     an exemption under this paragraph, and elects to implement 
     the exemption, shall promptly notify the Secretary, the 
     appropriate State agencies, and participants and 
     beneficiaries in the plan of such election.
       ``(ii) Requirement.--A notification to the Secretary under 
     clause (i) shall include--

       ``(I) a description of the number of covered lives under 
     the plan 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;
       ``(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 use 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 use 
     disorder benefits under the plan.

       ``(iii) Confidentiality.--A notification to the Secretary 
     under clause (i) shall be confidential. The Secretary shall 
     make available, upon request 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 type of 
     employers submitting such notification; and
       ``(II) a summary of the data received under clause (ii).

       ``(F) Audits by appropriate agencies.--To determine 
     compliance with this paragraph, the Secretary may audit the 
     books and records of a group health plan relating to an 
     exemption, including any actuarial reports prepared pursuant 
     to subparagraph (C), during the 6-year period following the 
     notification of such exemption under subparagraph (E). A 
     State agency receiving a notification under subparagraph (E) 
     may also conduct such an audit with respect to an exemption 
     covered by such notification.'';
       (4) in subsection (e), by striking paragraph (4) and 
     inserting the following:
       ``(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 Federal and State law.
       ``(5) Substance use disorder benefits.--The term `substance 
     use disorder benefits' means benefits with respect to 
     services for substance use disorders, as defined under the 
     terms of the plan and in accordance with applicable Federal 
     and State law.'';
       (5) by striking subsection (f);
       (6) by striking ``mental health benefits'' and inserting 
     ``mental health and substance use disorder benefits'' each 
     place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
     (a)(2)(B)(i), and (a)(2)(C); and
       (7) by striking ``mental health benefits'' and inserting 
     ``mental health or substance use disorder benefits'' each 
     place it appears (other than in any provision amended by the 
     previous paragraph).
       (d) Regulations.--Not later than 1 year after the date of 
     enactment of this Act, the Secretaries of Labor, Health and 
     Human Services, and the Treasury shall issue regulations to 
     carry out the amendments made by subsections (a), (b), and 
     (c), respectively.
       (e) Effective Date.--
       (1) In general.--The amendments made by this section shall 
     apply with respect to group health plans for plan years 
     beginning after the date that is 1 year after the date of 
     enactment of this Act, regardless of whether regulations have 
     been issued to carry out such amendments by such effective 
     date, except that the amendments made by subsections (a)(5), 
     (b)(5), and (c)(5), relating to striking of certain sunset 
     provisions, shall take effect on 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.
       (f) Assuring Coordination.--The Secretary of Health and 
     Human Services, the Secretary of Labor, and the Secretary of 
     the Treasury may ensure, through the execution or revision of 
     an interagency memorandum of understanding among such 
     Secretaries, that--
       (1) regulations, rulings, and interpretations issued by 
     such Secretaries relating to the same matter over which two 
     or more such Secretaries have responsibility under this 
     section (and the amendments made by this section) are 
     administered so as to have the same effect at all times; and
       (2) coordination of policies relating to enforcing the same 
     requirements through such Secretaries in order to have a 
     coordinated enforcement strategy that avoids duplication of 
     enforcement efforts and assigns priorities in enforcement.
       (g) Conforming Clerical Amendments.--
       (1) ERISA heading.--
       (A) In general.--The heading of section 712 of the Employee 
     Retirement Income Security Act of 1974 is amended to read as 
     follows:

     ``SEC. 712. PARITY IN MENTAL HEALTH AND SUBSTANCE USE 
                   DISORDER BENEFITS.''.

       (B) 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. Parity in mental health and substance use disorder 
              benefits.''.

       (2) PHSA heading.--The heading of section 2705 of the 
     Public Health Service Act is amended to read as follows:

     ``SEC. 2705. PARITY IN MENTAL HEALTH AND SUBSTANCE USE 
                   DISORDER BENEFITS.''.

       (3) IRC heading.--
       (A) In general.--The heading of section 9812 of the 
     Internal Revenue Code of 1986 is amended to read as follows:

     ``SEC. 9812. PARITY IN MENTAL HEALTH AND SUBSTANCE USE 
                   DISORDER BENEFITS.''.

       (B) 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. Parity in mental health and substance use disorder 
              benefits.''.

       (h) GAO Study on Coverage and Exclusion of Mental Health 
     and Substance Use Disorder Diagnoses.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study that analyzes the specific 
     rates, patterns, and trends in coverage and exclusion of 
     specific mental health and substance use disorder diagnoses 
     by health plans and health insurance. The study shall include 
     an analysis of--
       (A) specific coverage rates for all mental health 
     conditions and substance use disorders;
       (B) which diagnoses are most commonly covered or excluded;
       (C) whether implementation of this Act has affected trends 
     in coverage or exclusion of such diagnoses; and
       (D) the impact of covering or excluding specific diagnoses 
     on participants' and enrollees' health, their health care 
     coverage, and the costs of delivering health care.
       (2) Reports.--Not later than 3 years after the date of the 
     enactment of this Act, and 2 years after the date of 
     submission the first report under this paragraph, the 
     Comptroller General shall submit to Congress a report on the 
     results of the study conducted under paragraph (1).

     SEC. 3. DELAY IN APPLICATION OF WORLDWIDE ALLOCATION OF 
                   INTEREST.

       (a) In General.--Paragraphs (5)(D) and (6) of section 
     864(f) of the Internal Revenue Code of 1986 are each amended 
     by striking ``December 31, 2010'' and inserting ``December 
     31, 2012''.
       (b) Transition.--Paragraph (7) of section 864(f) of such 
     Code is amended by striking ``30 percent'' and inserting ``85 
     percent''.


[[Page 20227]]


  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Nebraska (Mr. Terry) 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 to revise and extend their remarks and 
include 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 ask unanimous consent that the gentleman 
from California (Mr. Stark) and the gentleman from New Jersey (Mr. 
Andrews) each be permitted to control 6\1/2\ minutes of my time.
  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.
  Mr. Speaker, I rise today in support of the passage of H.R. 6983, the 
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 
Equity Act of 2008, a comprehensive bill which will establish full 
mental health and addiction care parity.
  We live in a time when discrimination in any form against any person 
should not be tolerated. One out of every five adults in the U.S. 
suffers from mental health or substance abuse disorders on an annual 
basis, and yet studies show that people with mental illnesses continue 
to face insurers and employers unwilling to provide them the same level 
of care they would for a medical problem.
  The legislation before us will fully ensure equity in the 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.
  I want to recognize two of my colleagues, Representative Patrick 
Kennedy and Representative Jim Ramstad, who have worked tirelessly to 
bring this bill to the floor. We can't delay any longer. I strongly 
urge my colleagues to vote in favor of the passage of this important 
legislation.
  I reserve the balance of my time.
  Mr. TERRY. Mr. Speaker, I yield myself such time as I may consume.
  Mental health deserves serious attention. We all share in this 
concern. The debate around mental health parity hinges on that 
principle, does government really know what is best? Isn't it better to 
allow consumers choice and not a one-size-fits-all government-dictated 
mandate? People should be able to decide if they want to pay more for 
health insurance.
  We have been here before, and, from what I am told, this isn't the 
only time or possibility even this week that we will be considering a 
government-dictated mental health mandate.
  Earlier this year, the House passed H.R. 1424, a bill that served as 
the House mental health parity bill for purposes of negotiation with 
the Senate. At the time, CBO estimated that H.R. 1424 would have 
increased premiums for group health insurance by an average of about 
four-tenths of 1 percent before accounting for the responses of health 
plans, employers and workers to the higher premiums. Those responses 
would include reductions in the number of employees enrolling in 
employer insurance, changes in the types of health plans that are 
offered, including eliminating coverage for mental health benefits and/
or substance benefits, and reductions in the scope or generosity of 
health benefits, such as increased deductibles or higher copayments.
  I opposed H.R. 1424 for these and other reasons regarding the offsets 
presented at that time, as well as many of my colleagues on Energy and 
Commerce.
  The bill before us today is not H.R. 1424. It may be confusing to see 
this stand-alone mental health parity bill here today, since I know we 
just passed one a few months ago. After a little digging, I soon 
realized that this bill is a cut-and-paste of the same agreed-upon text 
from the tax extenders bill originating in the Senate to be sent over 
to this body to consider possibly as early as today or tomorrow. So 
what the majority has done is take language negotiated directly with 
the Senate without any House Democrats in the room and dropped into 
another stand-alone bill.
  One has to wonder why we are considering this bill today, when the 
exact same language is on its way over to us pursuant to an agreement 
between the majority and the Senate. Is this just another political 
gimmick by the Democrat leadership?
  This is a prime example of what happens when Democrats stop leading 
on issues and start politicking. The Democrat do-nothing Congress is 
doing something today. Instead of addressing outstanding issues our 
country faces, such as a need for real energy reform, they are hard at 
work to put in front of us a bill that already passed the House this 
year and will be arriving momentarily from the Senate. Are we really 
supposed to pass the same bill three times this year? That is not 
progress. That is a waste of taxpayer time.
  Mr. Speaker, I reserve the balance of our time.
  Mr. ANDREWS. Mr. Speaker, I am pleased at this time to yield 2 
minutes to the chairman of the Education and Labor Committee, the 
gentleman from California (Mr. George Miller).
  Mr. GEORGE MILLER of California. Mr. Speaker, I rise in very strong 
support of this legislation. It is an important piece of legislation. 
It does some very important things for families and individuals with 
mental health problems.
  H.R. 6983 amends the Employer Retirement Income Security Act to 
prohibit employers and group health plans from imposing mental health 
or substance abuse treatment limitations, financial requirements or 
out-of-network coverage limitations, unless comparable limitation 
requirements are imposed upon medical surgical benefits.
  Under this provision, if a mental health plan permits individuals to 
go to an emergency room for a medical condition without prior 
authorization or an out-of-network hospital or treatment center at in-
network rates for a medical condition, then the plan must apply the 
same rules to an individual suffering from mental illness or substance 
abuse.
  However, if a group plan does offer mental health or substance abuse 
benefits, there must be equity between the mental health or substance 
abuse coverage and all comparable medical and surgical benefits in the 
plan. Nothing in H.R. 6983 is intended to preempt the stronger State 
mental health and substance abuse parity laws.
  Having said that, I want to pay tribute to two of our colleagues. Jim 
Ramstad, who has been tireless in his effort to see this measure become 
law, and hopefully with our actions today it will be on its way to the 
President's desk and become law. I just want to thank you on behalf of 
so many families, not just my constituents who have mental health 
illness problems in their families, but so many families in America and 
individuals, for your work on this legislation.
  And to Patrick Kennedy, our colleague who again has just done a 
remarkable job of rounding up support and votes for this legislation 
and getting to people to explain it to them, to get them to understand 
it and appreciate the problems that these families have when they try 
to get services from the insurance plans, from their health networks, 
and the barriers that are erected in front of them.
  Hopefully this legislation will do what it is supposed to do to make 
sure that they can get treatment, they can get care, and they don't 
have to run all of the gauntlet that they today encounter with those 
barriers.
  So to Congressman Ramstad, thank you so very much for all of your 
work, and to Patrick Kennedy, thank you so very, very much for all of 
your advocacy on this legislation.

[[Page 20228]]



                              {time}  1415

  Mr. TERRY. Mr. Speaker, the Energy and Commerce Committee is not 
taking a position saying or encouraging other Members to vote for or 
against this bill. Our frustration is with the process on this bill.
  At this time, I want to, seeing no other Energy and Commerce speakers 
here, yield the balance of my time to Mr. Ramstad of the Ways and Means 
Committee.
  The SPEAKER pro tempore. Without objection, the gentleman from 
Minnesota will control the time.
  There was no objection.
  Mr. RAMSTAD. I thank the gentleman for yielding.
  Mr. Speaker, we would not be having the debate here today without the 
compassionate leadership of the late Senator Paul Wellstone.
  I want to thank the Speaker and majority leader, as well as Chairmen 
Rangel, Stark, George Miller, Dingell, Pallone and Andrews, for their 
key support.
  The issue before us today is not just another public policy issue. 
The issue today before us is a matter of life and death for 54 million 
Americans suffering the ravages of mental illness and 26 million 
Americans suffering from chemical addiction.
  Last year alone, more than 30,000 Americans committed suicide from 
untreated depression and 150,000 Americans died as the direct result of 
chemical addiction. On top of the tragic loss of lives, untreated 
addiction and mental illness cost our economy $550 billion last year, 
according to the Wall Street Journal. In fact, the Journal cited $70 
billion was lost from our economy because of untreated depression 
alone.
  I am alive and sober today only because of the access that I had to 
treatment following my last alcoholic blackout on July 31, 1981. I woke 
up that day in a jail cell in Sioux Falls, South Dakota, and I am 
living proof that treatment works and recovery is possible. But far too 
many people in our country don't have the same access to treatment that 
I and other Members of Congress, other Federal employees have.
  A major barrier for thousands of Americans is insurance 
discrimination, plain and simple, against people in health plans who 
need treatment for mental illness or chemical addiction. The 
legislation my friend from Rhode Island (Mr. Kennedy) and I have 
authored, H.R. 6983 before us today, would end this discrimination by 
prohibiting health insurers from placing discriminatory restrictions on 
treatment for people with mental illness or addiction.
  No more inflated deductibles or copayments that don't exist for 
physical diseases. No more limited treatment stays that don't apply to 
physical ailments, no more discrimination against people with mental 
illness or chemical addiction.
  I just want to say a word about the chief sponsor of this 
legislation, Mr. Kennedy, who has worked tirelessly on this bill. We 
have worked together for many years now on this legislation since he 
first came to the House. I want to publicly acknowledge and thank Mr. 
Kennedy, who has not only worked hard on this legislation, but has been 
an inspiration to literally hundreds of thousands of Americans as we 
traveled this country to 14 States, holding field hearings on this 
important legislation.
  Simply stated, the Paul Wellstone and Pete Domenici Mental Health 
Parity and Addiction Equity Act, which has, by the way, 274 cosponsors 
from both sides of the aisle, simply stated, provides equal treatment 
for diseases of the brain with the body. Diseases of the brain should 
be treated the same as diseases of the body.
  There is no government mandate. Nobody is mandated to insure anybody 
for treatment for mental illness or chemical addiction. There is no 
mandate in this bill. All it says is if your policy includes coverage 
for mental illness or addiction, then you cannot be discriminated 
against, that is, those ailments must be treated the same as physical 
ailments.
  Providing treatment equity is not only the right thing to do, it's 
the cost-effective thing to do. Believe me, we have over the last 12 
years assembled all the empirical data in the world, all the actuarial 
studies in the world, and they all showed the same thing, that equity 
for mental health and addiction treatment will save, not cost, but 
save, literally, billions of dollars nationally.
  At the same time, treatment parity will not raise premiums more than 
two-tenths of 1 percent. That's according to the Congressional Budget 
Office. Let me repeat that. Premiums will not raise more than two-
tenths of 1 percent.
  So, in other words, for the price of a cheap cup of coffee per month, 
I am not talking about a fancy restaurant, I am talking about Pete's 
Diner, where many of us go, millions of people could receive treatment 
for chemical addiction and mental illness. In fact, 16 million people 
of the 26 million people in health plans could receive treatment under 
this bill.
  When my friend from Rhode Island and I traveled this country holding 
field hearings on this legislation, we heard, literally, hundreds and 
hundreds of stories of human suffering that ripped your heart out, 
broken families, tragic deaths, ruined careers, shattered dreams, all 
because insurance companies would not provide access to treatment for 
mental illness and addiction for people who were in health plans. We 
could change that here today.
  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 on treatment. It's time to join 
the coalition of insurance companies, yes, I said insurance companies. 
More than 10 of them now support this, as well as the major business 
groups who support parity. They know it's cost effective, they know 
parity saves health care dollars. It's time to make this bipartisan 
legislation the law of the land.
  The people of America cannot wait any longer for Congress to act.

     Mr. David Wellstone
     Son of the late Senator Paul Wellstone
     Co-Founder, Wellstone Action

    Statement for the Record in Support of the Passage of the Paul 
 Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 
                      Act of 2008, September, 2008

       I am pleased to speak in support of the Paul Wellstone and 
     Pete Domenici Mental Health Parity and Addiction Equity Act 
     of 2008. This legislation is critically important to the 
     future of health care, and it is also very close to my heart. 
     During my father's time in the Senate, he never stopped 
     fighting for fairness in coverage and treatment for mental 
     illness and substance use disorders. My family and I are 
     grateful for the tribute that the Senate and the House have 
     paid to my father's legacy by naming the bill after him, as 
     well as his close colleague, Sen. Pete Domenici.
       My brother and I founded Wellstone Action to carry on my 
     father's work, and through this organization, thousands of 
     people are trained each year to run for office and to develop 
     grassroots skills in organizing and leadership. But nothing 
     represents my father's passion and commitment more than his 
     work to pass legislation that would end the discrimination 
     against those with mental illness and substance use 
     disorders. This legislation is a major achievement and will 
     do so much to end that discrimination.
       For some time, I have been coming to Washington to speak on 
     behalf of this legislation, but the fight for parity has a 
     long history with many milestones: the 1996 federal law; the 
     1999 Executive Order that gave federal employees mental 
     health and addiction parity benefits; the many successes at 
     the state level to strengthen their parity laws; the times 
     that Congress came very close to passing the expansion of the 
     federal law; and the endorsement by President Bush in 2002. 
     For my father, these milestones were very personal. His 
     dedication stemmed from his personal observations of the 
     terrible conditions in psychiatric institutions when his 
     brother was hospitalized in the 1950s. These conditions, and 
     the eventual catastrophic financial toll that my grandparents 
     had to bear, inspired my father to do everything he could to 
     make things right for those in similar circumstances.
       The legislation that my father and Sen. Domenici passed in 
     1996 was groundbreaking and important, for it established in 
     law an important first principle of parity: that those with 
     mental illness should not be discriminated against in 
     insurance coverage. But my father knew that it was not 
     enough, and that is why this legislation is so necessary. It 
     is the critically important next step toward ending the 
     persistent discrimination against people who suffer from 
     mental illness and addiction.

[[Page 20229]]

       In the House, the tireless leadership of Congressman 
     Patrick Kennedy and Congressman Jim Ramstad has been 
     extraordinary, especially with the groundbreaking inclusion 
     of substance use disorders in the parity bill and their 
     protection of the rights of patients. They and the House 
     Leadership, especially Speaker Nancy Pelosi and Majority 
     Leader Steny Hoyer, should be proud of their efforts to make 
     this legislation one that will strongly protect the needs of 
     millions of Americans who have mental illness and substance 
     use disorders. In the House, the efforts by the Chairmen of 
     the Energy and Commerce, Ways and Means, and Education and 
     Labor Committees should be proud of their successful efforts 
     to fight for the rights of those with these illnesses. And, 
     as I know well, nothing is accomplished without the 
     unflagging commitment of hundreds of dedicated staff and 
     advocates who have worked so hard to right the wrong of 
     discrimination that has existed for so long in our country.
       I also want to extend my deep gratitude to former First 
     Lady Rosalynn Carter for her many years of leadership on this 
     issue and many other problems related to mental illness. She 
     and my father worked closely together on parity for many 
     years, and he was always grateful for her support and 
     leadership.
       We know that mental illness is a real, painful, and 
     sometimes fatal disease. It is also a treatable disease. My 
     father used to say that the gap between what we know and what 
     we do is lethal. Available medications and psychological 
     treatments, alone or in combination, can help most people who 
     suffer from mental illness and addiction. But without 
     adequate treatment, these illnesses can continue or worsen in 
     severity. Suicide is the third leading cause of death of 
     young people in the U.S. Each year, 32,000 Americans take 
     their lives, hundreds of thousands attempt to do so, and in 
     90% of these situations, the cause is untreated mental 
     illness. This legislation will save lives. It will also go a 
     long way toward ending the stigma that is behind the 
     discrimination.
       People have asked me why I am so involved in this issue. My 
     first response is, ``Because of my father, of course''. I 
     loved him and I miss him, and I have learned that many others 
     here in Washington and throughout the country miss him too, 
     especially his courage and his compassion. He fought hard for 
     those who had no voice, and he had a strong personal 
     commitment to helping those with mental illness and 
     addiction. After he died, Congressional members honored him 
     and my family by promising to name the parity bill after him, 
     and this meant a great deal to my family. But I also knew the 
     kind of man my father was, and the kind of parity bill he 
     would have wanted finally passed into law, and I wanted to 
     help ensure that the final bill was one worthy of his name. 
     The safeguards for patients that have been included in this 
     final bill, such as protections of stronger state laws, out 
     of network benefits, oversight of diagnosis coverage, and 
     transparency of medical necessity, are essential to a strong 
     law. This Congress can be remembered as the one that had the 
     courage and leadership to pass a strong parity bill, one 
     where everyone's voices had a chance to be heard.
       I, along with millions of Americans, look forward to the 
     day when people with mental illness and substance use 
     disorder receive decent, humane, and timely care. The passage 
     of the Paul Wellstone and Pete Domenici Mental Health Parity 
     and Addiction Equity Act of 2008 brings us so much closer to 
     this day.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I yield myself such time as I may consume, 
and I will be brief.
  I am here to establish my ranking among distinguished Members like 
Chairman Dingell, Chairman Pallone, Chairman Miller, Chairman Andrews, 
Ranking Member McCrery, Ranking Member Camp and all of my colleagues. 
We all get the title today as pieces of parsley on a platter of fish. 
We are here to garnish the work that Jim Ramstad and Patrick Kennedy, 
led by former Senator Wellstone and Senator Domenici, have accomplished 
with diligent hard work. Without it, we would not be here to protect 
the people and add the protection that people need.
  I urge my colleagues to support the Paul Wellstone and Pete Domenici 
Mental Health Parity and Addiction Equity Act, H.R. 6893, to honor 
Patrick and Jim for the marvelous work they have done.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RAMSTAD. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from Connecticut, who has been a long supporter of parity, 
Mr. Shays.
  Mr. SHAYS. Mr. Speaker, I rise in support of the Paul Wellstone and 
Pete Domenici Mental Health Parity and Addiction Equity Act. Twenty-
five percent of the U.S. adult population suffers from mental disorders 
or substance abuse disorders.
  Yet despite the prevalence of mental disorders, there continues to be 
widespread misinformation and ignorance surrounding the condition. We 
need to ensure those who have 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. With passage of this legislation, we will end these 
discriminatory practices and bring mental health care on par with care 
for physical ailments.
  I congratulate my friends, Congressman Ramstad and Congressman 
Kennedy, for all their efforts to help the mentally ill.
  I urge adoption of this legislation.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Rhode Island, who has worked so tirelessly as a chief sponsor of this 
bill, Mr. Kennedy.
  Mr. KENNEDY. Mr. Speaker, I rise in support of H.R. 6983, the Paul 
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 
Act of 2008.
  I would like to acknowledge the hard work of Chairmen Dingell, Rangel 
and Miller, as well as subcommittee Chairmen Stark, Pallone and 
Andrews, without whose unflagging commitment to this bill we would not 
be so close to sending it to the President's desk.
  I would also like to thank Speaker of the House Nancy Pelosi, and our 
majority leader, Steny Hoyer, and the whole Democratic leadership for 
their consistent support in making this bill a top priority.
  I most would like to thank my good friend, Jim Ramstad. Jim is 
leaving this year, and there will be no greater testament to his 
devotion to those with mental illness and substance abuse disorders 
than to see this bill signed into law by President Bush this year.
  Mr. Speaker, I have a letter in support of this bill from former 
First Lady Rosalynn Carter, who has been such a champion for this 
issue, and I will insert it into the Record.

    Statement for the Record in Support of the Passage of the Paul 
 Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 
 Act of 2008 by Mrs. Rosalynn Carter, Former First Lady of the United 
States, Chairwoman, Carter Center's Mental Health Task Force, Atlanta, 
                                Georgia

       I am pleased to have the opportunity to express my strong 
     support for the passage of a critical health issue facing 
     millions of Americans: parity for the treatment of mental 
     illnesses and substance use disorders.
       I have been working on mental health issues for more than 
     35 years. When I began no one understood the brain or how to 
     treat mental illnesses. Today everything has changed--except 
     stigma, of course, which holds back progress in the field.
       Because of research and our new knowledge of the brain, 
     mental illnesses now can be diagnosed and treated 
     effectively, and the overwhelming majority of those affected 
     can lead normal lives--being contributing citizens in our 
     communities.
       I join many individuals and hundreds of national 
     organizations calling for an end to the fundamental, 
     stigmatizing inequity of providing far more limited insurance 
     coverage for mental health care than for treatment of any 
     other illnesses. Again, I join forces with my friend Betty 
     Ford in urging action on this important issue.
       Jimmy and I founded The Carter Center 25 years ago, and I 
     have a very good mental health program there. Annually we 
     bring together leaders to take action on major mental health 
     issues of concern to the nation. We have focused many times 
     on stigma and discrimination and the importance of insuring 
     adequate, equitable coverage for people with mental 
     illnesses.
       To me, it is unconscionable in our country and morally 
     unacceptable to treat 20 percent of our population (1 in 
     every 5 people in our country will experience a mental 
     illness this year) as though they were not worthy of care. We 
     preach human rights and civil rights and yet we let people 
     suffer because of an illness they didn't ask for and for 
     which there is sound treatment. Then we pay the price for 
     this folly in homelessness, lives lost, families torn apart, 
     loss of productivity, and the costs of treatment in our 
     prisons and jails.

[[Page 20230]]

       I have always believed that if insurance covered mental 
     illnesses, it would be all right to have them. This may be 
     why the stigma has remained so pervasive--because these 
     illnesses are treated differently from other health 
     conditions.
       All mental illnesses are potentially devastating. But today 
     living a life in recovery from a mental illness is not only 
     possible, but expected. We had an intern at The Carter Center 
     this spring, for example, who has obsessive compulsive 
     disorder and depression. While she was in high school, she 
     once spent two solid weeks in her house, unable to leave or 
     be with her friends. I am happy to say that she received 
     treatment, is a college graduate with Phi Beta Kappa honors, 
     and just got a job in Washington, DC. Without resources and 
     support, she could still be sick and shut in her home, which 
     is what happens to so many who do not get the help they need 
     because of lack of the ability to pay for services. We as a 
     country lose all the many contributions of these wonderful 
     people.
       I have the pleasure of being friends with Tom Johnson, the 
     former publisher of the Los Angeles Times and former CEO of 
     CNN and a person who has struggled with depression. He has 
     been interested in the mental health benefits offered by 
     employers in Atlanta. He and two other prominent CEOs in the 
     Atlanta community--all of whom have suffered from severe 
     depression and are now great leaders--have had an enormous 
     impact on businesses in the area.
       Through the research of people like Howard Goldman and 
     Richard Frank, we know that parity in insurance benefits for 
     behavioral health care has no significant increase in total 
     costs when coupled with management of care. We also know that 
     a number of enlightened companies such as AT&T, Delta Air 
     Lines, Eastman Kodak, General Motors, and IBM have provided 
     comprehensive coverage for their employees. (Report to the 
     Office of Personnel Management, by Washington Business Group 
     on Health)
       Since the mental health commission we held during Jimmy's 
     presidency, there have been several major reports released 
     including the first Surgeon General's Report on Mental 
     Health, President Bush's New Freedom Commission on Mental 
     Health, and the Institute of Medicine included mental and 
     substance use conditions in its series of reports on the 
     quality of American health care. All of the reports reinforce 
     the statement that effective treatments are available, but 
     most people who need them do not get them.
       The whole nation has learned a lot about the importance of 
     mental health issues through the events of Hurricane Katrina 
     and the needs of our returning soldiers and National Guard 
     troops. We support our troops in the field, and it is 
     critical that we continue to support them when they come 
     home.
       Finally, I would like to comment on the number of states 
     that have moved ahead with parity. These have been long-
     fought battles with some states managing wonderful successes. 
     It is so important that stronger state parity laws continue 
     to improve the lives of people with mental illness and 
     addiction. It is also critically important that plans not 
     override the intent of this legislation by discriminating 
     against those with certain diagnoses of mental illness and 
     addiction in their coverage. I am glad to see that this 
     legislation includes efforts to keep a close watch on this 
     issue. The intent of this law is fairness, not 
     discrimination.
       After waiting for 15 years, we finally have mental health 
     and addiction parity legislation in sight. If this 
     legislation is passed, many of our citizens will be 
     healthier, and our nation will be stronger, more resilient, 
     and more productive.
       On behalf of the millions of people affected by mental 
     illnesses, I applaud your efforts to pass the mental health 
     and addiction parity legislation. I know the work has been 
     hard, but the benefits to our nation will be enormous.

  We are bringing to the floor today a bill that is fully paid for, 
bipartisan, bicameral and a compromise, a mental health parity bill 
that has long been coming to this floor. It is the result of extensive 
negotiations between the House, the Senate, and is supported by the 
chairmen of the relevant House committees and subcommittees, as well as 
Senators Kennedy, Enzi and Domenici.
  We cannot afford one more day without parity, because each day five 
United States soldiers take their lives because of suicide. We cannot 
afford one more day without parity because each year $1.3 billion is 
lost because of those workdays due to mental disorders, more than 
arthritis, stroke, heart attack and cancer combined.
  The World Health Organization in this chart shows you. It's hard for 
anyone to really understand until you see it in this chart.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. RAMSTAD. I yield the gentleman 2 additional minutes.
  Mr. KENNEDY. If you look at the comparison in illnesses by lost days, 
burden of illness, mental illness is amongst the worst; sure, cancer; 
sure, arthritis; sure, heart disease, but these are illnesses that 
capture people usually at the end of life. Mental illnesses, addictive 
disorders, really paralyze people from their beginning of life 
throughout their life. That's why it's such a burden of illness in our 
society.
  It catches us in the Justice Department. Drug-related crime in our 
country costs us $107 billion a year. We cannot afford not to have 
parity because 80 percent of our trauma admissions in our emergency 
rooms are alcohol and drug related. We cannot afford not to have 
parity, because by denying an individual's treatment to their diseases, 
we are denying them the opportunity to live out their full potential 
and live a full and fulfilling life.
  Treatment works, as my good friend from Minnesota has said. It has 
worked for those who have had the opportunity to seek it.
  If you are a Member of Congress, you have treatment opportunities. 
Like my friend from Minnesota said, he has had it; I have had it. 
Recovery is possible.
  We need to end the stigma against those with mental illness, but it 
isn't going to happen until we first outlaw, outlaw, the embedded 
discrimination in our laws. That is what we are about to do today by 
passing this legislation. We simply cannot afford to wait one more day.
  In fact, just today the Administration released a Statement of 
Administration Policy concerning an identical policy provision in the 
Senate tax extenders bill which reads, ``the Administration supports 
passage of mental health parity legislation included in the Senate 
amendments to H.R. 6049 that eliminates disparities between mental 
health benefits and medical and surgical benefits without significantly 
increasing health coverage costs.'' The mental health parity 
legislation that statement refers to is identical to the bill we are 
considering on the floor today.
  In March, we passed H.R. 1424, the Paul Wellstone Mental Health and 
Addiction Equity Act. At that time, some of my colleagues on the other 
side of the aisle expressed a preference for the Senate mental health 
parity bill. I would urge those members to join with us now to pass 
this compromise bill.
  Mr. Speaker, it is past time that we enact mental health parity into 
law.
  Enacting mental health parity will affect nearly every individual in 
this country who has watched a friend or family member struggle with 
mental illness or addiction, or who has battled the disease themselves.
  The bill we are passing today is one more step in the long struggle 
to ensure that all Americans have a chance to realize their dreams.
  I ask all of my colleagues to join me in putting an end to the 
discrimination against mental illness. I urge a yes vote for H.R. 6983.

                              {time}  1430

  Mr. RAMSTAD. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just want to take this opportunity, like the previous 
speaker, to thank Senators Domenici and Kennedy. It has been a real 
privilege to work with such committed public servants on this 
legislation, and also the chief cosponsor in the House, the gentleman 
from Rhode Island, who just spoke so eloquently about this legislation.
  I want to say, as I have said many times before as I have traveled 
this country, were the gentleman from Rhode Island's uncle, President 
Kennedy, still alive today, and were President Kennedy to write a 
sequel to his book ``Profiles in Courage,'' there would be a complete 
chapter about his nephew, the gentleman from Rhode Island, Patrick 
Kennedy, because not only has he been right on the policy and has done 
a tremendous job over the past several years fighting for parity, but 
also his personal story, which he shared with people all across this 
Nation, has literally inspired hundreds of thousands of people to get 
help. He has been a real profile in courage and a pleasure to work 
with.
  At this time, Mr. Speaker, I reserve the balance of my time.
  Mr. ANDREWS. Mr. Speaker, I yield myself 1\1/2\ minutes.
  Mr. Speaker, the person who is being helped and touched by this bill 
is someone we all know. He is a person who comes home from work and is 
confronted with the heartache that his son

[[Page 20231]]

or daughter is dealing with the ravages of clinical depression. And 
they are worried about it, but they feel secure because they say at 
least we are insured. At least we can take care of her.
  Then they find out that there is a $10,000 deductible before the 
insurance company will pay for the visits. Or they find out there is a 
$5,000 limit on how much care can be received.
  If their daughter had broken her knee, there would be a $100 
deductible and no limit on the care. But because she is dealing with 
clinical depression or a substance abuse problem or another mental 
illness, they are conscripted and limited. This person is who will be 
helped by the efforts of Mr. Kennedy and Mr. Ramstad.
  This bill is long overdue, and it will save the system money. More 
importantly, it will bring justice and fairness to people like the 
family I talked about in these remarks here today.
  I congratulate Mr. Kennedy and Mr. Ramstad on bringing together this 
broad coalition. I urge both Republicans and Democrats to vote ``yes'' 
on this worthy legislation.
  I reserve the balance of my time.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, at this time I would like to yield 1\1/2\ 
minutes to the distinguished gentleman from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Mr. Speaker, it is time to remove the stigma and to 
destroy the barriers for individuals struggling with mental illness and 
addiction. Experienced by many of our returning brave soldiers, on the 
front page of USA Today, finally we have a breakthrough here.
  A society of denial results in stigmatizing the admonition of 
emotional problems. For far too long we focused on the external 
injuries to the body and ignored the maladies of the mind. For too long 
it seemed as if we could not treat what we could not see. But modern 
medicine and science is showing us that these are real diseases with 
real treatments. It shows us that there is hope, as stated by Mr. 
Kennedy and Mr. Ramstad.
  Mr. Speaker, this is a civil rights issue. Parity removes the 
discrimination against a population that has been discriminated against 
and stigmatized. This is a humanitarian issue. Without parity, we allow 
those with illnesses to continue to suffer.
  In closing, I would like to say that Paul Wellstone was a great and 
admirable man. He was a champion for this legislation. Today we honor 
him by passing this bill. The time is right. Let's pass this today.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. ANDREWS. Mr. Speaker, I am pleased to yield 1 minute to my friend 
from Pennsylvania (Mr. Murphy).
  Mr. PATRICK J. MURPHY of Pennsylvania. Mr. Speaker, I rise for the 
purpose of a colloquy with the gentleman from New Jersey (Mr. Andrews).
  Mr. Andrews, I rise today in favor of a health care system that works 
for those in need. I am proud that this legislation promotes fairness 
for those with mental illness. I am also proud that it will not preempt 
stronger State laws, laws such as Pennsylvania Act 106 which has saved 
countless lives in our Commonwealth.
  I stand with a leading Republican State representative from my 
district, Gene DiGirolamo, a leading advocate for mental health parity 
and someone who has worked tirelessly for health care laws that are 
fair and just.
  Mr. Andrews, just to clarify, does the parity legislation leave 
intact Pennsylvania's Act 106 protections for those seeking treatment 
of substance abuse and similar protections in other States?
  Mr. ANDREWS. If the gentleman will yield, that is correct. This bill 
will not preempt in any way the services and benefits provided to 
citizens of Pennsylvania Act 106 and similar legislation in other 
States. Some examples of the types of State laws that are not preempted 
by this bill include State laws that mandate minimum coverage, State 
laws that control access to benefits, and State laws that require 
access to out-of-network providers.
  Mr. PATRICK J. MURPHY of Pennsylvania. I thank the gentleman from New 
Jersey, and I urge my colleagues to vote in support of this bill.
  Mr. RAMSTAD. I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the chairman of the 
Energy and Commerce Committee, the gentleman from Michigan (Mr. 
Dingell).
  Mr. DINGELL. Mr. Speaker, I am proud to rise in support of H.R. 6983, 
the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 
Equity Act of 2008, which will permanently reauthorize and improve the 
Mental Health Parity Act of 1996. This legislation will put mental 
health and mental illness and substance-related disorders on the same 
footing as other medical and surgical disorders for health insurance 
benefits.
  I would observe that we have much to thank our colleagues for. I 
particularly want to commend my colleagues, Representatives Kennedy and 
Ramstad and Senators Kennedy and Domenici, for their tireless efforts 
in crafting this important piece of legislation. They have been 
unwavering in their commitment to end the discrimination against those 
with mental health and substance abuse disorder.
  I also want to congratulate and thank my friends, Mr. Andrews and Mr. 
Pallone of New Jersey; and Mr. Barton of Texas and Mr. Deal, the 
ranking members of the Commerce Committee and of our Health 
Subcommittee and a superb staff on both the side of the majority and 
minority of the Commerce Committee.
  I urge my colleagues to support the bill as it will create true 
parity of coverage for mental health and substance abuse disorders. I 
speak as one who has had to deal with the problem of mental health 
within the family of which I am a part, and I know the terrifying and 
awful consequences that exist not only to the person involved but to 
the whole family. So I hope that this legislation will go a long way to 
addressing the concerns millions of Americans have with regard to this 
terrifying disease.
  I want to urge my colleagues to support this legislation, and note 
that in accordance with PAYGO rules, the bill is paid for with a 
worldwide interest allocation tax provision that delays a tax break for 
American companies that operate overseas. It is a good bill. I urge 
passage by the House.
  Mr. RAMSTAD. Mr. Speaker, who has the right to close?
  The SPEAKER pro tempore. The gentleman from New Jersey (Mr. Pallone) 
has the right to close.
  Mr. RAMSTAD. Are there speakers remaining?
  Mr. STARK. I have two or three speakers remaining.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I recognize for 1\1/2\ minutes the 
distinguished gentleman from Michigan (Mr. Levin).
  Mr. LEVIN. Mr. Speaker, I first became involved with mental health 
services over 50 years ago when my beloved late wife, Vicki, worked in 
the network of child guidance clinics in Oakland County, Michigan. 
Those clinics tried to fill huge gaps in mental health services which 
in most cases were not covered by any insurance.
  Since then the battle has ensued to provide mental health services on 
a parity with all other services in health insurance, private and 
public, including Medicare.
  Twelve years ago, Congress and President Clinton came together to 
approve legislation that put this country on the road to mental health 
parity. It was a vital first step.
  Today, we take another important step towards genuine mental health 
parity. Fifteen percent of Americans have no health insurance at all. 
Even Americans who do have health insurance often find themselves 
unable to receive care because of discriminatory policies in their 
health plans that require them to pay more and receive less for mental 
health care than for other services. This bill will change that.
  This bill is another milestone in the long battle that must continue 
until everyone has full access to mental health services in our beloved 
Nation.
  The SPEAKER pro tempore. The Chair will advise the gentleman from

[[Page 20232]]

Minnesota that he has 6\1/2\ minutes remaining. The gentleman from New 
Jersey (Mr. Andrews) has 2 minutes remaining. The gentleman from New 
Jersey (Mr. Pallone) has 2 minutes remaining. And the gentleman from 
California (Mr. Stark) has 2\1/2\ minutes remaining.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from 
California (Mrs. Napolitano).
  Mrs. NAPOLITANO. Mr. Speaker, I thank the authors of this wonderful 
piece of legislation, the Paul Wellstone and Pete Domenici Mental 
Health Parity and Addiction Equity Act. This action is long, long 
overdue.
  As Chair of the Mental Health Caucus here in Congress, we have been 
working and dealing with this issue for over 10 years. Mental health 
and addiction services are decades behind other services. We must 
recognize that the brain is part of the body and it also has rights. 
Stigma has always been a part of what has prevented us from being able 
to move forward to work for the benefit of the people.
  It used to be businesses indicated that family leave was going to be 
a detriment and costly. It turned out not to be. This has that same 
effect. It is going to be a saver.
  It is my deepest hope that this will open the gates for further 
legislation addressing mental health, whether addiction or other 
issues. Suicide is the third leading cause of death in young people 
aged 10 to 24. It can lead to academic failure, family conflicts, 
substance abuse, violence, incarceration and alarming rates of suicide.
  The SPEAKER pro tempore. The gentlewoman's time has expired.
  Mr. RAMSTAD. I yield the gentlelady an additional minute.
  Mrs. NAPOLITANO. I thank the gentleman.
  The cost to society, to businesses and our families is unacceptable, 
and we need to move forward. Seventy-nine percent of those treated 
experience reduction of symptoms. We will continue to see these things 
crop up, whether it is veterans returning from Iraq, catastrophic 
happenings in our country such as 9/11, the hurricanes, the floods, the 
fires, all of that is going to cause us to continue to have a better, 
longer look at the effects it is costing our society, and the cost to 
our businesses and to our country. Our government cannot continue to 
ignore this issue. It affects our businesses and our health industry. 
They need to recognize this, and Congress has got to be able to 
recognize they can no longer ignore this. It affects the quality of 
life, and it is vital for the health and well-being of our communities 
and our schools.
  I urge my colleagues to support this vital legislation. Let's move on 
and remove the stigma for mental health.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. ANDREWS. Mr. Speaker, I am pleased to yield at this time 1 minute 
to the gentleman from New Jersey (Mr. Holt).
  Mr. HOLT. Mr. Speaker, I thank the gentleman.
  Today is a landmark day. Three cheers for Patrick Kennedy, Jim 
Ramstad and for the late Senator, my friend, Paul Wellstone. Today 
Congress makes clear that health is about more than having a healthy 
body, but being a complete individual from head to toe.
  We know that mental illness is treatable, yet because maybe one-third 
of the people affected do not receive the needed treatments, mental 
illness remains a leading cause of disability and premature death. 
Untreated mental illness is costly to individuals, to families, to 
companies large and small; yes, to the entire society. But from now on, 
millions of Americans who suffer from mental illness will receive full 
access to the treatment they need and deserve without higher copays and 
treatment limits.
  Finally, I am pleased to say that this bill protects States like New 
Jersey who go above and beyond coverage requirements that this 
legislation establishes. There is more to do, but this is a landmark, 
red letter day.
  Mr. RAMSTAD. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from 
Washington (Mr. Baird).
  Mr. BAIRD. I thank the gentleman.
  Before coming to Congress, I spent 23 years as a clinical 
psychologist. Let me share with you two key points. One, mental illness 
is not only debilitating, it can be fatal. But we can treat mental 
illness. The treatment for mental illness is research based. It is 
effective, it is cost effective, and it saves the American people in 
terms of quality of lives and dollars, and it is long past time that we 
stop discriminating.

                              {time}  1445

  I want to commend Patrick Kennedy, Jim Ramstad, all the cosponsors of 
this bill, and all the associations and the individuals who have worked 
so hard to, at long last, see it pass.
  Support this good bill. Make mental health parity reality at long 
last.
  Mr. RAMSTAD. I reserve the balance of my time.
  Mr. STARK. Mr. Speaker, I would be happy to yield the balance of my 
time to the distinguished gentleman from Illinois (Mr. Emanuel).
  The SPEAKER pro tempore. The gentleman is recognized for 2\1/2\ 
minutes.
  Mr. EMANUEL. Mr. Speaker, the issue of mental health parity doesn't 
always grab the biggest headlines, but the hard work that Democrats and 
Republicans have done to pass this landmark legislation will not go 
unnoticed.
  For too long, millions of Americans with treatable mental illnesses 
have gone without care. Some in the business community and the 
insurance industry said mental health parity simply costs too much, 
declined to provide that type of coverage, and patients and their 
workers and their families suffered.
  As those that know, when one individual in the family has an illness, 
a mental illness, the whole family is affected. That wrong ends today 
with this legislation. It ends because Democrats and Republicans, under 
the leadership of Patrick Kennedy, Ted Kennedy and Jim Ramstad, came 
together to back this landmark legislation, and never gave up.
  It ends because even once-skeptical insurance companies and the 
business community across the country, know that mental health parity 
is cost effective, and helps ensure that American workers and their 
families remain healthy and productive. And it is a tremendous victory 
for the millions of Americans who will finally have access to this type 
of care.
  This issue might not always be on the front page of the newspaper, 
but millions of Americans will finally get care they need and they will 
remember the work of those of us who do this.
  I'd also like to add a note that while I was campaigning for 
Congress, I wrote an op-ed on this issue because I had worked in a 
White House that through executive order, President Clinton signed, as 
you remember, legislation, Jim, that insured that Federal workers had 
this and set a model for Federal employees. Not one op-ed I had got 
more comment from people at the subway stops, at the grocery stores, 
people who wanted to usually talk about something else until you began 
that discussion, never really began this discussion, but it touched 
people of all walks of life, whether it was at the grocery store, on 
the way to work or on their front doorstep. They told you about what 
was going on in their family.
  Again, it's not the biggest headline; it's not the greatest. It's an 
important piece of legislation to give people peace of mind that they 
don't have to hide given the illnesses of depression and other types of 
substance abuse that they are facing, they now have an insurance policy 
that allows them and, again I want to say, their family to get 
protection, because one sick member of a family, with this type of 
illness, the entire family is affected.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. RAMSTAD. I yield an additional minute to the gentleman, Mr. 
Speaker.
  Mr. EMANUEL. I would like to thank Mr. Ramstad for that. I will try 
to not use that whole time.
  But this is the type of thing that you will find that people who 
normally

[[Page 20233]]

wouldn't talk to you about it will tell you stories of their family, 
their loved ones, their children who are facing illnesses, and you'll 
have done something to give them something; and it's ironic and I use 
this and I mean it when I say, a peace of mind. They will finally know 
that their sick child who is facing depression can get that care and it 
doesn't affect the whole family. And they know they got the type of 
care and they don't have to face a financial decision and being a good 
parent decision.
  We're doing something that allows people to go on with their lives. I 
want to thank Jim and Patrick and Ted Kennedy for never giving in. When 
all of us wanted to say, you know, it's just not the right time, it's 
too hard, the insurance industry doesn't like it. You never gave in. 
You never gave up. This is your day for making sure America lived up to 
its best potential. I want to thank you on a personal level from the 
floor. Thanks, Jim.
  The SPEAKER pro tempore. The gentleman from Minnesota (Mr. Ramstad) 
has 4\1/2\ minutes left. The gentleman from New Jersey (Mr. Andrews) 
has 1 minute left. The gentleman from New Jersey (Mr. Pallone) has 30 
seconds left.
  Mr. RAMSTAD. Mr. Speaker, in closing, I just want to thank all of 
those who have brought us to this point here today. As one who's worked 
on this legislation for 12 long years, it's truly been a team effort. I 
want to thank all of the organizations, all of the individuals, too 
many to mention here today, but I want to thank particularly David 
Wellstone and Allan Garrity from Senator Wellstone's staff who have 
kept the legacy of Paul Wellstone alive in terms of moving this mental 
health and addiction treatment parity legislation.
  I also want to thank the 274 bipartisan cosponsors of the current 
bill. I want to thank the leadership of Speaker Pelosi, Majority Leader 
Hoyer, because without their leadership we wouldn't be here today about 
to pass mental health parity.
  I want to thank the distinguished chairmen of the full committees and 
the subcommittees and the other side of the aisle whose cooperation has 
been incredibly positive and helpful; and without their support, every 
one of you, without your support we wouldn't be here today as well.
  I want to thank the leadership and the tireless efforts of my friend 
from Rhode Island, the chief cosponsor, Patrick Kennedy, who has worked 
so hard on this legislation from the minute he was sworn in as a Member 
of the House.
  I want to thank all the staff from the full committees, the three 
full committees of jurisdiction, as well as the three subcommittees of 
jurisdiction.
  And I particularly want to thank Karin Hope, my legislative director, 
who has worked on this legislation day and night for all 12 years that 
we've worked together.
  Let me just wrap it up, Mr. Speaker, by saying that it's time for 
Congress to deal with America's number 1 public health problem. It's 
time for Congress to outlaw discrimination in treatment against people 
with mental illness and chemical addiction. It's time for Congress to 
pass mental health and chemical addiction treatment parity.
  I yield back.
  Mr. ANDREWS. Mr. Speaker, I am pleased to yield the balance of our 
time to the gentlewoman from California (Mrs. Davis).
  The SPEAKER pro tempore. The gentlewoman is recognized for 1 minute.
  Mrs. DAVIS of California. Mr. Speaker, as everyone has said before, 
this bill is a victory. It may not be everything that everyone had 
hoped to get into this bill, but it is going in the right direction. It 
does ensure treatment, it does address the stigma associated with 
mental health disorders.
  I just wanted to point out that we have so many of our servicemembers 
who are coming home who have fought in Iraq and Afghanistan. And they 
are coming home and transitioning to civilian life. But they are going 
to find some barriers as well. The barriers to mental health care are 
really playing themselves out today because I just talked to a family 
just a little while ago, and they felt that even though we're starting 
to put in some of those services, there's great resistance to people 
seeking that kind of care.
  This bill begins to change that. It sends a very clear and a very 
direct message that mental health care is as important as physical 
care. We wouldn't stop people in the middle of their treatment for 
something of stomach ulcers. You cannot stop people in the middle of 
their treatment for mental health disorders.
  Mr. Speaker, I'm pleased this bill is on the floor.
  The SPEAKER pro tempore. The gentleman from New Jersey is recognized 
for 30 seconds.
  Mr. PALLONE. Mr. Speaker, this bill would allow those individuals and 
families struggling to cope with the diverse array of mental illnesses 
to have greater access to affordable care. We can't delay any longer.
  I strongly urge my colleagues to vote in favor of the passage of this 
important legislation which will ensure access to equitable health 
coverage for the millions of American who suffer from mental illness.
  Mr. LARSON of Connecticut. Mr. Speaker, I rise today in support of 
H.R. 6983, the ``Paul Wellstone and Pete Domenici Mental Health Parity 
and Addiction Equity Act of 2008.'' I would first like to commend 
Representative Patrick Kennedy and Representative Jim Ramstad on their 
outstanding efforts and tireless work on this important issue.
  For far too long too many individuals and families have struggled 
with mental health illness and substance abuse disorders and yet have 
faced a health care system that provided them with unequal access to 
care. This bill is a step in the right direction for our country as it 
provides another degree of fairness for our citizens.
  In short, it ensures that group health plans can no longer charge 
people more for seeking treatment for mental health or substance abuse 
problems. It also provides that out of pocket and visit limits may be 
no different for mental health and substance abuse care than for other 
medical care.
  According to a report by the Lieutenant Governor's Mental Health 
Cabinet in Connecticut, of the nearly 600,000 of our state residents 
who experience symptoms of mental illness, 135,000 suffer from a 
serious condition and 66,000 suffer from a severe condition. Countless 
others suffer from debilitating substance abuse disorders. These 
problems are every bit as serious as other medical conditions and must 
be treated by our health care system as such.
  Again, I want to commend my colleagues who worked so hard on this 
issue to reach a bipartisan compromise and reiterate my strong support 
for this legislation.
  Mr. COURTNEY. Mr. Speaker, stigmas surrounding mental health illness 
have negatively impacted disease acceptance, and in turn, access to 
quality care and treatment. For too long, members of our eastern 
Connecticut community and Americans across our nation have suffered the 
consequences of these inequalities in our health care system. Today, we 
have the opportunity to ease access to quality care and treatments for 
those with mental illness by passing the Paul Wellstone and Pete 
Domenici Mental Health Parity and Addiction Equity Act (H.R. 6983).
  In 1996, the Mental Health Parity Act codified the first national 
mental health parity requirements, mandating that annual and lifetime 
dollar limits on coverage for mental health treatment be no less than 
those for physical illness. While this legislation marked a monumental 
achievement with improving access to mental health care and treatments, 
more must be done.
  Throughout the 110th Congress, the House and Senate have worked on 
mental health parity legislation that will extend coverage requirements 
beyond those established in the Mental Health Parity Act of 1996. The 
Mental Health Parity Act (S. 558) introduced in the Senate and the Paul 
Wellstone Mental Health Parity and Addiction Equity Act (H.R. 1424), 
which I cosponsored in the House, both extend coverage mandates to 
include equity in copayments, deductibles, as well as in- and out-of-
network coverage. On March 5, 2008 and September 17, 2007, the House 
and Senate respectively passed H.R. 1424 and S. 558 with bipartisan 
support. The Paul Wellstone and Pete Domenici Mental Health Parity and 
Addiction Equity Act reflects a compromise between the House and Senate 
bills, and more broadly, an equitable standard for mental health care 
coverage.
  Mr. Speaker, nearly one in four Americans suffers from a diagnosable 
mental disorder. By passing the Paul Wellstone and Pete Domenici Mental 
Health Parity and Addiction Equity

[[Page 20234]]

Act we recognize the prevalence and seriousness of mental health 
illness as well as the need for expanded coverage. I ask my colleagues 
to join me in voting in favor of this critical legislation.
  Mr. VAN HOLLEN. 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 on 
this very important issue that is so important to millions of Americans 
around this country.
  The bill before us today is the product of their determination, 
perseverance and passion. They traveled across this great land holding 
field hearings listening to Americans from all walks of life. I had the 
privilege of hosting one of those hearings in my congressional 
district. The message from that hearing, as with 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 dictate that mental health 
diseases be treated on an equal footing with other conditions. 
Unfortunately, employer-provided health care set stricter treatment 
limits and imposed higher out-of-pocket costs for mental health care 
for many years. The Paul Wellstone and Pete Domenici Mental Health 
Parity Act of 2008 will reverse this practice and ensure that group 
health plans do not charge higher co-payments, coinsurance, 
deductibles, and do not lower day and visit limits on mental health and 
addiction care than for medical and surgical care.
  Mr. Speaker, this bill is completely paid for. Let us honor the 
spirit of Paul Wellstone and pass this much-needed legislation. I 
strongly urge my colleagues to vote for it.
  Ms. LEE. Mr. Speaker, I rise today in support of H.R. 6983, the Paul 
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 
Act, to require equity in mental health and substance-related disorders 
under group health plans.
  I want to thank Representative Patrick Kennedy for his leadership in 
developing and negotiating the passage of this critical law.
  It's also right that this bill be named in honor of Senator Domenici 
and our friend, the late Senator Paul Wellstone. Senator Wellstone was 
truly a champion for mental health and this Act honors his memory.
  As a former psychological social worker, I appreciate the necessity 
of mental health parity and the significance of this bill. Many 
diseases go hand in hand with depression, substance abuse, and a 
variety of other mental health issues that cannot go untreated.
  For example, when a person is diagnosed with cancer or HIV, they and 
their families go through a range of emotional responses. To treat only 
the physical signs of illness is to ignore the broad ranging emotional 
implications of a disease.
  Currently, companies can limit both the number of visits that a 
person makes to a mental health professional in a year and the network 
of doctors a patient can see, even where no such limit exists for 
medical or surgical benefits. That is ridiculous.
  Disease treatment must provide individuals with the ability to adapt 
their lifestyle and manage the changes associated with their illness. 
Whether it is anxiety, stress, or even stigma--the diagnosis of a 
disease always impacts an individual's mental health. To downplay the 
necessity of mental health care in treatment is simply 
counterproductive.
  By enacting this bill to require mental health parity, we take a 
crucial step forward in guaranteeing that our constituents can access 
the level of health care that they need. I believe however, that 
fundamentally, we need to move to a universal health care system.
  Additionally, the Act prohibits insurance companies from charging 
different rates for deductibles, copayments, coinsurance, and out-of-
pocket expenses for mental health.
  These commonsense changes will help expand access to mental health 
services throughout the country, and I am pleased to support them.
  I urge the president to sign H.R. 6983, the Paul Wellstone and Pete 
Domenici Mental Health Parity and Addiction Equity Act and to recognize 
that mental health care is a crucial tool in promoting the overall 
health and well-being of the American people.
  Mr. ETHERIDGE. Mr. Speaker, I rise today in support of H.R. 6983, the 
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 
Equity Act of 2008. I applaud your leadership in bringing this bill to 
the floor and addressing the issue of mental health parity. We must 
expand access to mental health to ensure a strong and productive 
America that provides for its most vulnerable citizens. This bill will 
do just that, without creating an undue hardship on employers or 
insurers.
  The Paul Wellstone and Pete Domenici Mental Health Parity and 
Addiction Equity Act requires those insurers or group health plans who 
do choose to cover mental health to do so on an equal basis with other 
covered health needs. This will ensure that those in need can get the 
treatment that is medically necessary.
  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, and I am pleased that we are following suit today in passing 
this bill.
  I urge my colleagues to join me in voting for H.R. 6983.
  Ms. ESHOO. Mr. Speaker, the legislation we are voting on today, the 
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 
Equity Act, can be appropriately characterized as civil rights 
legislation. Our country has made a great deal of progress in ending 
discrimination over the last half century, but a person's medical 
condition is still the basis for discrimination. Nowhere has this fact 
been more evident than with respect to mental illness and the stigma 
that has been attached to it.
  Until a generation ago, parents were accused of causing their 
children's mental illnesses. In passing the Paul Wellstone and Pete 
Domenici Mental Health Parity and Addiction Equity Act, America is 
taking a giant step to remove the stigma surrounding mental illness, 
and how proud I am that my constituent, David Wellstone, has taken up 
his late father's effort to make this bill, which I'm a cosponsor of, a 
reality.
  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 use disorders when compared to medical and 
surgical disorders. The legislation ensures that group health plans 
cannot charge higher copayments, coinsurance, or deductibles nor can 
they impose higher maximum out-of-pocket limits on mental health and 
addiction care than for medical and surgical benefits. While the bill 
does not mandate group health plans to provide mental health coverage, 
it does require parity if they do.
  This is landmark legislation. It is fair and it is sensible. And it 
stands as a tribute to the families and patients who for decades have 
advocated for its passage. With true parity for mental health benefits, 
the door that was locked by stigma is once and for all open to coverage 
for more Americans, recognizing their worth and dignity.
  How proud I am to have been part of the long fight which has brought 
us to this day!
  Ms. McCOLLUM of Minnesota. Mr. Speaker, I rise today in strong 
support of H.R. 6983, the Paul Wellstone Mental Health and Addiction 
Equity Act. It is long past time that the 54 million Americans 
suffering from mental illness have access to the care they need, and we 
cannot afford another day to go by.
  This legislation is named in tribute to the late Minnesota Senator 
Paul Wellstone whose work on this issue was groundbreaking. I also rise 
to thank my colleague from Minnesota, Congressman Jim Ramstad, for his 
courage in sharing his experience with substance abuse and his hard 
work on this legislation. Without his dedication and perseverance, we 
would not be at this critical moment.
  We have all been affected in some way--ourselves, a family member, a 
friend, or colleague--by mental health or substance abuse. This is an 
issue I hear about in my district a lot and I thank my constituents who 
have been willing to share their stories to make change.
  The current system is unfair and inadequate. People should not have 
to forego essential treatment because of cost when care could mean 
improvements to their quality of life and productivity. Parents should 
not end up with an emergency room bill they cannot pay because they 
rushed their child to the hospital after a suicide attempt. Our service 
men and women returning from Iraq should not be handed a 1-800 number 
to treat a mental illness.
  Passing this bill is both morally and economically right because 
delay not only affects individuals and families, but it also affects 
schools, businesses, and our communities. I urge my colleagues to join 
me in voting for this important bill. Today we can finally make mental 
health parity a reality.
  Mr. GEORGE MILLER of California. Mr. Speaker, I rise today in support 
of the Paul Wellstone and Pete Domenici Mental Health Parity and 
Addiction Equity Act of 2008.
   Over the years, there have been numerous hearings in DC and around 
the country at which individuals and their family members testified 
about the need for parity in the treatment of mental health and 
addiction conditions.

[[Page 20235]]

   The final bill being considered today will eliminate most if not all 
of the abuses that families across the country have testified about. 
The following are examples of many of the major inequities that the 
bill is designed to eliminate:
   Emergency Care:
   Dr. Gerry Clancy described seeking prior authorization for a 
suicidal patient. Wanting to confirm that this was a serious suicide 
attempt, the health plan reviewer asked whether the patient had a plan 
to take his own life. Dr. Clancy answered that the patient planned to 
shoot himself. He said the reviewer then went farther and said, ``Does 
that person have a gun?'' and Dr. Clancy answered ``yes.'' Dr. Clancy 
said he could not believe the next question: ``does the person have 
bullets?''
   No family in America should have to face having to justify why a 
suicide attempt is a real medical emergency. The final bill would 
require plans to have the same requirements for prior authorization, 
terms and financial limitations, co-pays, deductibles and day and visit 
limits on emergency benefits for mental health and addiction treatment 
services as the plan has on medical and surgical emergency services 
covered under the plan.
   Medical Necessity:
   Michael Noonan, the father of a college-enrolled daughter who 
suffered from chemical dependence, testified about the struggle his 
family faced to access inpatient addiction treatment for his daughter. 
After his daughter encountered a series of escalating problems and 
relapses, her clinician recommended inpatient rehabilitation for her 
alcohol dependence. He contacted his insurance company and was told 
that his contract included a benefit for inpatient rehabilitation for 
substance use disorders with a $200 deductible and 30 day coverage. In 
spite of confirming these benefits with his managed behavioral health 
care company, the authorization of his daughters' inpatient care was 
suspended after only five days of care. Mr. Noonan endured repeated 
denials, took out a home equity loan of $23,000 to pay for treatments 
while processing appeals, and requested the assistance of his 
congressional representative in order to secure payment for the 
treatment of his daughter. His experience was echoed in the testimony 
of many others, like Xavier Ascanio, whose daughter Samantha was 
hospitalized for an eating disorder. ``During the inpatient stay, the 
insurance company doled out pre-approval two or three days at a time. 
Imagine that hanging over you, both as a parent and as a patient.''
   Under the final bill, health plans are required to disclose upon 
request the criteria for medical necessity determinations and the 
reason for any denial made under the plan with respect to mental health 
and substance use disorder benefits to the participant or beneficiary.
   Out of Network:
   Xavier Ascanio testified how difficult it was to find a qualified 
provider in-network to treat his daughter for an eating disorder. He 
said that after dealing with a parade of providers who were not 
helpful, they finally found some who were knowledgeable and could 
really help. Unfortunately, the providers were not on any insurance 
company's PPO list.
   Ms. Melinda Lemos-Jackson whose young son was diagnosed with an 
autism spectrum disorder when he was 3 years of age testified, ``Would 
you go to an internist for a heart condition or would you go to a 
cardiologist? I have placed the calls to the clinicians, who upon 
interview, don't meet my son's needs, I have tried some of the in-
network clinicians who clearly are not suitable. I've sometimes spoken 
to highly regarded folks who are actually on the list, only to find out 
that their practices are closed or they can't take a child like my son 
at this time, so we get the services our son needs and we learn to 
bring our checkbook and our Visa. Our health insurance is not 
accepted.''
   What Mr. Ascanio and Ms. Lemos-Jackson described are ``phantom 
networks.'' ``Phantom networks'' are networks offered by plans that 
lack an acceptable number and array of providers that offer real 
options for help or hope for people with mental illness or addiction.
   Ensuring equitable access to out-of-network benefits for mental 
health and addiction benefits is critical for making sure patients 
receive the care they need. A February 2007 RAND Corporation study 
looked at one health plan and found only 11.8% of patients accessing 
mental health benefits under the plan received care out-of-network. 
Moreover, a December 2007 study in Health Affairs on parity in the 
FEHBP found that parity legislation that does not extend parity to out-
of-network benefits may have the unintended consequence of decreasing 
access to mental health and addiction treatment services altogether.
   The final bill requires health plans to have the same terms and 
financial limitations on out-of-network benefits for mental health and 
addiction treatment services as the plan has on medical and surgical 
services covered under the plan. Plans must provide out-of-network 
benefits for mental health and substance use disorders in exactly the 
same manner as out-of-network medical and surgical benefits provided 
under the plan in order to be in compliance with this Act.
   Wellness Plans:
   Wellness plans can include information about diet, exercise, stress 
management and other forms of chronic disease management tools, but 
they are no substitute for mental health and addiction benefits. 
Increasingly, we have seen employee assistance programs that provide 
drug and alcohol treatment move to providing family counseling, stress 
management and other extremely helpful resources--but they are not a 
substitute for addiction treatment.
   The final bill would prohibit a plan from changing its benefit 
design to a ``wellness plan'' to avoid compliance with the parity 
requirements of this Act.
   The Diagnostic and Statistical Manual DSM:
   Kitty Westin, the President of the Eating Disorder Coalition, spoke 
movingly about the need for full diagnostic coverage of mental 
illnesses. Anna Westin, Kitty's daughter, died at the age of 21 due to 
lack of access to care for her severe eating disorder. Despite having 
the ``Cadillac'' of insurance policies, Anna was repeatedly denied the 
treatment she needed. Eating disorders, like other diagnoses affecting 
children and youth, are often singled out for denial, a form of 
discrimination that led to the strong push in this legislation to 
require insurers to use the widely-accepted Diagnostic and Statistical 
Manual (DSM), rather than allowing plans to pick and choose diagnostic 
coverage based on cost or bias.
   The DSM is a diagnostic manual developed by the American Psychiatric 
Association, through an open process involving more than 1,000 national 
and international mental health researchers and clinicians. It is used 
by virtually all private insurance companies, along with Medicaid, OPM 
for the Federal Employees Health Benefit Program, Tricare, and 
Medicare, which all require DSM criteria for the submission of claims. 
All NIH grant submissions, FDA drug indications for treatment, and 
legal indications for mental competency require the use of DSM codes 
and guidelines.
   Despite this status as a recognized authority, the DSM itself became 
the focal point for many heated debates during the parity negotiations, 
launched by opponents of parity. However, in the end, language to 
require the DSM as the basis for coverage was not included in this 
bill. The final bill requires the Government Accountability Office 
(GAO) to monitor and report to Congress on the extent to which health 
plans comply with the requirements of this Act to provide meaningful 
parity to the millions of families who experience mental health or 
substance abuse conditions.
  Mrs. MALONEY of New York. Mr. Speaker, I rise in strong support of 
H.R. 6983, the Paul Wellstone and Pete Domenici Mental Health Parity 
and Addiction Equity Act. I stand with millions of families, 
caregivers, healthcare professionals, and individuals in gratitude to 
this Congress, led by chief sponsor, Representative Patrick Kennedy, 
who have joined forces in a bipartisan manner to help those suffering 
from mental illness. Today, we tell Americans from all walks of life 
that we understand that mental illness is just like any physical 
illness, we understand the difficulties you have been facing, and we 
are here to end discrimination against patients seeking treatment for 
mental illnesses.
  One out of every five adults in the United State suffers from mental 
or substance abuse disorders, which according to the Wall Street 
Journal, cost our economy $550 billion last year. Of course, treating 
mental illness is not about dollars and cents. It's about lives which 
are ruined and lives which are lost. Last year one, more than 30,000 
Americans committed suicide from untreated depression and 150,000 
Americans died as the direct result of chemical addiction. When people 
are not properly treated, or not treated at all, our Nation as a whole 
suffers.
  H.R. 6983 permanently reauthorizes and expands the Mental Health 
Parity Act of 1996 to provide for equity in the coverage of mental and 
substance use disorders compared to medical and surgical disorders. The 
legislation ensures that group health plans do not charge higher 
copayments, 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. As under current law, the 
Department of Health and Human Services, the Department of Labor, and 
the Internal Revenue Service may penalize health plans for 
discriminatory practices under the bill and individuals may bring a 
private right of action to receive covered benefits.

[[Page 20236]]

  Discrimination on all counts must be eliminated in this country. This 
bill takes a giant step in the right direction. I am grateful to our 
leadership for moving this bill which is sure to help millions of 
Americans.
  Mr. GEORGE MILLER of California. Mr. Speaker, I rise in strong 
support of the Paul Wellstone-Pete Domenici Mental Health Parity and 
Addiction Equity Act.
  This important bipartisan piece of legislation would not have been 
possible without the vigorous advocacy of the late Senator Paul 
Wellstone and the continued dedication and commitment of Senator 
Wellstone's family.
  In addition, I want to thank Congressmen Kennedy and Ramstad as well 
as Senators Kennedy and Domenici. Without their tireless efforts, this 
bill would not be before us today.
  Mental illness and substance abuse affects millions of families 
across this country.
  Without treatment, those suffering from mental illness and substance 
abuse often struggle to hold a job or make ends meet.
  Today, approximately 44 million Americans suffer from mental illness, 
but only one-third receive treatment.
  A key component of this problem is that private health insurers 
generally provide less coverage for mental illnesses and substance 
abuse than for other medical conditions.
  A 2002 Kaiser Family Foundation study found that, while 98 percent of 
workers with employer-sponsored health insurance had coverage for 
mental health care, 74 percent of those workers were subject to annual 
outpatient visit limits, and 64 percent were subject to annual 
inpatient daily limits.
  H.R. 6983 amends the Employer Retirement Income Security Act (ERISA) 
to prohibit employer group health plans from imposing mental health or 
substance abuse treatment limitations, financial requirements, or out-
of-network coverage limitations unless comparable limitations 
requirements are imposed upon medical-surgical benefits.
  The out of network coverage provisions are particularly important.
  Under this provision, if a health plan permits individuals to go to 
an emergency room for a medical condition without prior authorization; 
or an out-of-network hospital or treatment center at network rates for 
a medical condition, then the plan must apply the same rules to an 
individual suffering from a mental illness or substance disorder.
  In addition, the bill does not require group health plans to provide 
any mental health or substance abuse coverage.
  However, if the group health plan does offer mental health and/or 
substance abuse benefits, there must be equity between mental health 
and/or substance abuse coverage and all comparable medical and surgical 
benefits that the plan covers.
  As a result, more Americans will be able to access affordable mental 
health and substance abuse benefits.
  Nothing in H.R. 6983 is intended to preempt stronger state mental 
health and substance abuse parity laws.
  The Committee on Education and Labor has analyzed each state's mental 
health and substance abuse law; it is our understanding and intent that 
this legislation will not preempt any of these laws.
  In other words, a state law that may contain broader or more 
favorable mental health and/or substance abuse benefit requirements 
will not be preempted.
  Finally, this bill directs the Department of Labor to provide 
information and assistance to individuals, employers, and states in 
order to help them comply with the requirements of this law.
  H.R. 6983 enjoys broad, bipartisan support.
  And, I would particularly like to recognize the dedication and 
commitment of Paul Wellstone's family to getting this bill passed. We 
know how important this issue was to Paul and it is in his memory that 
we take this vote today.
  I urge all of my colleagues to join me in voting for the Paul 
Wellstone/Pete Domenici Mental Health Parity and Addiction Equity Act.
  It is time to end the stigma and provide fair coverage to those in 
need.
  Mr. PALLONE. I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 6983, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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