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been the courage of citizens and citizen groups that has made the difference.

Now, Mr. Chairman, the Wall Street Journal has had some articles about all the ways in which the business community and the employers recognize this is the right thing to do. I think there is a tremendous amount of momentum.

Here is the way I would conclude: the current estimate is 20 percent of the U.S. adult population, over 70 million Americans, are affected by mental disorders every year. The research on children is not as well documented, but the percentage of children affected by mental or emotional disorders appears to be very similar, at about 20 percent, with 9 percent severely affected. So, Mr. Chairman, this legislation is certainly an idea whose time has come.

For one illness, depression, 18 million people in the country suffer from depression. Suicide is the eighth leading cause of death in our country, and the second leading cause among young people 15 to 24. The highest percentage of suicide is with the elderly population. Yet, we also know that this illness is so diagnosable and treatable.

We need to do more. Federal legislation is needed. The next critical step is to pass this legislation, the Mental Health Equitable Treatment Act. Mental illness, as my colleague from New Mexico said, does not discriminate among political parties. It doesn't discriminate along race or gender or age. I think all of us need to come together to support people. I think this is an historic, bipartisan effort. I ask each and every one of you to join us—many of you have-as cosponsors of this bill.

I hope and pray—I use that word carefully—I hope and pray that this legislation will pass because I know it will make such a positive difference in the lives of people.

Thank you.
The CHAIRMAN. Thank you very much.
[The prepared statement of Senator Wellstone follows:]

PREPARED STATEMENT OF SENATOR WELLSTONE Mr. Chairman, I want to thank you for the opportunity to speak to the committee this morning on an extremely critical health issue facing millions of Americans: parity for the treatment of mental ill

ness.

On March 15 of this year, I joined my colleague Senator Pete Domenici in the introduction of the Mental Health Equitable Treatment Act of 2001 (MHETA, S. 543) that will help ensure that private health insurance companies provide the same level of coverage for mental illness as they do for other diseases. The bill is based on the Federal employee health benefit plan, which became effective in January of 2001. It will expand the Mental Health Parity Act of 1996 to prohibit a group health plan from imposing treatment limitations or financial requirements on the coverage of mental health benefits, unless comparable limitations are imposed on medical and surgical benefits.

It is time to move forward on this bill. We know from the CBO that the cost is affordable, and we know from the experience of the 1996 bill that the new bill is necessary.

This bill is the critically important next step toward ending the persistent discrimination against people who suffer from mental illness. Some have suggested that expansion is not needed, that we should just reauthorize the 1996 law, which has a sunset date of September 30, 2001. It is my view that to merely reauthorize the 1996 law is, in some ways, worse than simply allowing the law to lapse. Why? Because we know that the discrimination against the mentally ill has worsened. As was reported in a hearing held in the last Congress, we learned from a GAO report requested by the HELP committee chairman at that time, Sen. Jeffords, that despite the limited objectives of the 1996 law, there were numerous examples of violations of not only the spirit, but even the letter of the law. GAO found that although most employers complied with the Act, they expanded other discriminatory coverage limits. Eightyseven percent of the surveyed employers have a limit on mental health benefits lower than what is offered for other medical/surgical benefits. Several states were seen as noncompliant and HCFA reported that they are working with them to make the appropriate changes. It is clear from this report that the gains intended by the 1996 law have not yet been attained and that further federal legislation strengthening and expanding the 1996 law is badly needed.

A new research article in the July August issue of Health Affairs notes that the 1996 law contributed to a surge of efforts to establish parity for mental health treatment at the state level. Threefourths of these new state laws were passed after the federal law was passed. More than 34 states have established as law some form of mental health treatment parity. But the variation of state laws is extensive and confusing to many consumers, particularly to those who may live in one state and work in another. More importantly, the thousands of consumers who work for companies protected by the Employee Retirement Income Security Act (ERISA) exception will not be affected by any changes in state law. ERISA allows companies who self-insure not to comply with state laws. We know that this exception has created problems for other conditions that required federal legislation, including maternity treatment and mastectomy treatment.

It is time now to establish mental health parity for all Americans covered by private insurance. I recognize, of course, that this does not address the difficulties of those who are not covered by any insurance, or who receive their health care through public programs. But it is essential that this Congress provide the federal leadership that has already been demonstrated for federal employees. It is time to establish fair and equitable treatment for those with mental illness as the law of the land.

Today, you will hear powerful testimony about how badly this treatment coverage is needed, how mental illness has affected the lives of so many Americans throughout our country, and how the costs for such treatment are very low. We know from testimony in last year's hearing from Delta Airlines representatives that employers recognize the value of coverage for those with mental illness. This year, a Statement for the Record is being submitted by Stanford Alexander, Chairman of Weingarten Realty Investors, a Texas-based company with properties in 15 states and over 200

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employees. He states that his company fully supports federal legislation to establish parity for mental health insurance coverage.

Numerous reports have shown that fair and equitable mental health treatment can be offered as part of a health benefit package without escalating costs. Today, we have even more compelling evidence that this is so. There should be no further doubt that treatment for mental illness is a health care benefit is that our country can afford, and even more important, is one that the our country should and must provide for the millions of Americans covered by private insurance. It is time to lay the issue of cost to rest, for we know that with the appropriate medical oversight, costs are low. It is no longer a question of can we afford it, but rather, can we afford not to provide health care for the millions who suffer from mental illness.

It is clear that there is support for this bill throughout our country. There are 41 cosponsors of this new bill, and we fully expect new cosponsors in the coming weeks. There are 116 diverse groups supporting its passage. I am so proud of the extraordinary efforts of the mental health community to come together to advance this cause. I am particularly pleased that so many other groups have come forward as well to support this bill, including advocates for children, the disabled, and the elderly, and representatives of religious organizations, educational associations, and other health care organizations. So many areas of community life are affected by the

problems of untreated mental illness. These groups recognize that private insurance systems must do their part, alongside public health systems, to ensure that adequate treatment is accessible and affordable. It is clear that the time is now for employers to recognize that mental illness is as real an illness as any other medical condition, and that without treatment, it is life-threatening and severely disabling.

Many employers already do recognize this basic fact. A series of articles published in the Wall Street Journal in June, 2001, recounts the growing recognition of employers that mental illness is a reality in the workplace and can be documented as a workplace

the same time, the articles note that when employees are given access and benefits to receive proper treatment, companies are able to retain highly able and productive employees. The articles note that the stigma associated with mental illness can lead to untreated illnesses that turn up as other healthcare costs, lost productivity, or absenteeism, so that attempts to reduce overall health care costs by targeting those with mental illness may in fact lead to other workplace costs, in addition to greater suffering.

In our country, and throughout the world, mental illness continues to be stigmatized as a disease for which one should feel shame. People are made to feel that they are lucky or should feel grateful when they get any coverage, even when they are routinely denied adequate treatment. Why? The stigma associated with the illness is one reason, for it not only doubly burdens the person who suffers from this illness, but it makes it easier for insurance companies to deny treatment, knowing that the person may not want to or be able to file public appeals or bring this matter to their employer. A cloak of secrecy has surrounded this disease, and people with mental illness are often ashamed and afraid to seek treatment. They fear that they may lose their jobs or even their friends and family.

The statistics concerning mental illness and the state of health care coverage for adults and children with this disease are startling and disturbing. The current estimate is that about 20 percent of the U.S. adult population-over 50 million Americans—are affected by mental disorders during a given year. Although the research on children is not as well-documented, the percentage of children affected by mental or emotional disorders appears to be very similar, at 20 percent, with 9 percent severely affected.

One severe mental illness affecting millions of Americans is major depression. The National Institute of Mental Health, a NIH research institute within the U.S. Department of Health and Human Services, describes serious depression as a critical public health problem. More than 18 million people in the United States will suffer from a depressive illness this year, and many will be unnecessarily incapacitated for weeks or months, because their illness goes untreated. Depressive disorders are not the normal ups and downs everyone experiences. They are not just "the blues." They are illnesses that affect mood, body, behavior, and mind. Depressive disorders interfere with individual and family functioning. Without treatment, the person with a depressive disorder is often unable to fulfill the responsibilities of spouse or parent, worker or employer, friend or neighbor. Without treatment, a person can die.

Available medications and psychological treatments, alone or in combination, can help 80 percent of those with depression. But without adequate treatment, future episodes of depression may continue or worsen in severity. Yet, the steady decline in the quality and breadth of health care coverage is truly disturbing.

The movement for parity for treatment for mental illness is growing. Over the past few years, the principle of parity in insurance coverage for mental health treatment has received the strong support of the previous White House, the Surgeon General and many leading figures in medicine, business, government, journalism, and entertainment who have suffered from mental illness and have been successfully treated. Federal employees receive full mental health and substance abuse treatment parity. Mental health hearings on the Hill have frequently highlighted recent major advances in scientific information about the disease, the biological causes or consequences of mental illness, the effectiveness and low cost of treatment, as well as many painful, personal stories of people, including children, who have been denied treatment. In addition to federal parity legislation, 34 of our states have passed some form of mental health or substance abuse treatment parity. We do not discriminate against other illnesses where the brain is affected. Why do we continue to discriminate against mental illness? It is time for the federal government to enact legislation that will help move us toward full treatment parity for mental illness.

The important thing to remember is that we cannot wait any longer for mental health treatment parity. Mental illness is a real illness, and to fail to provide treatment for those suffering from this disease is costly and life-threatening. Suicide is the 8th leading cause of death in our country, and is the second leading cause of death among young people aged 15-24 in many states, including

New Hampshire, Wyoming, Virginia, Maine, Iowa, New Mexico, Washington, Vermont, and my own state of Minnesota. Suicide has the highest rate among the elderly. We know that among those who have died from suicide, more than 90 percent had a diagnosable mental illness.

We need to do more to help. This hearing today is an important step to making sure we change the laws, the attitudes, and the practices in our society that lead to this discrimination. But it is only a modest first step. The 1996 Mental Health Parity law was a groundbreaking federal law that sent the message loud and clear that we will not tolerate the exclusion of those with mental illness from our health care system. A critical next step is enactment this year of this new bill, the Mental Health Equitable Treatment Act of 2001 which is designed to take an even larger step toward ending the suffering of those with mental illness who have been unfairly discriminated against in their health coverage. I hope the Senate will move forward quickly on this bill and ensure its enactment before the 1996 law sunsets in September of this year.

The CHAIRMAN. Senator Roberts indicated that he has other conflicts in his schedule, and we always try to accommodate members in those cases. We will do the best we can.

Senator Domenici, we wanted to invite you up here.
Senator DOMENICI. I am coming up.
Senator WELLSTONE. Am I invited up there, too?

The CHAIRMAN. You are invited up here. So there go the questions, gang. (Laughter.]

This has gotten off to a rather ominous beginning. Witnesses leave the witness table and come up here and take charge, and the rest. But I guess that is the way it is with the new leadership. [Laughter.]

I will ask Senator Roberts if he wants to comment, and then we will go back to Senator Dodd and Senator Collins. I think we can address any questions to our colleagues on the dais here, and then we will move ahead with some good witnesses.

OPENING STATEMENT OF SENATOR ROBERTS Senator ROBERTS. Well, I don't know of any other commitment that is more important than this.

I noted in my conversation with you, sir, that my colleagues were able to give an opening statement, and that is basically what I have, but I will shorten it up. I just want to thank Paul and I want to thank Pete for their leadership in this.

Mr. Chairman, I think there is another aspect to this that I feel very strongly about. I don't know if it is the proper aspect or the correct one, and this is in relation to my very close relationship with Pete and St. Nancy, who is in the audience, and she is a saint. It was after the tragedy at the Capitol where the Capitol Hill Police paid the ultimate sacrifice for our safety.

Senator Frist, who is our resident doctor in charge, was on the scene immediately, as he is with those kinds of incidents, and reported to us that the perpetrator—and we all know that circumstance and that is all tied up in all sorts of lawsuits had no idea what he had done.

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