We were discussing this. I think it was at lunch, Pete. I can't remember the exact place, but several of us were visiting and Pete said how many lost souls are out in our society doing violent acts, not even knowing what they are doing, that are lost from their families, obviously off their medication, absent from any treatment? So in terms of, I call it an anti-violence remedy-I don't know if that is a good acronym. We will have to come up with a better acronym, but if we really think about that, I think that is part of the equation. So I want to thank both Pete and Paul for their efforts. Paul, if we introduce this as an amendment to a bill, could we have Pete do it? [Laughter.]

Senator WELLSTONE. Absolutely.

Senator ROBERTS. Just a suggestion.

Senator WELLSTONE. I will make a commitment to do far fewer amendments on the floor.

Senator ROBERTS. All right, thank you.

I am an original cosponsor. Mr. Chairman, I wanted to get our former governor and speaker of the Kansas House, Mike Hayden, to come as a witness. I must say that I know that apparently there was a 7-day notice requirement July 3, but we were all on vacation. That is, in part, our fault as well. I know Senator Gregg had a lot of feeling about this, and so I would hope from a process standpoint we could work that out.

I just want to brag a little on my State. Kansas first enacted mental health legislation in 1977 under the leadership of State Senator Jan Meyers. She later became a Congresswoman, an outstanding lady. Speaker Mike Hayden later became governor.

Benefits were limited, caps were placed on coverage, and 98 employees of the State of Kansas had not been receiving the same benefits as other physical illnesses for its HMO plan. Then after 14 years of tireless work and deliberation, our current governor, Bill Graves, signed into law mental health parity legislation.

So the State of Kansas joins over 30 other States, Mr. Chairman, all throughout the country that require employers who offer mental coverage within their insurance plans to cover them on an equitable basis. In fact, the Kansas State employees health care plan expanded the mental health care coverage for mental illness to all health plans. Note the cost: during the 2-year trial period, it only increased 1 to 1 1/2 percent, so it was cost-effective.

Now, Mr. Chairman, the only thing that I would like to say in regard to this legislation is I would hope we take another look and reconsider the small-business exemption. I know that was lowered from 50 to 25. I just don't want to see a business in Kansas that employs 28 people incurring any additional cost.

I know in regard to the Patients' Bill of Rights legislation that we have considered-and I don't want to go back over that argument by any means, but I think the small-business community deserves some attention. I don't mean that to be a clinker in the legislation, but I would hope that we could certainly reconsider that. Again, I want to thank Paul and Pete and the members of this committee. I am a strong cosponsor of the legislation, and I thank you for the time.

The CHAIRMAN. Thank you very much.
Senator Dodd?

18

OPENING STATEMENT OF SENATOR DODD

Senator DODD. Thank you, Mr. Chairman, and let me voice of support for our two colleagues, Paul Wellstone Domenici. Í have worked a lot on many issues with both and I want to commend them immensely for their effor area of mental health. Let me join, as well, in commenda Nancy, who is in the audience, who is a great pal and fr has been a real leader on this issue for so many years.

I will ask unanimous consent that a prepared stateme cluded in the record.

The CHAIRMAN. It will be included.

Senator DODD. I have often said—and I think all of us c to this that in any audience you speak to, and I don't c it is, if you turn to an audience and say, is there anyone has not been affected by this issue, whether it is a parent ling or a child or a close relative, never in my experien years in public life have I ever raised that issue with any and had a person raise their hand as not being affected by So it is always stunning to me in a way that this issu ways been relegated to the fringes, despite the fact tha never met an audience in my home State of Connecticut country that had not been touched by this issue either the or through someone they cared about deeply.

So, in a sense, what our two colleagues are doing, and all of us are here, is bringing this issue which has been la the fringes-back into the mainstream, as it ought to be. very grateful to them for their efforts in this regard.

Like Pat Roberts, we take some pride in Connecticut. O cut was one of the very first States, to enact legislation to d mental health, and we have always been very proud of that. Yet, today, as a result of the laws that we passed, about cent of my constituents are outside of the protections of the law because of the ERISA exemption of State law. I am are going to hear about that today from our witnesses.

Last, Mr. Chairman, I would just invite my colleagues t volved in this. We have been preparing some hearings w Subcommittee on Children and Families, trying to sele would be some good hearings for us to hold. One of the firs ings we are going to deal with is children and this problem. We did a survey in Connecticut among juniors and ser high school. I have got to go back and look at these numbe 49 percent of juniors and seniors in Connecticut high schoo said they have contemplated suicide-49 percent. That is chilling statistic and number, and yet we know it is the thi est cause of death among teenagers more teenagers and adults die from suicide than from cancer. Of heart disease, birth defects, pneumonia, flu, chronic lung disease combined. So we want to, with your permission, Mr. Chairman, focus-while obviously this covers a range of issues, we wou to pay some attention to children particularly because som they just get lost in all of this.

So I am looking forward, as the rest of my colleagues working with the two major sponsors of this bill in the hop

we can build a strong bipartisan piece of legislation to try and fill in the gaps that so desperately need to be filled in.

So I thank you, Mr. Chairman, for holding the hearing. And, of course, Pete Domenici and Nancy, and Paul and his family as well have been involved in this issue for a long time. I mentioned Nancy, but Paul's family as well has a deep understanding of these issues, and so we thank you for that.

The CHAIRMAN. Thank you very much.

Senator Frist has returned from Africa, where he has been performing some volunteer work with a number of individuals who had some very serious kinds of health challenges. He always inspires us with his commitment to health issues. We are delighted to welcome you back, Senator Frist, and recognize you.

OPENING STATEMENT OF SENATOR FRIST

Senator FRIST. Thank you, Mr. Chairman. I got up at two o'clock this morning. The 7-hour time change I haven't gotten used to yet, so I have been up a while. I feel like it is late in the day from Africa, where I did have an opportunity to address a lot of issues. It really is interesting in terms of the topic that we have today, which is really universal.

But we are blessed in this country to have research and science that is really unparalleled in the world today as we approach what is a fairly new understanding of mental health treatment that, to me, makes it all the more important that we address in a leadership way and set the vision and goals which can be fulfilled on a more local level.

I am very careful before I want the Federal Government to get legislating too active in too many fields, but this is a field that, because of the science and the developments and the innovation and the creativity, we are ahead in terms of what we know how to diagnose and treat as to what we are doing and practicing. And it really does translate over into how insurance companies, as well as private and public entities, view mental health, the issues of diagnosis and treatment. I am sorry to have missed both Senator Domenici and Senator Wellstone's presentation, but I do want to applaud both of them for their real leadership as well.

Dr. Steve Hyman, Director of the National Institute of Mental Health, testified before this committee last year, and I am not sure if reference has been made to that, but he made the point that a broad scope of research, including genetics, this whole Human Genome Project and the 3 billion bits of information that have been unleashed in the last 4 to 5 years, the advances in neuroscience, the behavioral sciences and clinical investigation, all have shown that there is no scientific basis for treating many of the mental health disorders any differently than the physical health disorders. I think that is a very important statement as we go forward.

We don't know completely that range of mental health yet, but there are certain areas, and I would urge us systematically to address those areas where we do have very good science as we legislate to be addressed first and foremost.

This Congress, even after expressing its concern in 1996, again through the leadership of the two people who have spoken so eloquently earlier today even though we acted there to achieve some

level of parity, even though there is mounting evidence of the expanded mental health coverage being cost-effective, and even after two-thirds of the States have acted to guarantee consumers some level of parity, health plans today have continued to impose arbitrary limits, or what most people regard as arbitrary limits on mental health coverage.

I do think that mental health coverage is one of those rare areas where government and Federal Government is going to be necessary, in part because the science of diagnosis and treatment has far outstripped what is being implemented today.

I just want to mention very quickly several areas where I think we need to place a real focus and spotlight as we improve legislation that has been put forward.

First, I want to make sure that small employers and those in rural areas who may not have access to the managed behavioral health care networks are shielded from excessive premium increases. I think that that has been documented in the past and I want to be able to focus on that.

I want to make sure we don't sacrifice, as we achieve parity, any element of quality in trying to achieve equality, and I will elaborate on that at some point over the next several weeks.

I want to make sure that we focus on those illnesses, at least initially, that are biologically based, serious conditions where we do have the scientific support for treatment. And then I think it is also important as we try to achieve equality and parity that we recognize that this is not a vacuum, that mental health really is part of a much larger spectrum of health, and any time we address a particular area it does have an impact elsewhere.

So, again, let me thank Senator Domenici and Senator Wellstone for their leadership, and I look forward to working with them on this legislation.

[The prepared statement of Senator Frist follows:]

PREPARED STATEMENT OF SENATOR FRIST

Thank you, Mr. Chairman, for holding today's hearing on this critically important issue.

I want to commend my colleagues Senator Domenici and Senator Wellstone for their leadership on the mental health issue. To my good friend, Senator Domenici, let me say that I know how much you care about achieving greater fairness and equality for those who suffer from mental illness. You have been fighting for these reforms for many years; I greatly respect your commitment and persistence. And I want you to know that I will work with you to pass meaningful legislation this year that provides real parity protections.

Significant progress has been made during the past decade in the diagnosis and treatment of mental illness.

As Dr. Steven Hyman, Director of the National Institute of Mental Health, testified before this Committee last year: a broad scope of research, including genetics, neuroscience, behavioral science and clinical investigation, have shown that there is no scientific basis for treating many mental disorders differently from other medical disorders.

In fact, the efficacy of mental health treatments is well documented in the medical literature and a range of existing treatments are available for most mental disorders.

Since the federal Mental Health Parity Act was enacted in 1996, we also have learned much more about how to enhance access to quality mental health care without significantly increasing health

costs.

Despite this progress, health insurers have continued to place arbitrary limits on mental health coverage available under private plans. It is clear that, in most instances, these limits are the outgrowth of outdated fears and outmoded notions about the science of treating mental illness.

Even after Congress signaled its concern with this practice in passing the Mental Health Parity Act of 1996

Even after more than two-thirds of the States have acted to guarantee consumers some level of parity in private health coverage

Even after the mounting evidence that expanded mental health coverage can be cost-effective .

Health plans have continued to impose arbitrary limits on mental health coverage.

As I have said in the past when Congress has confronted this type of legislation, I do have concerns about the federal government playing too active of a role in requiring employers to pay for certain health benefits.

I do believe that mental health coverage is one of those rare instances where government intervention is necessary. I arrive at this conclusion primarily because coverage has lagged so far behind scientific and medical advancements and health insurers have maintained arbitrary coverage limitations in the face of growing research evidence about the efficacy of mental health treatments. As the Surgeon General said in his groundbreaking 1999 Report on Mental Health, perhaps the "most formidable obstacle to future progress" toward improving the availability and accessibility of mental health treatment is the stigma attached to mental illnesses. There are several areas where I believe the legislation before us should be improved to more appropriately balance efforts to achieve greater access to mental health treatment with concerns about pricing health insurance coverage out of reach for vulnerable Americans. In particular, I want to make sure that small employers and those who live in rural areas who may not have access to managed behavioral health care networks are shielded from excessive premium increases.

In addition, I want to make sure that in our efforts to increase parity, we do not sacrifice quality in the name of equality. I believe we need to be careful to not inadvertently prohibit sound quality practices which may have differential impacts in terms of coverage, but may make sound clinical sense in terms of treatment.

I also believe that we may want to focus our legislative efforts first on those areas involving serious, biologically-based conditions where there is greater scientific support for treatment efficacy.

Finally, we also must take into account the fact that this type of legislation is not being considered in a vacuum. In fact, in the context of potential passage of sweeping new patient protection