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conditions. That means no day limits, no visitation limits, no exorbitant copay or deductibles.

The need for this legislation is clear. One in five Americans will experience some form of mental illness this year, but only a third of them will receive treatment. Too often, for example, persons suffering from depression must face the burden of paying for the entire cost of their medication even though their health insurance covers medications for physical illnesses.

Opponents claim that parity costs too much, but study after study shows that implementing parity makes good financial sense. In Pennsylvania, for example, insurance carriers reported less than a half-percent increase in premium costs related to their State's parity law. And in Maryland—the first State to enact full parity for mental illness and drug abuse-insurance companies reported that premiums for mental health rose by less than 1 percent and then fell slightly after the legislation was implemented.

We can afford mental health parity. What we can't afford is to continue to deny persons with mental disorders the services they need. According to the Surgeon General, mental illness costs the Nation $150 billion each year in treatment expenses and lost worker opportunity. That is why 34 States have already guaranteed their citizens some form of mental health parity, but this patchwork of laws has created inequity by geography. Some Americans have full coverage for mental health services, while others must take out loans to pay for necessary treatment. Mental health parity is not only the cost-effective thing to do; it is the right thing to do.

One of the most interesting observations, I think, is that mental disorders can be treated. If we look at bipolar disorder and depression, we see high success rates—approximately 80 percent and 65 percent respectively—from actual treatment of them. But with other chronic diseases such as hypertension and diabetes-physical illnesses—we are making progress, but we still haven't reached the kinds of successes in terms of the treatment that we have with mental illness. Treatment success rates for hypertension run approximately 50 percent, and for diabetes, success runs roughly 60 percent. So we know how important treatment is.

Just a final point. We will hear a great deal about costs as we debate this issue, but I believe there is a moral imperative. The costs spread over the range of different groups and people who are covered are very, very small. My own sense is, over a period of time, we will find out that it pays for itself in reduced kinds of physical costs, and I think there is a good case to be made.

But the costs for individuals are devastating—are absolutely devastating—and the costs in terms of their families are devastating indeed. We are reminded that we are in a situation where, if it was heart disease, we know that the treatment would be there and no one would ask about costs.

We should go about the business of this legislation. We have every intention of bringing this measure to the floor as quickly as possible, and we welcome the fact that it is a matter of priority to the Majority Leader.

I recognize my friend and colleague, Senator Gregg.


Senator GREGG. Thank you, Mr. Chairman.

The issue of mental health is something I have been involved with ever since I have been involved in profession life. I was president of the local mental health facility in my hometown of Nashua for many, many years. It was actually built by my grandfather, and so it is an issue that I am intimately involved in, and have been for many years.

Parity is also an issue that I have been involved in, as New Hampshire was one of the first States in the country to pass a mental health parity law, which I supported at the time and which I continue to support and which is one of the better ones in the country.

So the issue is an issue that needs to be addressed. Whether it needs to be addressed through this type of legislation at the Federal level is something that should be adequately aired. The Senator from Massachusetts has raised the issue of the cost of this. That is a question, whether more people would lose insurance as a result of the cost. There is also the issue of States' responsibility in the area of insurance which needs to be raised.

But all those issues can and should be raised in a fair and open hearing process, and unfortunately the manner in which this issue came forward has not been fair to the Minority.

The rules do require that there be a 7-day notice before a hearins, and on July 3, in the evening, we received notice of this hearing. That meant that the next day was July 4, and it meant that most of the staff of our office and of the Minority, and I suspect even of the Majority, didn't plan to be around until the next Monday.

That put us in a position where basically our staff did not receive the notice, nor did we have any knowledge of this hearing, until well into the weekend, last weekend. On Monday morning, of course, to try to get witnesses who might be able to present some of the issues which have already been raised by the chairman and which need to be addressed, which are issues of cost, issues of State coverage, became impossible because of the fact that we hadn't received notice of this, other than in a pro forma manner pursuant to a pro forma exercise of the rules.

It would seem that an issue of this importance should have a full and fair and honest hearing. It would also seem that since this is the first hearing that the Majority has resumed its position as Majority, after the chairman's hiatus for a period of time during which the Republicans had control, that the hearing process would have been set up in a way which would have made a special effort to make sure that the Minority received an adequate and fair opportunity to participate in the hearing process. This wasn't the case at all.

For that reason, I don't intend to participate in this hearing. I understand that it is an important hearing, but it is not a hearing that has been adequately and appropriately developed, and it is not a hearing which has certainly given the Minority a fair opportunity to participate.

Now, this is an issue that should be addressed. I don't argue with that at all. It has bipartisan support. I have reservations about nationalizing the question of parity, but they are reservations which I think could be resolved in a proper and full hearing process. But under this scenario, I cannot participate in this hearing.

Therefore, Mr. Chairman, I have to withdraw myself from this meeting.

The CHAIRMAN. Just while the Senator is here
Senator GREGG. The Senator is leaving.

The CHAIRMAN. Well, that is all right, and I will make it clear in the record that we gave notice for a hearing on mental health parity for June 7. The hearing was postponed because of scheduling issues, but the committee has been on notice that we were going to have this hearing.

I regret the fact that our colleagues will not be here to listen to really outstanding professionals in this area. I will give, even though they are not here, the assurance that, if they want, we will have a second hearing and we will have their witnesses. If Senator Domenici and Senator Wellstone would come back at that time, we will be glad to hear from them again. We never get tired of listening to them.

We will give our colleague—if they want the notice, they have got it as of now, today, at 10:10—that there will be another hearing, and they can invite the witnesses that they so desire, and we will conduct that hearing. I will make it very clear that we will wait for a markup until we have that hearing, but we will then move ahead and mark up. So, that is the way we are proceeding. We have all been busy on this

committee with our education legislation and with the Patients' Bill of Rights. But I had indicated to my friend and I regret that he is not here that the record will show that I had every intention of marking up mental health, just as we have every intention of marking up the genetic discrimination legislation, and also the medical errors legislation.

We will give sufficient notice to our colleagues. We regret they are not here. I doubt very much that they could be doing anything more important than listening to some of the most thoughtful people on an issue which is of central concern to families across this country.

Again, I apologize to our two witnesses. They have been tireless in pursuing me and the other members of the committee on this issue. Although they didn't have to pursue this chairman. As I was listening to my colleague, I didn't know we were getting into the question of establishing our legitimacy in terms of the timing of our interest in mental health. I can remember one of President Kennedy's first initiatives was in the area of mental health, and it was one of the most important. I always take a great deal of pride, as I know he did on that issue as well.

Before we begin I have a statement from Senator Dodd. [The prepared statement of Senator Dodd follows:

PREPARED STATEMENT OF SENATOR DODD Mr. Chairman: Thank you for convening a hearing on the critical issue of insurance coverage parity for mental health services. I

would also like to thank Senators Domenici and Wellstone for their tireless efforts on behalf of the mental health community.

Millions of Americans are affected by mental illness. Each year, more than 50 million American adults will suffer from a mental disorder. All of us know a friend, a relative, a neighbor, a colleague whose life has been touched by mental illness—either their own or the illness of a loved one. Yet despite the compelling need, under many health plans, mental health benefits are much more limited than benefits for medical or surgical care. Even though a range of effective treatments exist for almost all mental disorders, those suffering from mental illness often face increased barriers to care and the stigma that underlies discriminatory practices in how we treat mental illness. And these are the individuals that have insurance. It can only be worse for those without insurance.

At our hearing last year, the General Accounting Office reported that 14% of employers were not compliant with the law Congress passed in 1996 prohibiting plans from setting more restrictive annual and lifetime dollar limits for mental health care than for physical care. Of those employers who were compliant, 87% adopted at least one more restrictive provision for mental health benefits after the law was enacted. Some employers, for example, limited the number of mental health outpatient visits or implemented higher co-payment requirements for mental health care to offset what they inaccurately predicted would be soaring costs.

Recognizing the need for more comprehensive protections, Senators Wellstone and Domenici have introduced a groundbreaking bill that would expand the original law to include full parity not only for mental health dollar limits, but for hospital and outpatient visits and cost-sharing requirements. I applaud my colleagues for their commitment to ensuring full parity in the coverage of mental health benefits. And as a cosponsor of both the 1996 Mental Health Parity Act and the pending legislation, I share their concerns that mental health care MUST not take a backseat to other health conditions.

Opponents of mental health parity laws argue that the parity laws will raise health insurance costs. But we have heard from the Congressional Budget Office and the General Accounting Office that the cost of this law is negligible

contributing less than a 1% increase to health care costs. And if we are going to talk about costs, let's talk about the staggering societal costs to leaving mental illness untreated. When mental illness goes untreated physical health deteriorates, jobs are lost and families are destroyed. The National Institutes of Mental Health estimates that the annual cost of untreated mental illness exceeds $300 billion. It just makes good economic sense to provide equal coverage for all illnesses-including illnesses of the brain.

My own state of Connecticut has recognized the fundamental fairness of treating mental health services equal to those for physical health. We have a state law that exceeds our federal parity laws—requiring mandated mental health benefits and parity in all respects dollar limits, services, and cost sharing.

However, because ERISA limits the ability of states to regulate self-funded employer health plans, 41% of Connecticut residents are left out of the state protections. Therefore, federal legislation is desperately needed.

We must renew our commitment to focus on the issue of children with mental illness—the most vulnerable of the mentally ill. 5-10% of children have serious mental disorders, but the U.S. Surgeon General estimated in a landmark report that as many as 80% of these kids go untreated.

Inadequate treatment for children with mental illness has led to tragic consequences, such as a dramatic increase in adolescent suicide and the high-profile cases of school violence we have seen. Suicide is now the 3rd leading cause of death among teenagers—more teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, pneumonia, flu, chronic lung disease combined. In my own state, a recent study classified 49% of high school juniors and seniors as contemplating suicide. These numbers are terrifying. And I fear that we are not reaching enough of our kids with proper treatment. 90% of suicide victims have at least one treatable psychiatric illness at the time of death. I intend on holding a hearing on this issue in the Subcommittee on Children and Families and exploring legislative remedies to address this public health crisis.

A key barrier to treatment is the lack of insurance coverage. It is difficult for families to obtain services for children because of copayments that are higher for behavioral services than for other medical services or more limited yearly and lifetime dollar caps. Also, health plans often do not provide adequate panels of clinicians who are qualified to address pediatric mental illness. And on Monday, we read in the New York Times about a dramatic lack of treatment options and resources for mentally ill children outside of the hospital setting.

It is my hope that through a coordinated effort, we will begin to change the way health care providers, insurers, and society in general, view mental illness. It is my hope that through legislation such as that introduced by Senators Wellstone and Domenici, we can foster an understanding of what mental illness is not a character flaw or stigmatizing condition and what it is a cluster of diseases in an organ of the body that is treatable, just like any other physical illness. Ensuring mental health parity is an important step towards reducing the stigma associated with mental illnesses and increasing the understanding that mental illness is preventable and treatable, just like physical illness.

Mr. Chairman, I thank you again for holding this hearing. I look forward to working with you and other members of the Committee as we work to address this critical public health issue.

The CHAIRMAN. So we will hear from two really outstanding leaders who have, I think, made an enormous difference to date and will continue to make an enormous difference. We will recognize, in our true spirit of bipartisanship, Senator Domenici to lead us off, and then Senator Wellstone.

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