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STATEMENTS OF PETE V. DOMENICI, A U.S. SENATOR FROM

THE STATE OF NEW MEXICO; AND PAUL D. WELLSTONE, A U.S. SENATOR FROM THE STATE OF MINNESOTA

Senator DOMENICI. Thank you. Well, I regret what happened this morning because this bill, Mr. Chairman and fellow Senators, is truly a bipartisan bill, not only in that it is called DomeniciWellstone, but we have 10 Republican Senators on this, and I believe in due course we will have more.

As of today, we have 41 Senators cosponsoring this, and I believe its time has come. If we have to wait for a week or 2 weeks for something procedural, and if you need me to come back, Mr. Chairman, don't worry about that. I have been waiting a long time to have a hearing on this kind of legislation.

In 29 years in politics, while I have done a lot of things, if we pass parity of insurance treatment for those American with mental illness and it gets by the House and gets signed into law, I think I can say I have been part of one of the most serious and significant activities in terms of wellness for the mentally ill people of this country.

You have many witnesses, so I won't go through how many people are involved. That is all available to you, excepting you should know a couple of things. The efficacy of treatment is higher in trying to cure and stabilize some of the serious mental illnesses; efficacy is higher than for heart operations and heart treatment.

What actually happened is sometime in history when the insurance plans and insurance coverages were evolving in America from sporadic to large numbers, and then to employers buying insurance for literally millions and millions of Americans, insurance has provided resources to the professionals and the private sector people who want to be involved in making people well.

What happened at that time when these policies started to get developed is they left out mental illness, just because it was not like all the other illnesses; it had some vagaries to it. Essentially, I asked the question I have asked it across this land-what if we had excluded from health care the human heart? That is rather arbitrary, but they have been rather arbitrary about mental illness.

So let's assume the heart is not covered, Senators. Where do you think the wellness of heart patients would have been? Would we have all of the technological breakthroughs for heart treatment that we have? My answer is no, because success requires resources. Helping people who are sick requires that they have some resources.

Now, I have been active for more years than I can remember with the National Alliance for the Mentally Ill. I know something about mental illness, but I also know that there are thousands and thousands of American families who have gone literally bankrupt in trying to care for their schizophrenic daughter or seriously depressed young son, or even beyond that a serious mental illness at another age.

What happens is they run out of money. They come and tell me at meetings, we have nothing left and our son is a schizophrenic and we have no coverage; nobody will help him, he is probably walking the streets of San Francisco at this point, but we don't have anything left because we gave him the best care possible.

Now, think with me for a minute. If, in fact, we had covered mental illness just as we did the heart-you know, the heart has some spirituality to it, if you are talking about mental illness as being something that you can't quite touch and it is in the brain. The truth of the matter is, had this been covered, we would have community health centers taking care of the mentally ill across this land, Senator.

When your brother decided let's move ahead and get these people out of the insane asylums and out of the prison cells, the idea was to develop some local community mental health centers. But it was always dependent in the first years on the Federal Government paying for it and we didn't, did not.

Now, what is going to happen is, if you pass this, every mentally ill American that has insurance either directly or through their family progeny, children, insurance will have to cover them for mental illness, if they cover mental illness at all, to the exact same level that they cover cancer illness, diabetes disease, all of them.

Let's just pick a group. Every schizophrenic family who has a child or two is carrying on their back like a backpack resources. Resources for what? Resources to take care of their illness, to take care of them if they have to go to a center, to take care of them if they have to be hospitalized.

And, you see, what will happen in a decade or two is there will be facilities because people will charge to treat, we expect, and if there is money to pay it, facilities are going to get built because that is what is happening elsewhere. Have you ever seen a heart hospital? I have, because the heart has become such a researched part of our body that now you need to take care of them in a special facility. Who pays for that beautiful hospital? Are only multimillionaires in the hospital? Of course not. Insurance pays for it.

Now, here we are with millions of Americans; generally, schizophrenics are between 18 and 27 years of age when it comes on. Manic depressives, with all the suicides that are growing—that is also a youthful one, but it also affects seniors. Bipolar is a terrible disease. It is now defined with sufficiency, and there is medical treatment and there are drugs that take care of it. But we don't have the resources because the resources do not follow; insurance does not follow as a resource to the sick individual.

In the process of getting here this day, I remember one award that I received. It is in my office. It is not very big, but it is a bell, like a victory bell with a crack in it, like our victory bell. It was given to me at a Mental Health Association meeting and it said the metal in the bell all came from the prisons that housed the mentally ill. So they proceeded to buy up some of the wrought iron and others as sick people got of these hospitals and they made a bell of freedom for those whom they think deserve it.

Now, if there are some who believe that we should not do this because it is too expensive, I don't have the time, nor do you want me to speak as long as it would take me. But I believe it is going to be obvious to this committee, just absolutely obvious, that as a matter of fact there are huge numbers of the seriously mentally ill. We are not talking about a little bit; we are talking about a lot.

Second, the business people are paying a lot of money out right now for not having coverage because there is a huge loss of produc

tivity and there is a huge loss of time. Anybody who works around the seriously mentally ill knows that even when they are on a very healthy, very widely prescribed drug, they do have trouble. Sometimes they quit the medication, so they don't go to work. So I would think the business community would back this.

We will put in the record now, with your permission, an official letter from the Congressional Budget Office. They have analyzed this and they say American people who are mentally ill will be treated just like the Federal employee health plan. That is the essence of this bill.

[The letter referred to was not received at press time.)

Senator DOMENICI. Now, without any question, it might add some cost, but the Congressional Budget Office says it might add 1 percent. We had much bigger readings before when we first did the bill, which you alluded to. But, essentially, I believe what has happened is because of medication, because of treatment, because some people have now tried it—and you don't have to do a little model; you can go ask a company that insures 50,000 people-it has become less expensive rather than more expensive.

I wouldn't think before we are finished this episode in American history of arbitrary denial or accidental denial-nonetheless, it should not go on forever. I mean, we said it isn't covered because it is the brain. OK, but how many more years do we have to keep saying that when we know now where the diseases are in the brain? Because of the magnificent type of research going on, we will know precisely what part of the brain is affected when you are bipolar. We know the effect of medicine right on the living brain because we will be able to take pictures of it as it assimilates the drugs that would be given for a cure.

These are exciting things, and right square in the middle of it, Mr. Chairman, is are there going to be any resources to see that this exciting research continues and that people are covered. I would think when you report this bill out will be a day when across this land millions of parents who have gone through suicidal teenagers because of depression, who have gone bankrupt trying to take care of their 19-year-old son with treatment and hospitals and the like I would think that they would have the opportunity to take a real, real breath of hope.

Now, for those who continue to say we shouldn't do this, we should leave it up to someone else, let me say I have come to the conclusion, not consistent with everyone on this committee, that I think the Government in some areas can't do very well. But I am firmly convinced if you leave the mentally ill and the insurance issue to evolve without us stepping in, it will never evolve right. There will be less resources and we will never make the cures and do treatment that, in fact, we absolutely know must occur.

We are all talking to the Leader about having hearings, Mr. Chairman, but I think the sooner you can work out something with your ranking member, the sooner we can proceed.

Now, I want to thank my cosponsor. This bill is known as the Domenici-Wellstone bill. The first was that and this one is that. I appreciate his tremendous efforts in working to get people's support. Over 141 organizations back this bill as of your hearing today and my friend has a lot to do that.

Thank you very much.

The CHAIRMAN. Well, thank you, Senator Domenici. I don't know what your time frame is. Are you going to be able to remain with us through Senator Wellstone?

Senator DOMENICI. Yes, I will.
The CHAIRMAN. Good, because I have some questions.

[The prepared statement of Senator Domenici may be found in additional material.]

The CHAIRMAN. We will hear from Senator Wellstone.

Paul, we welcome you here, a member of our committee. We know how strongly you feel about this issue and the strong leadership you have provided, along with Pete Domenici. So we are delighted to hear from you on this, as we always are.

Senator WELLSTONE. Well, thank you, Mr. Chairman. I am going to try to be very brief so we can go to some of your questions. I want to say a couple of things at the beginning.

First of all, I want to thank each and every one of you for being here. It means a great deal to us, and I think more importantly it means a great deal to the other people who are here representing a lot of groups and organizations, and it means a lot to people throughout the country.

Second of all, I want to say I could acknowledge the work of each and every one of you because all of you have worked in this area. I did want to say to Senator Kennedy that I remember when I was a college teacher following his work in the mental health area, and I very much appreciate his leadership as Chair of the committee. But then I could start talking about each and every one of you. Thank you.

It has been an important effort working with Senator Domenici. I think he deserves a tremendous amount of credit for his leadership.

Senator Domenici, I think today the announcement that the CBO has done the scoring on this and we are talking about 1 percent by way of premium increase is extremely important news.

We have 41, Mr. Chairman, cosponsors right now; Senator Roberts, I think, and I think Senator Collins is a cosponsor. I don't know if I am right or wrong. If I am wrong, I apologize.

Senator ROBERTS. Soon to be.
Senator WELLSTONE. Soon to be. Maybe soon to be; I hope so.

We have 41; we have 10 Republicans. I really believe this is extremely good news. But I believe that Senator Domenici deserves a tremendous amount of credit, as does his wife, Nancy Domenici.

She is in the back of the room. I wonder if Nancy would be willing to stand up because she has done just fabulous work.

The CHAIRMAN. Nancy, we want to recognize you. [Applause.] Thank you very much.

Senator WELLSTONE. At least I can find one or two other issues I agree with Nancy on. With him, it is almost impossible. [Laughter.]

Senator DOMENICI. This is a pretty good one.
Senator WELLSTONE. This is a pretty good one.

Some years have gone by since we passed the partial parity bill in 1996, and it is a changing health care picture. We know that there are increasing numbers of people who are denied adequate

mental health treatment. There has been a lot of very good journalism on this and you just see the courage of people who have been willing to tell their stories.

We also know that medical science has advanced in the area of brain research and medication and psychotherapy treatment. The truth of the matter is that so much of this illness, Mr. Chairman, is diagnosable and treatable.

Kay Jamison, who, as you know, does powerful writing, a psychiatrist herself who has struggled with this illness, once wrote I just always remember her words "the gap between what we know and what we do is lethal". So if we could really get the treatment to people, what a difference it would make.

We also know that employers are increasingly aware that it is good to provide this coverage; it is good, sound business practice. Their employees and their families want this coverage and it can be done in a cost-effective way. We also know that the Federal Government—and indeed that is what this bill is patterned afterknows that this is the right direction to go.

We have introduced this Mental Health Equitable Treatment Act. What it does is ensure that private health insurance companies provide the same level of coverage for mental illness as they do for other diseases. It is that simple. It is based on the Federal employee health benefit package which became effective January 2001, so there just shouldn't be any different with copays, deductibles, outpatient visits, or days in hospital. This hearing will be, Mr. Chairman, a critical step forward to pass this piece of legislation.

One of the things that happened post1996, Senator Domenici, is that we were trying to say at least with annual and lifetime limits, plans must provide the same coverage for physical and mental illnesses. But we found that too many people from the beginning were denied coverage, so it didn't really make much difference. So this bill is a necessary and huge step toward ending the discrimination and getting the coverage to people, to children, to adults.

Now, Mr. Chairman, I want to just point out that there is going to be some powerful testimony, and one statement in the record was submitted by Stanford Alexander, chairman of Weingarten Realty Investors, which is a Texas-based company with properties in 15 States and I think, Senator Domenici, over 200 employees. What he states is that his company fully supports Federal legislation to establish parity for mental health insurance coverage, and he believes it is good business practice, and we should do it.

We have 41 cosponsors, and as Senator Domenici said, a lot of groups and organizations. There are a lot of people who came to this hearing today. I really believe that part of the reason that we are here today, part of the reason we will mark up the bill, and part of the reason we will bring it to the floor, and I believe it will pass and I believe it will become legislation, is because of the courage of so many people who have been willing to step forward and tell their story and say we no longer can accept this stigma, we can no longer accept this. They say, you know, we refuse to believe, whether it is us or whether it is our family members, that we are second-class citizens because we struggle with this illness. It has

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