Achieving Parity for Mental Health Treatment

The committee met, pursuant to notice, at 10:02 a.m., in room SD-430, Dirksen Senate Office Building, Senator Kennedy (chairman of the committee) presiding.

Present: Senators Kennedy, Dodd, Wellstone, Murray, Reed, Clinton, Gregg, Frist, Roberts, Collins, and Jeffords.

OPENING STATEMENT OF SENATOR KENNEDY

The CHAIRMAN. We will come to order, if we could, please. This is an extremely important hearing and we have some very significant witnesses and commentators on this issue, and we are looking forward to the hearing very much.

I want to welcome all of you to this hearing on mental health and our ongoing battle to see that those suffering from mental illnesses receive the services they need and to provide parity in coverage of mental health services. I particularly commend Senator Wellstone and Senator Domenici for their longstanding commitment and their leadership, not only in the Congress but nationally, in seeing that all Americans have access to mental health services. Mental health parity is one of the most important civil rights issues facing the Nation. For too long, persons living with mental disorders have suffered discriminatory treatment from insurers. They have been forced to pay more for the services they need, have faced harsher limitations on treatment, and have been denied access to the best service providers.

The failure to get treatment for a patient can mean years of shattered dreams and unfulfilled potential. Americans with mental illnesses deserve heath and happiness, too, just as those who face physical illnesses.

The 1996 Mental Health Parity Act was a good first step in ending this blatantly unfair treatment, but it did not go far enough. It left too many loopholes and too many opportunities for continued discrimination. Needed new legislation, the Mental Health Equitable Treatment Act, will close these loopholes and guarantee equal coverage for both physical and mental illnesses.

Our proposed legislation prohibits group health plans from imposing treatment limitations or financial requirements on the coverage of mental health conditions that do not also apply to physical

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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.

OPENING STATEMENT OF 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 hearing, 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.

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Achieving Parity for Mental Health Treatment: Hearing of the ..., Volume 4