On March 27, the House Ways and Means Subcommittee on Health held a hearing on mental health and substance abuse parity. The hearing also discussed the Medicare Health Modernization Act of 2007 (H.R. 1663) and the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424).
In his opening statement, Chair Pete Stark (D-CA) said, “We have come a long way in our diagnosis and treatment of mental illness and substance abuse. Unfortunately, laws governing mental health treatment have not come as far. Health insurers typically impose lower treatment or dollar limits for mental health, impose higher copayments, and limit hospitalization periods. This discrimination isn’t limited to the private sector. While we created mental health parity in the Federal Employees Health Benefit Plan, Medicare continues to discriminate against mental health treatment.” He continued, “I seldom agree with President Bush, but in April 2002 he identified unfair treatment limitations placed on mental health benefits as a major barrier to mental health care. He launched the New Freedom Commission on Mental Health to identify how mental health care can be improved…President Bush also urged Congress to enact legislation that would provide full parity in the health insurance coverage of mental and physical illnesses. I agree it is time to end discrimination against mental health in both commercial insurance and Medicare.”
“We all recognize the importance of health benefits for individuals suffering from mental conditions,” said Ranking Member David Camp (R-MI). He continued, “Given the dramatic increases in healthcare costs in recent years, many employers are already dropping healthcare coverage. This in turn makes it more difficult for their employees to obtain any health insurance, including mental health benefits. The question the subcommittee needs to ask is whether or not access to mental health benefits and more broadly, health care insurance, will be unintentionally reduced because of the added cost to employers. I hope that we will also get a chance today to discuss another mental health parity bill, which is being developed in the Senate by Senators Kennedy [D-MA] and Enzi [R-WY]… The Senate bill…adopts a much narrower approach to defining covered diseases and mandates the networks of providers that must be covered. This approach may significantly reduce the potential costs that could be imposed upon employers. It is my hope that Congress can move forward and consider both bills with the goal of enacting a bill that expands access to appropriate mental health services, while not reducing any workers’ access to healthcare benefits.”
Rep. Jim Ramstad (R-MN) relayed the story of his own substance abuse problem to the subcommittee: “On July 31, 1981, I woke up in a jail cell in Sioux Falls [South Dakota] under arrest as the result of my last alcoholic blackout. I’m alive and sober today only because of the Grace of God, the access I had to treatment and the fellowship of recovering people for the past 25 years.” Rep. Ramstad said it is “national disgrace” that substance abuse treatment is denied to many Americans. He concluded his remarks, “It’s time to end the discrimination against people who need treatment for mental illness and addiction. It’s time to prohibit health insurers from placing discriminatory restrictions on treatment. It’s time to provide greater access to treatment. The American people cannot afford to wait any longer for Congress to act.”
“Untreated mental health and addiction costs employers and society hundreds of billions of dollars in lost productivity,” said Rep. Patrick Kennedy (D-MA). He continued, “Depressed workers miss 5.6 hours per week of productivity due to absenteeism and presenteeism [a term used to describe workers who remain on the job, or come to work, despite physical or mental illness], compared to 1.5 hours for non-depressed workers.” Rep. Kennedy discussed the biological components of mental illness and urged his colleagues to fund treatment for such conditions, saying, “At the end of the day, this is about human dignity and whether we deliver on the promise of equal opportunity that is at the heart of what it means to be American. Nobody chooses to be born with particular genetics and anatomy, any more than they choose to be born with a particular skin color or gender. And nobody should be denied opportunities on the basis of such immutable characteristics. Anybody who pays their health insurance premiums is entitled to expect their plan to be there when they get sick, whether the disease is in their heart, their kidneys, or their brain.”
Kathryne L. Westin, a member of the Eating Disorders Coalition for Research, Policy and Action, testified about her daughter Anna. Anna was diagnosed with anorexia in 1995 and died of the disease in 2000; she was 21 years old. After Anna’s initiation diagnosis and treatment, she suffered a relapse in 1999. When her parents took her to the hospital, she was refused inpatient treatment: “According to our insurance company Anna’s care was ‘not medically necessary.’ Suddenly we were forced to somehow ‘prove’ that Anna was sick enough to get the care her doctors recommended…I have no doubt that if I had brought Anna to the hospital that day with similar symptoms caused by a ‘physical’ illness she would have been admitted without question and she would have gotten the best care available until she was fully recovered. Instead, Anna fought her eating disorder and at a time when we should have been totally focused on helping Anna we were forced to put energy into fighting with our insurance company.” Ms. Westin detailed her experiences with other families and their resulting financial burdens when care was denied. In closing, she urged the subcommittee to pass mental health parity legislation saying she agreed with Rep. Ramstad that it is a “life-or-death issue for millions of Americans.”
Henry Harbin, a psychiatrist and former CEO of two national managed behavioral health care organizations, shared his experiences as a clinician and manager. He remarked on the cost of providing mental health and substance abuse treatment services, saying “Numerous studies have shown that the increased cost for full parity ranges from no increase in cost to an increase of around 0.9 percent in total medical premiums. At Magellan we managed a number of accounts that introduced parity benefits, and in our experience, the increase in cost was from a low of 0.2 percent to about 0.8 percent of the premium.” Dr. Habin said that the lack of access has resulted in “a number of unintended and deleterious consequences from the arbitrary limitation of access to specialty behavioral services.” He focused on two outcomes: increased reliance on the general medical setting for behavioral care and the relationship between poorly managed chronic conditions and mental illness. On the first, Dr. Harbin said that patients are receiving psychiatric medication from general practitioners and not receiving other therapeutic services; he said that the combination of the two is the most effective treatment for mental health disorders. In regards to the second outcome, he cited the President’s New Freedom Commission on Mental Health’s report, which found that the costs of caring for patients with chronic disease and mental illness (most commonly, depression) are much higher than caring for those without mental illness because such patients tend to be less compliant with treatment plans. He concluded by recommending the subcommittee consider collaborative practice care as such programs “improve access to evidence-based mental health treatments and improve coordination of primary care and mental health care for patients with a combination of mental and chronic medical disorders.”
Additional witnesses included: Dr. David L. Shern, president and CEO of Mental Health America; Dr. Michael Quirk, director of behavioral health service at the Group Health Cooperative in Seattle; Dr. Ronald W. Manderscheid, director of mental health and substance use programs at the Constella Group LLC; and Dr. Eric Goplerud, director of the Ensuring Solutions to Alcohol Problems program at The George Washington University.
