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U. S. Senate Committee Conducts Hearing on Parity; GAO Reports on Employer Compliance with 1996 Federal Law

NAMI Member Dr. Ken Duckworth Testifies at the Hearing

For Immediate Release, May 19, 2000
Contact: Chris Marshall

On Thursday, May 18, 2000, the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) conducted a public hearing on the Mental Health Parity Act of 1996. The 1996 act expires September 30, 2001, unless reauthorized by the Congress. Testifying at the hearing was Ken Duckworth, M.D., NAMI member, NAMI volunteer, and a past recipient of NAMI's exemplary psychiatrist award. Dr. Duckworth, a community mental health psychiatrist and member of the faculty at Harvard University, will shortly become the Deputy Commissioner in the Massachusetts Department of Mental Health.

Convening the hearing was HELP Chair Senator James Jeffords (R-VT). Testifying at the hearing and then staying for the remainder of the forum was Senator Paul Wellstone (D-MN). Others attending the hearing were Senators Chris Dodd (D-CT), Edward Kennedy (D-MA), and Jack Reed (D-RI). Senator Pete Domenici (R-NM), scheduled to testify, was ill and not available.

Senators Domenici and Wellstone are primary sponsors of S. 796, the Mental Health Equitable Treatment Act. S. 796 would require full insurance parity for schizophrenia, bipolar disorder (manic depression), obsessive-complusive disorder, panic disorder, post-traumatic stress disorder, autism, and other severe and disabling illnesses such as anorexia nervosa and attention-deficit/hyperactivity disorder. Further, no health plan may use day and visit limits for mental illness which are different than physical illnesses.

Attached at the end of this e-news is NAMI's press statement handed out at the hearing. NAMI "supports S. 796, the Mental Health Treatment Act, and recognizes the progress that today's hearing" makes.

Though unable to attend the hearing, Senator Domenici's press statement declared that "the Mental Health Parity Act of 1996 was a good first start, but that law is not working as intended." Further, "Senator Domenici welcomed the conclusions of a new General Accounting Office (GAO) study released at the hearing confirming that employer compliance with the 1996 law is not driving up insurance costs."

GAO summarized the results from its May 2000 report, "Mental Health Parity Act: Despite New Federal Standards, Mental Health Benefits Remain Limited" (GAO/HEHS-00-95). Testifying on behalf of GAO was Associate Director for Health Financing and Public Health Issues Kathryn Allen. GAO's web site is GAO's findings were:

1. Costs associated with the Mental Health Parity Act of 1996 were "negligible for most health plans" with only 3% of employers reporting an increase in costs.

2. 14% of employers are not complying with the 1996 act. This does not include small employers, 50 or fewer employees, that are exempt from the 1996 law. Further, GAO did not find significant differences in the rate of employer noncompliance based on characteristics such as employer size, industry or geographic region, or whether the plan was fully insured or self-funded.

3. 87% of employers complying with the 1996 act restrict mental health benefits to a greater extent than medical and surgical benefits.

4. Only 5 employers in the nation dropped mental health coverage as a result of the 1996 act.

5. The Administration relies on complaints for monitoring compliance. Though 24 states may not be fully implementing the 1996 act, 3 states are not complying at all. The GAO report identifies the 24 states, but not the 3.

Also testifying at the hearing was Dr. Steven Hyman, Director, National Institute of Mental Health. Dr. Hyman testified about the science of diagnosis and treatment of mental illness, about the impact of youth suicide, about the genetic basis of some illnesses, and the direct medical and disability cost offsets associated with treatment of depression. Dr. Hyman observed that there is no scientific reason that a health plan should cover Parkinson's disease but not schizophrenia, for both are chronic and not yet curable diseases that affect dopamine systems in the brain.

Senators' questions to Dr. Hyman and Ms. Allen were the impact of managed care, the restrictions used by employers, the Health Care Financing Administration's slow rate of implementation, reimbursement rates of professionals, motivations other than cost, the problem faced by persons with co-occurring mental and addictive disorders, early intervention techniques with children, the day in the future when mental illnesses can be explained by biology and neurology, the attitudes of employers, the definition of full parity, the reliance on medication and relationship to behavioral interventions, the importance of investing resources in the treatment of mental illness, experience with state enacted parity, characteristics of non-complying employers, the over-use of medications in young children, the interface between special education and parity, and school violence and environmental influences.

The last witness panel testifying at the hearing were a representative of Delta Airlines who emphasized why they have a parity mental health benefit program, a representative of the Health Insurance Association of America (HIAA) who opposed any parity requirements, NAMI member Dr. Ken Duckworth, and Dr. Ken Libertoff, Ph.D., Vermont Association for Mental Health. Dr. Libertoff emphasized that he is a member of the National Mental Health Association (NMHA) and that NMHA "shares the values and public policy goals reflected in my statement." Dr. Libertoff emphasized that "this is a fight for civil rights, not insurance" and that "a comprehensive approach is the only approach." He declared that "anything less than full parity (such as only serious mental illness or brain disorders) continues partial discrimination." Laws that focus only on serious mental illness or brain disorders are "fundamental civil rights barriers." The Vermont parity law is full parity for all persons seeking mental health and substance abuse services.

Senator Jeffords asked "what is the most reasonable approach to parity?" Dr. Libertoff replied that "partial parity is foolish" as most of the costs of parity are for serious mental illnesses. Dr. Duckworth replied that "though the Vermont comprehensive parity law is laudable, the perfect is often the enemy of the good. There is gross discrimination against catastrophic and severe mental illness....The Domenici-Wellstone bill is a substantial step forward."

The hearing ended with Senator Wellstone explaining that his objective is to make an important step forward which has a realistic chance of passage. Senator Wellstone stressed again that the Domenici-Wellstone legislation (S. 796) would require full parity for severe and disabling mental illnesses and prohibit the use of day and visit limits for all mental illnesses. Senator Wellstone asked Dr. Duckworth: "Is this (S. 796) an important step forward?" NAMI member Dr. Duckworth replied "yes." Senator Wellstone then asked Dr. Libertoff the same question. Dr. Libertoff, the NMHA member, replied that "It would be a step side-ways." Senator Wellstone replied to Dr. Libertoff: "so, if we can't make it 100% perfect, all these people will have to do without any protection because we failed politically. Persons with mental illnesses may not accept this."

NAMI's press statement, which follows, declares NAMI "supports S. 796, the Mental Health Equitable Treatment Act, and recognizes the progress that today's hearing" makes. Likewise, the NMHA press statement stated that "Legislation from Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM), S. 796, is a step toward parity between mental and physical health treatments. NMHA and its 340 affilates will actively campaign for its passage." NAMI's statement follows.

NAMI Supports Domenici-Wellstone Bill For Full Insurance Coverage For Severe Mental Illnesses