Memorandum Date: March 29, 1993 To: Senator Dole From: Alec Vachon Re: Bill Co-Sponsorship; Appearance at Press Conference (End of Letterhead) Attached is a bill Senator Domenici will introduce tomorrow; the Senator hand delivered a note to you on this matter last Wednesday. The bill would establish as national policy that health in­surance shall cover treatment of severe mental illnesses, such as schizophrenia. This bill might be best described as a "sense of the federal government": it creates no actual mandates or other requirements and highlights an important issue. You were a co­sponsor of a very similar bill last year, which expired without action at the end of the session. As a practical matter we may expect that this bill will be superseded by whatever is proposed by Mrs. Clinton's task force. Senator Domenici has asked that you: 1. sign on as an original co-sponsor; and 2. appear tomorrow at a press conference to accept on behalf of the Congress a petition from the National Alliance of Mentally Ill (NAMI) with 600,000 signatures supporting the bill. The press conference will be at 2:00 p.m. in SD-562. You have a tentative commitment on your calendar at 2:00 pm tomorrow in SD-GSO. Senator Mitchell has also been asked to co-sponsor and to attend the press conference; his decision is pending. DO YOU WANT TO CO-SPONSOR THIS LEGISLATION? YES X NO WILL YOU ATTEND THE PRESS CONFERENCE TOMORROW AT 2:00 PM IN SD-562 AND ACCEPT THE PETITION FROM NAMI? YES NO 103D CONGRESS 1ST SESSION S.J.C. (End of Letterhead) In the Senate of the United States Mr. Domenici introduced the following bill; which was read twice and referred to the committee on ... A BILL To establish a comprehensive policy with respect to the provision of health care coverage and services to individuals with severe mental illnesses, and for other purposes. Be it enacted by the Senate and the House of Representatives of the United States of America in Congress assembled, Section 1. Short Title. This Act may be cited as the "Equitable Health Care for Severe Mental Illnesses Act of 1993." Section 2. Findings. Congress finds that -- (1) American families shuld have health insurance protection for the costs of treating severe mental illnesses that is commensurate with the protection provided for other illnesses; (2) currently, many private health insurance policies and public insurance programs discriminate against persons with severe mental illnesses by providing more restrictive coverage for treatments of those illnesses compared to coverage provided for treatments of other medical problems; (3) many health insurance plans limit the number of days allowed for facility care or limit the number of days allowed for facility care or limit the number of outpatient visits allowed for the treatment of severe mental illnesses while providing no limit for the treatment of other physical illnesses; (4) only 21 percent of all health insurance policies provide inpatient coverage for severe mental illnesses comparable to coverage for other illnesses, and only two percent have comparable outpatient coverage; (5) only two percent of Americans with private health care coverage have policies that adequately and fairly cover severe mental illnesses; (6) over 60 percent of health maintenance and preferred provider organizations specifically exclude treatment for those with severe mental illnesses; (7) private health insurance provides some type of coverage for 64 percent of all individuals with severe mental illness, but provides only 46 percent of the annual expenditures required for the treatment of severe mental illnesses; (8) health care reform plans designed to make health care more accessible and affordable often incorporate the policies that are discriminatory with respect to persons with severe mental illnesses which now exist in common private health insurance plans; (9) unequal health insurance coverage contributes to the destructive and unfair stigmatization of persons with severe mental illnesses, illnesses that are beyond the control of the individuals, just like cancer, diabetes, and other serious physical health problems; (10) schizophrenia strikes more than 2,500,000 Americans over the course of their lifetimes, and approximately 30 percent of all hospitalized psychiatric patients in the United States suffer from this most disabling group of mental disorders; (11) left untreated, severe mental illnesses are some of the most disabling and destructive illnesses afflicting Americans; (12) studies have found that up to 90 percent of all persons who commit suicide suffer from a treatable severe mental illness, such as schizophrenia, depression, or manic depressive illness; (13) some 10 percent of all inmates, or 100,000 people, in prisons and jails in the United States suffer from schizophrenia or manic-depressive psychosis; (14) severe mental illness places an individual at high risk for homelessness, as approximately one-third of the Nation's 600,000 homeless persons suffer from severe mental illnesses; (15) many persons suffering from severe mental illnesses can be treated effectively but ignorance and stigma continue to prevent many mentally ill individuals from obtaining help; (16) seventy to 80 percent of those suffering from depression respond quickly to treatment and 80 percent of the victims of schizophrenia can be relieved of acute symptoms with proper medication; (17) about 95 percent of what is known about both normal and abnormal structure and function of the brain has been learned in the last 10 years, but millions of severely mentally ill people have yet to benefit from these startling research advances in clinical and basic neuroscience; (18) ensuring adequate health insurance coverage for the treatment of severe mental illnesses can reduce health and societal costs by as much as $2,200,000,000 annually by preventing more costly interventions in the lives of persons with untreated severe mental illnesses and by helping those with severe mental illnesses, many of whom are young adults, remain productive members of society, and; (19) legislation to reform the health care system should not condone or perpetuate discrimination against persons with severe mental illnesses. Sec. 3. Statement of Policy. (a) In General -- It is the policy of the United States that -- (1) persons with severe mental illnesses must not be discriminated against in the health care system; and (2) health care coverage, whether provided through public or private health insurance or any other means of financing, must provide for the treatment of severe mental illnesses in a manner that is equitable and commensurate with that provided for other major physical illnesses. (b) Contruction -- Subsection (a) shall not be construed to preclude the adoption of laws or policies requiring or providing for appropriate and equitable coverage for other mental health services. Sec. 4. Nondiscriminatory and Equitable Health Care Coverage With respect to persons with severe mental illnesses, to be considered nondiscriminatory and equitable under this Act, health care coverage shall cover services that are essential to the effective treatment of severe mental illnesses in a manner that -- (1) is not more restrictive than coverage provided for other major physical illnesses; (2) provides adequate financial protection to the person requiring the medical treatment for a severe mentall illness; and (3) is consistent with effective and common methods of controlling health care costs for other major physical illnesses. Sec. 5. Commitment to Policy. It is the purpose of this Act to commit the Congress and the Executive Branch to incorporating the policy set forth in section 3 through efforts, including the enactment of legislation, which are intended to improve access to or control the cost of health care. Sec. 6. Definition. As used in this Act, the term "severe mental illness" means an illness that is defined through diagnosis, disability and duration, and includes disorders with psychotic symptoms such as schizophrenia, schizoaffective disorder, manic depressive disorder, autism, as well as severe forms of other disorders such as major depression, panic disorder, and obsessive compulsive disorder. Telecopier Transmittal Date: 3/30/93 To: Walt Riker/RLO From: Alec Vachon Office of Senator Bob Dole 141 Hart Senate Office Building Washington, D.C. 20510 (202) 224-6521 Number of pages to follow: Subj: 2 pm Press Conference Memorandum Date: March 30, 1993 To: Walt Riker From: Alec Vachon Re: Press Conference, Per Conversation (End of Letterhead) As attached memo indicates, Senator Dole was invited by Senator Domenici to attend a press conference today at 2:00 pm, where Senator Domenici will announce his introduction of a bill to establish as "national policy" that health care insurance include coverage for severe mental illness (such as schizophrenia). Senator Dole is asked to attend the press conference to accept on behalf of Congress a petition with 600,000 signatures from the National Alliance of the Mentally Ill in support of this bill. Senator Dole has agreed to be an original co-sponsor of the bill. Senator Dole's schedule is now open at 2:00 p.m. Senator Mitchell was asked to attend, but will not be there. Senator Simon will attend as another original co-sponsor. The contact person in Senator Domenici's office is Mike Knapp, 4-7087.