Good morning.
My name is Alan Hartl. I am Executive Director of Lenape Valley Foundation
located in Doylestown, Pennsylvania. Lenape Valley Foundation provides mental
health, mental retardation, and early intervention services to children and
adults.
First, I would like to thank Congressmen Patrick Kennedy (D-RI) and Jim Ramstad
(R-MN) for their leadership in crafting legislation calling for parity regarding
insurance coverage of mental health and substance abuse problems and for their
willingness to hold nationwide forums. I would also like to thank Congressman
Sestak, who happens to be my Congressman, for hosting one of the two Pennsylvania
forums. Also, thank you to the Mental Health Association for organizing this
event and to Elwyn for serving as the host site.
Today, besides Lenape Valley Foundation, I also represent the Pennsylvania Community Providers Association (commonly known as PCPA). I currently serve as PCPA’s Legislative Affairs Committee Co-Chair. PCPA represents over 200 community-based providers of mental health, mental retardation, substance abuse, and other human services. Our host today, Elwyn, is one of PCPA’s members. Our members provide services in over 1,100 locations throughout Pennsylvania’s 67 counties. As the premier Pennsylvania association with members who provide both mental health and substance abuse services, PCPA is in a unique position to comment on the legislation in question.
This legislation
is important because treatment for mental health and substance abuse issues
works. One need only speak to some of the very people here today – consumers
and families - to confirm this. All Americans must be afforded the opportunity
to seek such treatment when the need arises. The 1999 Surgeon General’s
Report on Mental Health and the 2003 President’s New Freedom Commission
on Mental Health both make this point. These reports further state that such
conditions must be treated with the same urgency and status as physical health
problems. Assuring that health insurance plans recognize this and provide
coverage in a manner equitable to other health conditions is a significant
step forward in improving the overall health of our citizens.
If you have any doubts concerning this, consider the following:
- The 1999 Surgeon General’s Report on Mental Health indicated that approximately 20% of all children and adults will, at some point, have their lives disrupted by a diagnosable mental health condition. (1)
- The 2003 President’s New Freedom Commission on Mental Health estimated an annual indirect cost of mental illnesses of $79 billion in the U. S. in lost productivity. (2)
- The problems of addiction permeate many other systems such as education, health care, law enforcement, welfare, domestic violence, children’s services including child abuse services and foster care, and health and auto insurance. These problems result in unnecessary costs and significant cost shifting. In fact, $1.00 invested in addictions treatment results in more than $7.00 savings in these other societal costs. (3,4)
- Alcohol, tobacco, and other drug abuses cause a host of medical problems including constricted blood vessels, liver damage, kidney damage, and blood-borne viruses from injection drug use. (5)
- Accidental injuries and death often occur in individuals under the influence of substances. Impairment caused by alcohol is a leading factor in trauma. As many as 50 percent of trauma patients have positive blood alcohol levels at the time of their injuries. Also, the increased cost of hospital care for drug-exposed infants is extremely high. (5)
Despite the overwhelming evidence of the cost and profound deleterious impact of not treating behavioral health disorders, the very need for this legislation points to the history of health care plans not including equitable coverage to their subscribers. Federal legislation is needed if this is to be reversed. If protections are imposed to assure behavioral health treatment, great things can be accomplished as evidenced by the unparalleled success of Pennsylvania’s carve-out of Medicaid behavioral health services in its HealthChoices program. These protections should not be limited to certain diagnoses, but rather should encompass all behavioral health diagnoses contained within the current Diagnostic and Statistical Manual. The brain-body connection is well-established, and an array of effective treatments is available. Anyone who can benefit from treatment should not be denied because their diagnosis is not one of a select few. Similarly, a health plan should be expected to provide coverage for treatment of a diagnosable behavioral health disorder that is disrupting the life of one of its members.
It is important
that this federal legislation be enacted now. Various states, including Pennsylvania,
are considering universal health care proposals. Without federal legislation
setting a minimum standard for parity in the treatment of mental health and
substance abuse disorders, states may be tempted to emulate the policies of
commercial plans that severely limit such coverage. The federal government
has the responsibility to assure that all its citizens have vital services
protected, such as healthcare, regardless of where someone might live.
Simultaneously, federal legislation need only establish a floor and should
not pre-empt state legislation that provides greater protection of coverage
for behavioral health disorders. Such is the case with Pennsylvania's Act
106 for drug and alcohol treatment under commercial insurance, which is not
clearly protected in Senate Bill 558, a parity bill which is now being considered
by the U.S. Senate. I do not believe that is your intention, but we must be
sure to protect such state laws - both by making sure language in the House
Bill reflects this and having it inserted in the current Senate companion
bill.
The 1999 Surgeon General’s report established that mental health is
fundamental to health and that "treatment and mental health services
are critical to the nation’s health. . . [and] have an immense impact
on individuals and families throughout this nation and the world." Given
this, it is time that we make sure that such services are one of our health
priorities, and not afforded second class or, worse, no coverage.
Thank you for your time today and allowing me to testify. George Kimes, PCPA's Executive Director, will testify at the March 12 Pittsburgh hearing. At that time, PCPA will submit additional comprehensive written testimony for your consideration.
Citations corresponding to bullets in the testimony of Alan J. Hartl, MS:
1. US Department of Health and Human Services. Mental Health: A Report of the Surgeon General, Rockville, MD: US Department of Helath and Human Services, Substance Abuse and Mental Helath Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
2. The President’s New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in Americy, Rockville, MD, 2003.
3. Rydell, C.P. & Everingham, S.S. (1994) Controlling Cocaine Supply Versus Demand Programs. RAND Drug Policy Research Center. Santa Monica, CA.
4. State of California (1994). Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA), Exec Summary, (ADP) 94-4628. Retrieved May 13, 2003 from http://www.adp.cahwnet.gov/RC/pdf/caldata.pdf
5. Holder, H.
(1998). Cost Benefits of Substance Abuse Treatment: An Overview of Results
from Alcohol and Drug Abuse. The Journal of Mental Health Policy and Economics,
1, 23-29.
