I

103D CONGRESS

1ST SESSION H. R. 1563

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.

IN THE HOUSE OF REPRESENTATIVES

MARCH 31, 1993

Mrs. ROUKEMA (for herself and Ms. KAPTUR) introduced the following bill;

which was referred to the Committee on Energy and Commerce

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Equitable Health Care

5 for Severe Mental Illnesses Act of 1993’’.

6 SEC. 2. FINDINGS.

7 Congress finds that—

8 (1) American families should have health insur9 ance protection for the costs of treating severe men-
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1 tal illnesses that is commensurate with the protec2 tion provided for other illnesses;

3 (2) currently, many private health insurance

4 policies and public insurance programs discriminate

5 against persons with severe mental illnesses by pro6 viding more restrictive coverage for treatments of

7 those illnesses compared to coverage provided for

8 treatments of other medical problems;

9 (3) many health insurance plans limit the num10 ber of days allowed for facility care or limit the

11 number of outpatient visits allowed for the treat12 ment of severe mental illnesses while providing no

13 limit for the treatment of other physical illnesses;

14 (4) only 21 percent of all health insurance poli15 cies provide inpatient coverage for severe mental ill16 nesses comparable to coverage for other illnesses,

17 and only two percent have comparable outpatient

18 coverage;

19 (5) only two percent of Americans with private

20 health care coverage have policies that adequately

21 and fairly cover severe mental illnesses;

22 (6) over 60 percent of health maintenance and

23 preferred provider organizations specifically exclude

24 treatment for those with severe mental illnesses;
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1 (7) private health insurance provides some type

2 of coverage for 64 percent of all individuals with se3 vere mental illness, but provides only 46 percent of

4 the annual expenditures required for the treatment

5 of severe mental illnesses;

6 (8) health care reform plans designed to make

7 health care more accessible and affordable often in8 corporate the policies that are discriminatory with

9 respect to persons with severe mental illnesses which

10 now exist in common private health insurance plans;

11 (9) unequal health insurance coverage contrib12 utes to the destructive and unfair stigmatization of

13 persons with severe mental illnesses, illnesses that

14 are beyond the control of the individuals, just like

15 cancer, diabetes, and other serious physical health

16 problems;

17 (10) schizophrenia strikes more than 2,500,000

18 Americans over the course of their lifetimes, and ap19 proximately 30 percent of all hospitalized psychiatric

20 patients in the United States suffer from this most

21 disabling group of mental disorders;

22 (11) left untreated, severe mental illnesses are

23 some of the most disabling and destructive illnesses

24 afflicting Americans;
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1 (12) studies have found that up to 90 percent

2 of all persons who commit suicide suffer from a

3 treatable severe mental illness, such as schizophre4 nia, depression, or manic depressive illness;

5 (13) some 10 percent of all inmates, or 100,000

6 people, in prisons and jails in the United States suf7 fer from schizophrenia or manic-depressive psycho8 sis;

9 (14) severe mental illness places an individual

10 at high risk for homelessness, as approximately one11 third of the Nation’s 600,000 homeless persons suf12 fer from severe mental illnesses;

13 (15) many persons suffering from severe mental

14 illnesses can be treated effectively but ignorance and

15 stigma continue to prevent many mentally ill individ16 uals from obtaining help;

17 (16) seventy to 80 percent of those suffering

18 from depression respond quickly to treatment and

19 80 percent of the victims of schizophrenia can be re20 lieved of acute symptoms with proper medication;

21 (17) about 95 percent of what is known about

22 both normal and abnormal structure and function of

23 the brain has been learned in the last 10 years, but

24 millions of severely mentally ill people have yet to
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1 benefit from these startling research advances in

2 clinical and basic neuroscience;

3 (18) ensuring adequate health insurance cov4 erage for the treatment of severe mental illnesses

5 can reduce health and societal costs by as much as

6 $2,200,000,000 annually by preventing more costly

7 interventions in the lives of persons with untreated

8 severe mental illnesses and by helping those with se9 vere mental illnesses, many of whom are young

10 adults, remain productive members of society; and

11 (19) legislation to reform the health care sys12 tem should not condone or perpetuate discrimination

13 against persons with severe mental illnesses.

14 SEC. 3. STATEMENT OF POLICY.

15 (a) IN GENERAL.—It is the policy of the United

16 States that—

17 (1) persons with severe mental illnesses must

18 not be discriminated against in the health care sys19 tem; and

20 (2) health care coverage, whether provided

21 through public or private health insurance or any

22 other means of financing, must provide for the treat23 ment of severe mental illnesses in a manner that is

24 equitable and commensurate with that provided for

25 other major physical illnesses.
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1 (b) CONSTRUCTION.—Subsection (a) shall not be con2 strued to preclude the adoption of laws or policies requir3 ing or providing for appropriate and equitable coverage

4 for other mental health services.

5 SEC. 4. NONDISCRIMINATORY AND EQUITABLE HEALTH

6 CARE COVERAGE.

7 With respect to persons with severe mental illnesses,

8 to be considered nondiscriminatory and equitable under

9 this Act, health care coverage shall cover services that are

10 essential to the effective treatment of severe mental ill11 nesses in a manner that—

12 (1) is not more restrictive than coverage pro13 vided for other major physical illnesses;

14 (2) provides adequate financial protection to the

15 person requiring the medical treatment for a severe

16 mental illness; and

17 (3) is consistent with effective and common

18 methods of controlling health care costs for other

19 major physical illnesses.

20 SEC. 5. COMMITMENT TO POLICY.

21 It is the purpose of this Act to commit the Congress

22 and the Executive Branch to incorporating the policy set

23 forth in section 3 through efforts, including the enactment

24 of legislation, which are intended to improve access to or

25 control the costs of health care.
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1 SEC. 6. DEFINITION.

2 As used in this Act, the term ‘‘severe mental illness’’

3 means an illness that is defined through diagnosis, disabil4 ity and duration, and includes disorders with psychotic

5 symptoms such as schizophrenia, schizoaffective disorder,

6 manic depressive disorder, autism, as well as severe forms

7 of other disorders such as major depression, panic dis8 order, and obsessive compulsive disorder.

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