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 provi-
sion of health care coverage and services to individuals
with severe mental illnesses, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives 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’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) American families should have health insur-
ance protection for the costs of treating severe men-
tal illnesses that is commensurate with the protec-
tion provided for other illnesses;
(2) currently, many private health insurance
policies and public insurance programs discriminate
against persons with severe mental illnesses by pro-
viding 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 num-
ber of days allowed for facility care or limit the
number of outpatient visits allowed for the treat-
ment of severe mental illnesses while providing no
limit for the treatment of other physical illnesses;
(4) only 21 percent of all health insurance poli-
cies provide inpatient coverage for severe mental ill-
nesses 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 se-
vere 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 in-
corporate 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 contrib-
utes 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 ap-
proximately 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 schizophre-
nia, depression, or manic depressive illness;
(13) some 10 percent of all inmates, or 100,000
people, in prisons and jails in the United States suf-
fer from schizophrenia or manic-depressive psycho-
sis;
(14) severe mental illness places an individual
at high risk for homelessness, as approximately one-
third of the Nation’s 600,000 homeless persons suf-
fer 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 individ-
uals 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 re-
lieved 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 cov-
erage 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 se-
vere mental illnesses, many of whom are young
adults, remain productive members of society; and
(19) legislation to reform the health care sys-
tem 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 sys-
tem; and
(2) health care coverage, whether provided
through public or private health insurance or any
other means of financing, must provide for the treat-
ment of severe mental illnesses in a manner that is
equitable and commensurate with that provided for
other major physical illnesses.
(b) CONSTRUCTION.—Subsection (a) shall not be con-
strued to preclude the adoption of laws or policies requir-
ing 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 ill-
nesses in a manner that—
(1) is not more restrictive than coverage pro-
vided for other major physical illnesses;
(2) provides adequate financial protection to the
person requiring the medical treatment for a severe
mental 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 costs of health care.
SEC. 6. DEFINITION.
As used in this Act, the term ‘‘severe mental illness’’
means an illness that is defined through diagnosis, disabil-
ity 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 dis-
order, and obsessive compulsive disorder.
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