From the Office of Senator Kerry

Thursday, April 10, 2003

WASHINGTON, DC – Seeking to end discrimination against Medicare beneficiaries with mental illness, Senators John Kerry (D-Mass.) and Senator Olympia Snowe (R-Maine) today introduced the Medicare Mental Health Copayment Parity Act of 2003, which would bring the co-payment rate for mental health services in line with the rates applied to all other outpatient services under Medicare.

“Under the current system, if a Medicare patient sees an endocrinologist for diabetes treatment, an oncologist for cancer treatment, a cardiologist for heart disease treatment, or an internist for treatment of the flu, the co-payment is 20 percent of the cost of the visit. If, however, a Medicare patient visits a psychiatrist for treatment of mental illness, the co-payment is 50 percent of the cost of the visit,” said Kerry. “This disparity in outpatient co-payments represents blatant discrimination against Medicare beneficiaries with mental illness.”

The Medicare Mental Health Copayment Equity Act of 2003 will phase-down the 50% co-payment for mental health care services to 20% over six years.

The prevalence of mental illness in older adults is considerable. According to the U.S. Surgeon General, 20 percent of older adults in the community and 40 percent of older adults in primary care settings experience symptoms of depression, while as many as one out of every two residents in nursing homes are at risk of depression. The elderly have the highest rate of suicide in the U.S., and there is a clear correlation between major depression and suicide: 60 to 70% of suicides among patients 75 and older have diagnosable depression.

In addition to seniors, 400,000 non-elderly disabled Medicare beneficiaries become Medicare-eligible by virtue of severe and persistent mental disorders. “To subject the mentally disabled to discriminatory costs in coverage for the very conditions for which they became Medicare eligible is illogical and unfair,” Kerry said.

There is ample evidence that mental illness can be treated. Unfortunately, those in need of treatment often do not seek it because they are ashamed of their condition. Among the Medicare population, the mentally ill face a double burden: not only must they overcome the stigma about their illness, but once they seek treatment they must pay one-half of the cost of care out of their own pocket.

“By applying the same co-payment rate to mental health services to which all other outpatient services are subjected, the Medicare Mental Health Copayment Equity Act of 2003 will bring parity to the Medicare program and improve access to care for our senior and disabled beneficiaries who are living with mental illness,” said Kerry.

The Snowe-Kerry bill was hailed by the American Psychiatric Association (APA). “The current Medicare system imposes a policy of discrimination by diagnosis that inflicts a heavy toll on Medicare patients who, by no fault of their own, happen to suffer from mental illness. This is a shameful policy to have written into Federal law,” said APA President Paul S. Appelbaum, M.D. “This legislation would end this statutory discrimination by requiring that Medicare patients pay only the same 20 percent co-payment for mental illness treatment that they pay when seeking any other medical treatment, including, for example, treatment for diabetes, cancer, heart disease, or the common cold.”

The American Association for Geriatric Psychiatry (AAGP) also praised the bill. “Your legislation stands to dramatically improve the lives of Medicare beneficiaries by providing them with the access to mental health care that they deserve,” said AAGP President Joel E. Streim, M.D. in a letter to Kerry.