by Phyllis Vine

Membership in one of America’s premier families does not guarantee health. Nor does it diminish the turbulence of managing co-occurring illnesses such as bipolar with addiction disorders. Congressman Patrick Kennedy (D-RI) keeps this in mind while stumping to expand treatment rights for people suffering from mental illness and chemical dependency — and not just for people who, like him, are fortunate to have the means to afford treatment.

Kennedy has been imploring Congress to tend to veterans before and after they see combat, to guarantee that children get services and treatments without being separated from their parents and families, to increase aid to states for uninsured children needing mental health services and, for older Americans to receive Medicare benefits equitably. During the last three months, he has also been crisscrossing the nation to hold hearings on insurance parity legislation named the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424), which he introduced last March.

Kennedy is quick to note that only the House version of insurance parity legislation, not the Senate’s, carries the endorsement of Wellstone Action, a nonprofit group promoting the late senator’s mission. "It was decided for the time being to attach [Wellstone’s name] to the most comprehensive proposal," said Wellstone Action’s Jeff Blodgett. By comprehensive, Blodgett means adhering to professional determinations of mental illness and accepting state laws when they exceed national standards.

Following a car crash in May, Kennedy disclosed his history of bipolar disorder. Despite troubled teen years and patterns of drug and alcohol use, it wasn’t until after his election to Congress that a doctor first used the words "bipolar" to explain his inconsistent swings, the behaviors that seemed "out there." By then, Kennedy’s entanglements with the Coast Guard and authorities at the Los Angeles International Airport had earned headlines. The public may have presumed he carried himself with a "Kennedy air of superiority," but he believes he suffered from hypomania and grandiosity. Who else would think himself capable of winning elected office at the age of 20, he asks rhetorically about his successful campaign for the Rhode Island Legislature? Or run for Congress at the age of 24, when he was elected to his first term in 1994? Kennedy has also seen the downswing of bipolar disorder — the depressive qualities leading to seemingly endless hours of sleep, especially when he was younger.

Kennedy says that breaking the stigmatic silence that usually surrounds bipolar disorder, and alcohol addiction has helped to energize him.

Recently Kennedy has been in the public eye during the insurance parity hearings he's holding nationwide. He sees these forums as a catalyst to a larger movement redefining the nation's responsibility to people with mental illnesses and addictive disorders. Our conversation on March 28 followed a vote in the House to amend the Wounded Warrior Assistance Act (H.R. 1538), to which he offered an amendment to plug holes in services offered to vets.

Many days Patrick Kennedy can be found testifying on one side or the other of Congressional hearings. When the House Ways and Means Subcommittee on Health heard about insurance parity for Medicare, Kennedy testified, repeating only a few of the poignant stories he has heard from people in the dozen or so hearings. Kennedy told the committee headed by Rep. Pete Stark (D-CA) what he had learned from people nationwide: dreams postponed, children lost and dignity drained because of inequities in responding to the mental illnesses in their families. He reported about studies from the Federal Employees Health Benefits Program as well as from several states that proved that costs did not increase after implementing parity. He provided a copy of PET scans showing differences in the brain of a person with schizophrenia and that of a healthy individual. He told of his own treatment and recovery, and spoke of the American Dream. And, he concluded, "It shouldn’t be rationed by diagnosis."

MIWatch posts Rep. Kennedy’s testimony from that public hearing below.

Testimony of Representative Patrick J. Kennedy
House Ways and Means Subcommittee on Health
Hearing on Mental Health and Substance Abuse Parity
March 27, 2007 | 10:00 a.m.

Chairman Stark, Ranking Member Camp, and my distinguished colleagues, thank you for inviting me to testify today, and, especially, for your commitment to ending insurance discrimination.

And of course, I must single out my great friend and the strongest champion for Americans with mental illnesses and addictions, Jim Ramstad. For years he has led this fight, leaning into the stiff wind of his own leadership without regard for the political consequences, speaking up for what he knows is right. We all owe him a debt of gratitude, nobody more than I. Jim, it has been an honor to stand with you in these efforts, and a greater privilege to be your friend.

This issue is first and foremost one of fundamental fairness. Kitty Westin, who you will hear from, paid her health insurance premiums just like everyone else. But when her daughter Anna got sick and needed her insurance coverage, she didn’t get it. That is just not fair. And it cost Anna her life.

There is no way to justify denying Anna Westin, and millions of others, the full benefit of the health insurance they pay for.

In the attached exhibit, you can see the visual evidence that these diseases are physiological brain disorders. Some brain diseases, like Parkinson's, affect the motor cortex, the basal ganglia, the sensory cortex, and the thalamus. Other brain diseases, like depression, affect the limbic cortex, hypothalamus, frontal cortex, and hippocampus.

There is no way to justify providing full coverage to treat certain structures of the brain, but to erect barriers to the treatment of other structures.

This discrimination is not only unjustifiable, it is enormously costly. Representative Ramstad and I have traveled across this country holding informal field hearings on this subject – a dozen so far, with more to come.

We've heard from chiefs of police, like Sheriff Baca in Los Angeles who says he runs the largest mental health provider in the United States: the L.A. County Jail. According to the Justice Department, more than half of inmates in jails and prisons in this country have symptoms of a mental health problem. Two-thirds of arrestees test positive for one of five illegal drugs at the time of arrest, according to the National Institutes of Health. That's a cost of our insurance discrimination.

We’ve heard from hospital presidents and emergency room doctors, like Dr. Victor Pincus. He said that 80% of the trauma admissions at Rhode Island Hospital, a level-one trauma center, were alcohol and drug related. Eighty percent.

The physical health care costs go beyond the emergency room. Research shows, for example, that a person with depression is four times more likely to have a heart attack than a person with no history of depression. Health care use and health care costs are up to twice as high among diabetes and heart disease patients with co-morbid depression, compared to those without depression, even when accounting for other factors such as age, gender, and other illnesses. Not surprisingly then, one study found that limiting employer-sponsored specialty behavioral health services increased the direct medical costs of beneficiaries who used behavioral health care services by as much as 37%. These are costs of our insurance discrimination.

In our field hearings, we’ve heard from enlightened business leaders and insurance executives, like Jim Purcell, the CEO of Blue Cross Blue Shield of Rhode Island. This is what Mr. Purcell said about limits on access to mental health and addiction treatment: "I believe that's bad medicine, it's bad law, and it's bad insurance."

Rick Calhoun, an executive in the Denver office of CB Richard Ellis, a Fortune 500 company, made a similar point. Mr. Calhoun said that the cost of treating mental illness is 50% of the cost of not treating it. As he said, "This is a no-brainer. How could we not cover it?"

Untreated mental health and addiction cost employers and society hundreds of billions of dollars in lost productivity. The World Health Organization has found that these diseases are far and away the most disabling diseases, accounting for more than a fifth of all lost days of productive life. Depressed workers miss 5.6 hours per week of productivity due to absenteeism and presenteeism, compared to 1.5 hours for non-depressed workers. Alcohol-related illness and premature death cost over $129.5 billion in lost productivity per year. These are the costs of our insurance discrimination.

All of these costs are preventable, and wasteful. But none are as tragic as the individual costs. We heard testimony from anguished parents who, like Kitty Westin, had to bury their children because their mental illnesses and addictions went untreated.

We heard testimony from people like Amy Smith, who said when she runs into people she knew 25 years ago, they're stunned she's still alive. She was in and out of jail and emergency rooms, unable to connect with other people, muttering to herself on the street, and unemployed. For 45 years, she says, she was a drain on society. Then she finally got the treatment she needed and now she's a taxpayer, holding down a good job.

Amy Smith lost decades of her life because she didn’t get treatment. If you want to know the costs of our insurance discrimination, Amy Smith can describe them: "I would have been able to pursue my dreams for my life, which were things like driving a car, or holding down a real job, or getting married, or volunteering in the community, any of those things…. I think my life would have been a lot different if I had had those services a lot earlier."

So many Americans have lost their dreams, lost years, and even lost their lives – unnecessarily. In Palo Alto we met Kevin Hines. He is a gregarious, outgoing person and is engaged to be married this summer. In 2001 he jumped off the Golden Gate Bridge, one of very few to survive that fall. Thirty-thousand people succeed where Kevin fortunately failed and take their own lives each year. How many of them would, like Kevin, be starting families, contributing to their communities, holding jobs, and realizing their potential if only they had access to treatment?

Mr. Chairman, I'm happy to provide the transcripts from the field hearings I have referenced to be included in the record of this hearing.

We will hear arguments that even if worthwhile, equalizing benefits is just too costly. The truth, however, is that equalizing benefits between mental health and addiction care on the one hand and other physical illnesses on the other hand is in fact low-cost. This is not speculation.

In 2001, we brought equity to mental health and addiction care in the Federal Employees Health Benefits Program (FEHBP), which covers 9 million lives including ours as Members of Congress. A detailed, peer-reviewed analysis found that implementing parity did not raise mental health and addiction treatment costs in the FEHBP. Since our bill specifically references the FEHBP to define the scope of our bill, this analysis provides strong evidence that our legislation will similarly have negligible impact on costs. This finding is consistent with virtually every study of state parity laws as well.

But frankly, the very fact that we need to debate how much it costs to end insurance discrimination is offensive. Nobody is asked to justify the cost-effectiveness of care for diabetes or heart disease or cancer. Tell Kitty Westin, or Amy Smith, or Kevin Hines, or the millions of others who live with these diseases that to keep health care costs down for everyone else, they will not have to pay with their lives. Why them?

People might say that there is a component of personal responsibility here, especially with addiction. That's true. I'm working hard every day at my recovery, and it's reasonable to ask of me. But it's also true that we don't deny insurance coverage to people genetically predisposed to high cholesterol who eat fatty foods. We don’t deny insurance coverage to diabetics who fail to control their blood sugar.

At the end of the day, this is about human dignity and whether we deliver on the promise of equal opportunity that is at the heart of what it means to be American. Nobody chooses to be born with particular genetics and anatomy, any more than they choose to be born with a particular skin color or gender. And nobody should be denied opportunities on the basis of such immutable characteristics. Anybody who pays their health insurance premiums is entitled to expect their plan to be there when they get sick, whether the disease is in their heart, their kidneys, or their brain.

Unlike any other country in the world, this one was founded on principles – the ideas of equality and freedom and opportunity. This history of America is the history of a country striving to live up to those self-evident truths. In pursuit of those values we’ve fought a civil war, chipped away at glass ceilings, expanded the vote, renounced immigration exclusion laws, and recognized that disabilities need not be barriers. Led by one of our colleagues, a generation of peaceful warriors forced America to look in a mirror and ask itself whether its actions matched its promise, and they changed history.

It is time, once again, to ask that question: are our actions matching our promises? And once asked, the answer is clear. Jim and I know, personally, the power of treatment and recovery. We are able to serve in Congress because we have been given the opportunity to manage our chronic mental-health diseases. Every American deserves the same chance to succeed or fail on the basis of talent and industriousness. That's the American Dream, and it shouldn’t be rationed by diagnosis.

Thank you.

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