by Phyllis Vine

Nearly ten years ago, Rep. Jim Ramstad (R-MN) proposed a bill to guarantee equal insurance protections for people recovering from alcohol or substance use. It was September, 1997, more than 40 years after the American Medical Association designated alcoholism a medical problem, yet most insurance companies still refused to include services to policy holders who were otherwise being treated for cancers, diabetes, or broken collar bones.

Ramstad, in recovery from alcohol addiction, and the late Sen. Paul Wellstone, a fellow Minnesotan who was waging a similar battle in the Senate for the mental illnesses, announced they were co-sponsoring the Substance Abuse Treatment Parity Act. Ramstad called it cost-effective, a “pragmatic approach” for roughly 10 percent of the population suffering with a disease that cost the nation more than $250 billion when left untreated.

As pragmatic as it may have seemed, Ramstad’s own Republican party stalled the effort, refusing to bring annually revised bills with more than 230 co-sponsors to the House floor. While they stood still, a movement grew: The Report of the Surgeon General (1999) defined mental illnesses as biological brain disorders, and the Clinton administration set a new standard for care when it linked the Federal Employees Health Benefits to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV). In 2002 President Bush endorsed insurance parity, sponsoring the Presidents New Freedom Commission (2002), which urged demolishing barriers — including insurance — to the treatment of psychiatric disorders. And states passed independent parity laws with varying levels of coverage.

This year Ramstad is confident that The Paul Wellstone Mental Health and Addiction Equity Act of 2007 (HR 1424) will finally be brought to the floor of the House. In March Rep. Patrick Kennedy (D-RI) introduced the bill with 258 co-sponsors, and Ramstad expects it to receive the support of the full House before reaching joint committees to reconcile differences with Senator Pete Domenici’s Senate’s version (S. 558). The Mental Health Parity Act of 2007, with 21 co-sponsors, was approved by the Senate Health, Education, Labor and Pensions Committee in February and sent to the full Senate for consideration.

Both bills require insurance companies to end discrimination based on mental illness or substance abuse.They also require equal co-pays and abolish artificial ceilings on out-patient treatment and hospitalization. Neither bill mandates companies to include these provisions (each bill applies only to those already doing so), and both bills exempt companies with fewer than 50 employees (up from 25 in the 1995-96 versions).

Differences between the Senate and House bills are also noteworthy. The Senate relies on group plans and employers to define coverage, and it also trumps laws in the 39 states that already have them. The House pegs coverage to definitions in the DSM-IV, extending coverage to more disorders, and bows to state rights where the ceiling is higher.

That Wellstone and Ramstad should have paired in 1997 to promote insurance for these disorders seems no accident even though one was Minnesota’s Senate Democrat and the other a House Republican from the 3rd District, an affluent Minneapolis suburb. Wellstone had already worked with Sen. Pete Dominici to establish parity for mental illness. Both hailed from Minnesota, a progressive state that has benchmarks for treating addiction and substance abuse disorders. After Wellstone’s death in 2002 in a plane crash, the bill was renamed in his honor.

Ramstad needed no lobby, no interest groups, no prodding to promote this legislation. It stems from first-hand knowledge of a 25-year recovery from alcoholism. It’s a story he has been telling since he left a Sioux City jail following an arrest for driving under the influence in 1981, an experience that shocked and humiliated him into treatment. At the time he was serving in the Minnesota state legislature. He tells the story to open hearings he and Kennedy have been holding around the country to gain traction for their bill. He repeated it in New York City on March 16th when fifteen people testified at the Congressional Field Hearings New York State Psychiatric Institute.

The conversation I had with Rep. Ramstad took place two weeks later, on March 28, as Congress was readying for Spring break. We met in his office in the Canon Office Building, and although he repeated what he has told reporters, advocates, and people in recovery on countless occasions, it sounded fresh, invigorated, as if it were rolling off his tongue for the very first time.

Q: Congressman Ramstad, how many people are we talking about?

We know we treat more than one person and we know it’s a family disease . . . and the impact is much greater than the numbers reflect. According to SAMSHA there are 26 million alcoholics and addicts, and there’s no question that it’s America’s number one health problem and we’re not dealing with it.

Q: What’s being done for them?

When he was president, Richard Nixon used the metaphor “War on Drugs.” At least he had the foresight to direct 60 percent of federal dollars to treatment. Today, less than 20 percent of Federal dollars are going to treatment. Our priorities are reversed; they’re upside down. We’re spending two-thirds of our dollars on the supply side: more crop eradication, more prisons, more law enforcement officers. And only one-third on prevention, education and treatment. In my judgment those priorities should be reversed.

Q: Do none of those people have insurance?

A: There are eight million Americans now in health plans who can’t access effective recovery. Their treatment is limited to an average of 7 days now, the co-payments and deductibles are artificially raised beyond the means of most of the 8 million policy holders. And that’s just one dimension of the problem, one aspect of the problem.

Q: The other dimensions?

We’ve also got to address the Medicare population with the increase in alcoholism among older Americans. Medicaid funding is woefully inadequate, not to mention that there are 45 million uninsured, and our veterans and troops who are not being taken care of. We just had one in Minnesota. Lance Cpl. Jonathan Schulze suffered from alcoholism and depression and with suicidal tendencies, called the VA and was told he was on a waiting list of 26 people. Four days later, they found him hanging from an electrical cord.

I should also add our nation’s prisoners because 80 percent of them are in prisons or jails directly as a result of drugs or alcohol. And most of those people are going to get out jail.

Q: Why do you think Congress is now more favorable to the Wellstone Act?

A: A change in the leadership. When the Republicans were in control, I was the chief sponsor. Patrick [Kennedy] was my co-sponsor. We had 232 co-sponsors. We couldn’t get a hearing even though we had more than a majority; my leadership would not give me a hearing. New leadership, this is one of their issues, and the Speaker [Nancy Polosi] told us she is ready to move the bill. We think we’re going to move this bill and get to conference by Memorial Day.

Q: Why cap the benefits for employers with more than 50 people?

A: There’s always some horse trading going on.

Q: Doesn’t that leave unmet needs?

A: The Senate bill lets the health plans essentially allow companies to determine what constitutes mental illness. And we know the first thing they’re going to do is carve out addiction treatments. Then they’re going to carve out eating disorders. Really what they’re going to allow is the top three in terms of frequency. Depression disorders, schizophrenia, anxiety and PTSD.

Q: Do you think you will be able to prevail using the DSM for diagnostic purposes?

A: I sure hope so. The American people deserve nothing less. If it’s good enough for members of Congress it would be good for the American people. We shouldn’t be treated any better in our Federal Employees Benefit Plans than the American people.

Q: The public seems more galvanized now. What has changed?

A: The treatment community in general has become more involved on the national level and the local level. It’s not surprising that they’ve become involved because they’ve seen 50 percent of their treatment beds disappear in the last 10 years. And even more alarming is 60 percent of the adolescent treatment beds have disappeared in the last 10 years. It’s a good thing they’re getting involved to keep treatment as a viable option for people suffering the ravages of addiction.

And a lot of the news media have publicized the epidemic -- I don’t think it’s hyperbole to call drug and alcohol usage in this country and epidemic -- people like Lou Dobbs. And we were on the “Today Show.”

Q: How hard was it to tell your story when you started?

When I started it was very hard. When I woke up in that jail cell, and then when I was released and went back to Minnesota, I wanted to be dead. I didn’t want to see anybody. I was embarrassed, humiliated, I felt incredible shame and I did want to be dead and not face anybody. It was very hard. Finally, when I mustered the courage to go back into the public, I remember the first time I went to speak at a dinner meeting of a citizens group at a Holiday Inn in Plymouth [Minn.]. But the more I opened up about my alcoholism, the more people came forward to support me and the better I felt, and easier it was. The second easier than the first, the third easier than the second, and down on to the fiftieth. And then I realized from a lot of other recovering people that it’s part of the recovery process. That “there’s hope for even a drunk like me.” So it’s a part of who I am.

I remember early on in my recovery somebody asked me “would you be embarrassed to talk about your disease if you had cancer or diabetes?” and I said, “No.” and they said, “Well you have a disease.” I learned that in treatment and I got the tools to recover from treatment. Once I started thinking about it as a disease, and the nature of the disease, it became easier to talk about my own disease.

Q. How long had you been an alcoholic?

Twelve years. I had several years as a binge drinker, mostly on the weekends.

Q. Did you ever come close to not being pulled out of a binge?

I remember one time in the winter I suffered a black out out in a farm field, lost in my Jeep, and I woke up and it was minus 35 degrees with wind chill. And I know that because I managed to crawl like I was taught in the army on my elbows and knees to a farm house. I could see the lights of the farmhouse because it was still dark when I awakened. And this young couple brought me in and put me in a bathtub with warm water, and I heard on the radio it was 35 below with wind chill and they took me to the hospital and I had frostbite on my hands and feet. That was one close call.

Another night I ended up in detox on Chicago Ave. in Minneapolis. I’m convinced if I hadn’t gotten into treatment and the road to recovery in 1981 I would surely be dead by now. I was drinking large quantities. Only because of the access I had to treatment, and the grace of God, and the support of other recovering people in the past 25 years.

If you had told me at St. Mary’s Rehabilitation hospital where I went for treatment that I would stay sober for 25 years, I would have bet my last dime. I was lucky.

I had a very effective intervention from the Sioux Falls police department. It was really hard for me to admit my alcoholism. I had two uncles who died from alcoholism and I never wanted to be an alcoholic, never wanted to be like them. I remember some of the things they did when I was a little boy. But the fact is that I am -- and once I realized that and took my first step, it started to get easier. That was really important, that first step. I was in denial for many years.

I went into treatment that Monday after leaving jail and that began the road to recovery.

Q: Did you personally feel the stigma?

A: I certainly was aware of the stigma and that’s why I was in denial because who would vote for an alcoholic? It was suggested to me many times that I go to meetings, but I didn’t want to be caught dead in an AA meeting.

Q: What do you see as the biggest obstacles in promoting Wellstone?

A: The refusal of people to look at the empirical data. We’re still getting demagogues on the costs of parity when in fact parity would be a cost savings. We’re being attacked saying this legislation is a mandate when in fact it’s not a mandate. We’re not requiring any insurance company to cover chemical dependency. We’re just saying if you cover it, you must treat it the same way as a physical disease. You can’t erect artificial barriers with artificial co-payments, artificial higher premiums or limited treatments than you impose on physical ailments.

Just getting hit by the mandate argument and the cost argument -- both of which are eminently disprovable.

And a third thing is the stigma. I have members, colleagues coming up to me, saying “where I come from people think alcoholism is a moral thing.” Of the 260 co-sponsors, there are only 35 Republicans.

It has a bigger stigma. People see it as a choice, you can’t choose to be schizophrenic or to be depressed or to have anxiety, but people see it as a choice and a moral failing if you choose to be that drunk.

I’m just grateful that I come from a progressive and enlightened state such as Minnesota where people see addiction and alcoholism as an illness. People in Minnesota understand that this is a disease, that recovery is possible, and that treatment works. I just wish that by the time this legislation comes to the floor, at least a majority of the members of Congress will also understand that.

Q: Next steps?

A: Patrick [Kennedy] and I plan to introduce further legislation, a patients’ bill of rights.

Our [current] legislation simply provides parity in treatment for all people suffering from mental illness and/or chemical addiction. You have to treat these diseases like you treat physical diseases if they’re included in the insurance policies.