American Psychiatric Association Applauds Effort to End Medicare Discrimination

Main Category: Psychology / Psychiatry
Article Date: 05 Mar 2005 - 15:00 PDT


Today the American Psychiatric Association (APA) reiterated its strong support for ending a four-decades-long discriminatory practice of Medicare: forcing patients to pay higher out-of-pocket costs for outpatient mental health services than for other medical services. As part of the Mental Health Liaison Group (MHLG), the APA sent a letter to U.S. Reps. Ted Strickland (D-Ohio) and Tim Murphy (R-Penn.), backing legislation the two members reintroduced in the House of Representatives today, the Medicare Mental Health Copayment Equity Act, which would phase out the practice over six years.

"It is simply unacceptable to compel patients who receive outpatient mental health services to pay 50 percent of the cost of their care out of their own pockets," said APA Medical Director James H. Scully Jr., M.D., who helped initiate the letter. "Medicare patients receiving other medical care pay 20 percent. This is discrimination, plain and simple. Patients are the real winners under the bill introduced by Congressman Strickland and Murphy, and we applaud their efforts. Passage of this legislation is long overdue."

The full text of the MHLG letter is as follows:

The undersigned organizations representing patients, health professionals, and family members are pleased to support your legislation, the Medicare Mental Health Copayment Equity Act. Under your legislation, Medicare's historic discriminatory 50 percent coinsurance for outpatient mental health care would be reduced over six years to 20 percent, bringing the coinsurance into line with that required of Medicare beneficiaries for other Part B services.

Simply put, current law discriminates against Medicare beneficiaries who seek treatment for mental illness. This affects elderly and non-elderly Medicare beneficiaries alike when they seek mental health care. According to the 1999 U.S. Surgeon General's report on mental health, almost 20 percent of elderly individuals have some type of mental disorder uncommon in typical aging. In addition, elderly individuals have the highest rate of suicide in the U.S., often the result of depression. The Surgeon General's report states, "Late-life depression is particularly costly because of the excess disability that it causes and its deleterious interaction with physical health. Older primary care patients with depression visit the doctor and emergency rooms more often, use more medication, incur higher outpatient charges, and stay longer at the hospital."

The 50 percent coinsurance requirement also is unfair to the non-elderly disabled Medicare population. Because many of these individuals have severe mental illnesses combined with low incomes and high medical expenses, a 50 percent coinsurance obligation is a serious patient burden. For elderly and non-elderly Medicare beneficiaries alike, Medicare is a critical source of care. Your legislation to ensure that Medicare beneficiaries needing mental health care incur only the same cost-sharing obligations as required of all other Medicare patients would end the statutory discrimination against Medicare beneficiaries seeking treatment for mental disorders.

Thank you for your leadership in addressing this important issue for the nation's 40 million Medicare patients.

MHLG member organizations include: the American Psychiatric Association; the American Association for Geriatric Psychiatry; the Alliance for Children and Families; the American Academy of Child and Adolescent Psychiatry; the American Association of Children's Residential Centers; the American Association of Pastoral Counselors; the American Association of Practicing Psychiatrists; the American Group Psychotherapy Association; the American Mental Health Counselors Association; the American Occupational Therapy Association; the American Psychiatric Nurses Association; the American Psychoanalytic Association; the American Psychological Association; the American Psychotherapy Association; the Anxiety Disorders Association of America; the Association for the Advancement of Psychology; the Association for Ambulatory Behavioral Healthcare; the Bazelon Center for Mental Health Law; Children and Adults with Attention-Deficit/Hyperactivity Disorder; the Clinical Social Work Federation; the Clinical Social Work Guild; the Depression and Bipolar Support Alliance; the Eating Disorders Coalition for Research, Policy & Action; Ensuring Solutions to Alcohol Problems; the International Society of Psychiatric-Mental Health Nurses; NAADAC; the Association for Addiction Professionals; the National Alliance for the Mentally Ill; the National Association for Children's Behavioral Health; the National Association for Rural Mental Health; the National Association of Anorexia Nervosa and Associated Disorders; the National Association of Mental Health Planning & Advisory Councils; the National Association of Protection and Advocacy Systems; the National Association of Psychiatric Health Systems; the National Mental Health Association; and Suicide Prevention Action Network USA.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose more than 36,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders. For more information, visit the APA Web site athttp://www.psych.org.

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