National Alliance on Mental Illness
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Senate Passes Work Incentives Improvement Act 99-0; Action Now Shifts To House Ways And Means Committee
After over a week of difficult negotiations among Senate leaders, the Work Incentives Improvement Act (S 331) passed unanimously today. As readers of the NAMI E-News, know, S 331 is designed to begin eliminating the pervasive disincentives to employment that exist in the SSI and SSDI programs. The centerpiece of the bill is an extension of eligibility for Medicare and Medicaid for SSDI and SSI beneficiaries who want to return to work.
As many NAMI members know first-hand, perhaps the biggest barrier to employment for adults with serious brain disorders is the threat of losing health care coverage once earnings rise above strict limits in the SSI and SSDI programs. S 331 also includes the "Ticket to Independence" proposal that would provide vouchers to adults with disabilities to purchase employment, training and rehabilitation services from private providers outside of the current public vocational rehabilitation (VR) monopoly. S 331 also contains several important beneficiary protections including suspension of work related continuing disability reviews (CDRs) and a new expedited re-entry to cash benefits if an acute episode of an individual's impairment temporarily forces them out of employment.
Controversy Over "Offset" Stalled Senate Action
For more than two weeks, a dispute over the "offset" revenue provision in S 331 delayed action by the full Senate. Senator Phil Gramm (R-TX) objected to inclusion of a foreign tax credit change that provided the $800 million in offsetting revenue needed to finance the cost of the bill. Earlier this week, Senate sponsors agreed to remove the provision and pass the bill without an "offset" to pay for the bill (most of the costs associated with S 331 are related to extended health benefits for people leaving the SSI and SSDI rolls). As part of the agreement to bring the bill to the full Senate, the supporters of S 331 - including President Clinton - agreed to find unspecified cuts in entitlement programs later this year.
Action Now Shifts to House Ways and Means Committee
The next step for the Work Incentives Improvement Act is the House Ways and Means Committee. Instead of moving forward with either the Senate version (S 331) or the version reported by the House Commerce Committee last month (HR 1180), Committee leaders are expected to move forward with their own bill, HR 1091. NAMI is now working hard to ensure that changes are incorporated into HR 1091 to make it more responsive to the needs of adults with severe mental illnesses who want to get off of SSI and SSDI.
HR 1091 does not contain the 6-year demonstration extension of Medicare for SSDI beneficiaries. Likewise, HR 1091 does not contain protections for people who leave the rolls and then face a "work related" CDR or the expedited re-entry on to cash benefits for workers experiencing an acute episode of their illness. However, HR 1091 does contain the same new state Medicaid eligibility options that are in both S 331 and HR 1180. HR 1091 also omits several provisions in S 331 that could allow state VR agencies to restrict access to VR services for individuals who "deposit" their "ticket" with a private provider not affiliated with VR. NAMI supports language in HR 1091that would prevent VR agencies from restricting access to VR services through prior written agreement requirements for private providers such as clubhouses and psychosocial rehabilitation programs.
NAMI advocates are urged to contact members of the House Ways and Means Committee in their state's congressional delegation and ask them to pass the Work Incentives Improvement Act as soon as possible. Urge them to support changes in HR 1091 to:
1) ensure that extended Medicare coverage meets at least the 6-year demonstration in the Senate bill (including protections that "grandfather" SSDI beneficiaries that access extended coverage);
2) allow all SSI and SSDI beneficiaries (and dual eligibles) to access extended health coverage when they go to work and not make eligibility contingent on use of a "ticket";
3) include CDR protections for beneficiaries who return to work (work activity should not trigger a CDR, nor should work alone be enough to kick an individual off the rolls); and
4) require Social Security to establish an expedited re-entry provision for people who leave the SSI and SSDI rolls but need to quickly restore cash benefits in the event of an acute episode of symptoms.
Members of the House Ways and Means Committee
Bill Archer (TX), Chairman, Philip M. Crane (IL), Bill Thomas (CA), E. Clay Shaw, Jr. (FL), Nancy Johnson (CT), Amo Houghton (NY), Wally Herger (CA), Jim McCrery (LA), Dave Camp (MI), Jim Ramstad (MN), Jim Nussle (IA), Sam Johnson (TX), Jennifer Dunn (WA), Mac Collins (GA), Rob Portman (OH), Phil English (PA), Wes Watkins (OK),), J.D. Hayworth (AZ), Gerald Weller (IL), Kenny Hulshof (MO), Scott McInnis (CO), Ron Lewis (KY), Mark Foley (FL), Charles Rangel (NY), Ranking Member, Pete Stark (CA), Bob Matsui (CA), William Coyne (PA), Sander Levin (MI), Benjamin L. Cardin (MD), Jim McDermott (WA), Gerald Kleczka (WI), John Lewis (GA), Richard E. Neal (MA), Michael McNulty (NY), William Jefferson (LA), John Tanner (TN), Xavier Becerra (CA), Karen Thurman (FL), and Lloyd Doggett (TX).
All Committee members can be reached through the Captiol Switchboard at 202-224-3121. Email addresses and mail addresses can be obtained through the NAMI website at:
http://www.nami.org/policy.htm and click on "Write to Congress."
Domenici and Kennedy Floor Speeches
On June 14, during debate on the Work Incentives Improvement Act, two of NAMI's longest and most important allies in the Senate engaged in a historic exchange on the Senate floor discussing the importance of employment to adults with severe mental illnesses and the need to ensure access to coverage for treatment that makes work possible. Both Senators Domenici and Kennedy (who together addressed the 1998 NAMI convention) spoke about the need to pass work incentives and parity bills so that people with severe mental illnesses will no longer be forced to quit their jobs when coverage is exhausted by the high cost of treatment. Included below is the text of their exchange on the Senate floor.
Congressional Record, June 14, 1999
Mr. DOMENICI. I say to Senator Kennedy, I commend him for what he is doing. I remind the Senate that the last time I looked, this bill had 33 Republicans on it and was led on the Senate side by the chairman of the Finance Committee. He is one of the leaders, not just Senator Jeffords from the Health, Education, Labor, and Pensions Committee.
Frankly, what has happened is, though we pass laws with reference to helping people who are disabled, either because of physical disabilities or mental disabilities, a lot of our terribly mentally handicapped do participate in disability programs.
What they do not participate in very well is the training programs for them. We are just getting that started.
But essentially we pass laws saying let's help them. Then we forget about them for about 15 or 20 years, which is what happened here. We find that in many respects the law has arbitrary finalization of benefit dates that hurt instead of help. Instead of encouraging that a person who is disabled go to work, if anybody is experienced with the old law, before we change it, what the people will be telling them is: Be careful, because if you try to go to work and get off, they take you off so quick and for such a tiny amount of earnings that sometimes that job finishes because the disabled do not have the propensity to have 6-year-long jobs; sometimes it is 6 months, 5 months.
In the case of the mentally ill, sometimes a schizophrenic works 1 month. This program, unless we change it, does not work for them, because they get taken off the benefit list too quickly. Then it is hard to get back on. So a parent may say: Let's just not ask Jimmy to go to the Green Door and get trained over here to get a job. They say: Let's just leave that alone and talk to him about volunteering, not earning money. But I tell you, to the extent we are encouraging that, we are doing a very bad thing for disabled people.
You will find across the board, for the disabled people, young or old, the most important thing going is for them to get a job. You cannot imagine how important it is for them to get a paycheck. It is among the most intriguing psychological things that happens to a disabled person--when they earn their own money--that you have ever seen.
Why should we have laws that help them but at the same time discourage them from getting a job because they may get kicked off the rolls too quickly, or they cannot get on quickly enough after they get unemployed? Let's change that and make it common sense.
I understand these laws are good laws, the ones we are changing. They put America in the vanguard when we passed them. They are good. But in the meantime, we are finding that nothing is as good as a job. These jobs do not pay a lot but pay just enough to qualify people under the old law to get off the rolls. So it is not as if it is rich people who are getting on and off the rolls, people earning $100,000; it is people earning minimum wage. In some instances, they even have youth jobs that are at less than minimum wage, and all of a sudden they qualify--no more aid--and they are worse off than they were before. That is what this is; the essence of it is to try to fix those things. We ought to fix them.
I thank the Senator. It is good to get an opportunity to comment.
Mr. KENNEDY. Madam President, I will not take much time.
The Senator has it absolutely right. We built in the program the ability to provide the medical and some income for people who have the disabilities and said that if they make over $500, they lose the insurance and they lose the additional kind of insurance, that they would be able to receive income, and they are just dropped out.
Very few of the families can be assured they can get a job after a training program where they would be able to offset their total medical expenses if they are able to get health insurance. They probably are not able to get it because they have a disability. The fact of the matter is, the insurance companies, by and large, do not include them.
I have a son who lost his leg to cancer and is a very healthy young person, but there is not a chance in the world he can get insurance. He has insurance only as a part of a much larger group. That happens to individuals who have any kind of disability. So they are out behind the 8-ball.
What we are saying is, continue their health care. OK, we can phase out or eliminate their income. They would be willing to take a chance on that. They will go out and try to pull their own weight. They are glad to do it. They will do it, and they will do it very well.
They have a desire to do it and the ability to do it. We have provided these incentives and training programs to enable them to be more creative to do it. There are more examples in a number of the States about how to do it. There are a number of examples in different countries on how to do it. We are going to do it in ways that are financially responsible.
Mr. DOMENICI. Madam President, before Senator Kennedy leaves the floor, I will just make a comment. He mentioned those disabled because of severe mental illnesses: manic depression, schizophrenia, severe chronic depression.
I say to the Senator, I introduced the parity bill with Senator Wellstone to try to get more insurance coverage resources applied to these serious illnesses. I want to share with the Senator, since we are talking about disabilities, a notion that came to me with reference to severely mentally ill people.
I said, what would happen if the United States, by definition, had decided we would not cover, under health insurance, illnesses of the heart because we did not want to cover illnesses of the brain? The complicated vessels are the heart and the brain. What if 30 years ago, as we produced the list of coverable illnesses, we said no coverage for heart conditions. Guess what would have happened. None of the breakthroughs in treating the heart would have ever occurred because there would not have been enough resources going into it for the researchers and the doctors to make the breakthroughs.
As a matter of fact, we would not have invented angioplasty and all those other significant techniques. What would have happened in the meantime is that hundreds of thousands of Americans would be dying earlier than they should. That would be along with what I just said.
When we say insurance companies should not cover schizophrenics, who have a brain disease, diagnosable and treatable, that we should not cover them, then are we not saying the same thing about a very serious physical frailty that hits between 5 and 15 million Americans during any given year, from the very young to the very old, with the highest propensity between 17 and 25 years of age for schizophrenia, manic depression, and the like? It seems to me that sooner or later, if we are going to call something `health insurance,' it ought to cover those who are sick, wouldn't you think?
Mr. KENNEDY. Absolutely.
Mr. DOMENICI. Why do we call health insurance `health insurance' and leave out a big chunk of the American population? Because the definition chooses to will away an illness. You define it so it does not exist, right? No. It exists. Families go broke. Their kids are in jails instead of hospitals. Because once they get one of these diseases, there is no way to help them, because there are no systems, because there are not enough resources. The resources come from the mass coverage by insurance. That is what puts resources into illnesses and cures.
So I just want to assure you, we are going to proceed this year. We are going to proceed with this parity bill. We are going to have a vote here. I do not know which bill yet, but we are going to have a good debate. We are asking the business community to get the price tag. We do not want to hear any of this business that it is going to break us.
We want to know, based on history, what is it going to cost? Then we are going to let the Senators and the public decide: Is that too much? What if it isn't too much in the minds of most Americans and Senators? Then it seems to me the marketplace will have to adjust to it.
Obviously, if I have a chance, I would like to talk about this. I would like to do it on the floor of the Senate so a lot of other Americans hear about it. I would like to do it when somebody is here to talk about the significance of this.
This is important business, the disabled in this country, whether they are disabled physically or disabled mentally. If we are going to have a real society that is proud of being free--and we have put so much emphasis on that--then we cannot leave out big chunks of the public with arbitrary laws or a failure to have insurance companies take care of the responsibilities of health coverage for disabled Americans.
I yield the floor.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. As the good Senator knows, we have such coverage for all Members of the Senate. Federal employees have it, over 11 million have it, and other groups have that as well. We find that it is suitable for Members of Congress and for the administration, other Federal employees.
I underline that I do not think we have health insurance worth its name if it doesn't meet the standard that the Senator from New Mexico has outlined here. I think it is basic and fundamental. There may have been troubles with the Clinton health insurance program, but the President has recently announced that he will issue an executive order to provide mental health parity.
I say to the good Senator, my friend--I have heard him speak eloquently, as well as our friend Senator Wellstone, and others speak on this issue--I pledge to him that I look forward to working with him. I think it is enormously important. I commend the Senator for what was initiated previously when we were dealing with this issue in related form on the Kassebaum-Kennedy legislation a few years ago. We want to see that and other legislation actually implemented. I commend him and look forward to working with him.
Finally, I would like to state my support for the efforts of my good friend and colleague from Nevada, Senator Reid, who has long been a champion of the need for better and more comprehensive approaches to suicide prevention. Suicide claims over 30,000 lives each year in this country; it is the eighth leading cause of death overall and the third major cause of death amongst teenagers from 15-19. It is an issue clearly associated with mental health parity. If better access to mental health services were available for all persons who have psychiatric conditions, the suicide rate would be dramatically reduced. It is time to provide mental health parity and to prevent these unnecessary family tragedies.
I thank the Senator.