MEETING THE MOMENT: IMPROVING ACCESS TO BEHAVIORAL AND MENTAL HEALTH CARE
Summary
Serial No. 117-6 prints the hearing Meeting the Moment: Improving Access to Behavioral and Mental Health Care before the Subcommittee on Health, Employment, Labor, and Pensions of the Committee on Education and Labor, U.S. House of Representatives, on April 15, 2021. Chairman DeSaulnier describes an entirely remote hearing and says the number of individuals reporting symptoms of depression or anxiety rose from 11 percent before the pandemic to 41 percent. Witnesses come from Psych-Appeal, The ERISA Industry Committee, the American Foundation for Suicide Prevention and the American Psychological Association. Additional submissions include statements from the Western Governors' Association, the American Benefits Council and the American Psychiatric Association, followed by questions for the record and responses.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
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“MEETING THE MOMENT: IMPROVING ACCESS TO BEHAVIORAL AND MENTAL HEALTH CARE.”
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[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
MEETING THE MOMENT: IMPROVING ACCESS
TO BEHAVIORAL AND MENTAL HEALTH CARE
=======================================================================
HEARING
before the
SUBCOMMITTEE ON
HEALTH, EMPLOYMENT,
LABOR, AND PENSIONS
of the
COMMITTEE ON EDUCATION AND LABOR
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, APRIL 15, 2021
__________
Serial No. 117-6
__________
Printed for the use of the Committee on Education and Labor
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via: edlabor.house.gov or www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-330 PDF WASHINGTON : 2022
COMMITTEE ON EDUCATION AND LABOR
ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
RAUL M. GRIJALVA, Arizona VIRGINIA FOXX, North Carolina,
JOE COURTNEY, Connecticut Ranking Member
GREGORIO KILILI CAMACHO SABLAN, JOE WILSON, South Carolina
Northern Mariana Islands GLENN THOMPSON, Pennsylvania
FREDERICA S. WILSON, Florida TIM WALBERG, Michigan
SUZANNE BONAMICI, Oregon GLENN GROTHMAN, Wisconsin
MARK TAKANO, California ELISE M. STEFANIK, New York
ALMA S. ADAMS, North Carolina RICK W. ALLEN, Georgia
MARK De SAULNIER, California JIM BANKS, Indiana
DONALD NORCROSS, New Jersey JAMES COMER, Kentucky
PRAMILA JAYAPAL, Washington RUSS FULCHER, Idaho
JOSEPH D. MORELLE, New York FRED KELLER, Pennsylvania
SUSAN WILD, Pennsylvania GREGORY F. MURPHY, North Carolina
LUCY Mc BATH, Georgia MARIANNETTE MILLER-MEEKS, Iowa
JAHANA HAYES, Connecticut BURGESS OWENS, Utah
ANDY LEVIN, Michigan BOB GOOD, Virginia
ILHAN OMAR, Minnesota LISA C. Mc CLAIN, Michigan
HALEY M. STEVENS, Michigan DIANA HARSHBARGER, Tennessee
TERESA LEGER FERNANDEZ, New Mexico MARY E. MILLER, Illinois
MONDAIRE JONES, New York VICTORIA SPARTZ, Indiana
KATHY E. MANNING, North Carolina SCOTT FITZGERALD, Wisconsin
FRANK J. MRVAN, Indiana MADISON CAWTHORN, North Carolina
JAMAAL BOWMAN, New York, Vice-Chair MICHELLE STEEL, California
MARK POCAN, Wisconsin Vacancy
JOAQUIN CASTRO, Texas Vacancy
MIKIE SHERRILL, New Jersey
JOHN A. YARMUTH, Kentucky
ADRIANO ESPAILLAT, New York
KWEISI MFUME, Maryland
Veronique Pluviose, Staff Director
Cyrus Artz, Minority Staff Director
------
SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS
MARK De SAULNIER, California, Chairman
JOE COURTNEY, Connecticut RICK W. ALLEN, Georgia
DONALD NORCROSS, New Jersey Ranking Member
JOSEPH D. MORELLE, New York JOE WILSON, South Carolina
SUSAN WILD, Pennsylvania TIM WALBERG, Michigan
LUCY Mc BATH, Georgia JIM BANKS, Indiana
ANDY LEVIN, Michigan DIANA HARSHBARGER, Tennessee
HALEY M. STEVENS, Michigan MARY E. MILLER, Illinois
FRANK J. MRVAN, Indiana SCOTT FITZGERALD, Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia VIRGINIA FOXX, North Carolina
(ex officio) (ex officio)
C O N T E N T S
----------
Page
Hearing held on April 15, 2021................................... 1
Statement of Members:
DeSaulnier, Hon. Mark, Chairman, Subcommittee on Health,
Employment, Labor, and Pensions............................ 1
Prepared statement of.................................... 5
Allen, Hon. Rick, Ranking Member, Subcommittee on Health,
Employment, Labor, and Pensions............................ 6
Prepared statement of.................................... 7
Statement of Witnesses:
Bendat, Meiram, JD, Ph.D., Founder, Psych-Appeal............. 51
Prepared statement of.................................... 53
Gelfand, James, Senior Vice President, Health Policy, The
ERISA
Industry Committee......................................... 32
Prepared statement of.................................... 35
Moutier, Dr. Christine Yu, Chief Medical Officer, American
Foundation for Suicide Prevention.......................... 24
Prepared statement of.................................... 27
Smedley, Dr. Brian D., Chief of Psychology in the Public
Interest of the American Psychological Association......... 9
Prepared statement of.................................... 11
Additional Submissions:
Chairman DeSaulnier:
Prepared statement from the Western Governors'
Association............................................ 87
Mr. Allen:
Prepared statement from the HR Policy Association and the
American Health Policy Institute....................... 93
Prepared statement from the American Benefits Council.... 97
Courtney, Hon. Joe, a Representative in Congress from the
State of Connecticut:
Prepared statement from the American Psychiatric
Association............................................ 106
Walberg, Hon. Tim, a Representative in Congress from the
State of Michigan:
Prepared statement from the Partnership for Employer-
Sponsored Coverage..................................... 113
Questions submitted for the record by:
Chairman DeSaulnier...................................... 124
Scott, Hon. Robert C. ``Bobby'', a Representative in
Congress from the State of Virginia.................... 116
Mr. Allen................................................ 122
Responses to questions submitted for the record by:
Ms. Bendat............................................... 117
Mr. Gelfand.............................................. 123
Dr. Moutier.............................................. 125
MEETING THE MOMENT: IMPROVING ACCESS
TO BEHAVIORAL AND MENTAL HEALTH CARE
----------
Thursday, April 15, 2021
House of Representatives,
Subcommittee on Health, Employment,
Labor, and Pensions,
Committee on Education and Labor,
Washington, DC.
The committee met, pursuant to notice, at 10:15 a.m., via
Zoom, Hon. Mark DeSaulnier (Chairman of the subcommittee)
presiding.
Present: Representatives DeSaulnier, Courtney, Norcross,
Morelle, Wild, McBath, Stevens, Levin, Scott (Ex Officio),
Allen, Walberg, Harshberger, Miller, Fitzgerald, and Foxx (Ex
Officio.)
Staff present: Phoebe Ball, Disability Counsel; Ilana
Brunner, General Counsel; Ijeoma Egekeze, Professional Staff;
Daniel Foster, Health and Labor Counsel; Christian Haines,
General Counsel; Sheila Havenner, Director of Information
Technology; Carrie Hughes, Director of Health and Human
Services; Ariel Jona, Policy Associate; Andre Lindsay, Policy
Associate; Max Moore, Staff Assistant; Mariah Mowbray, Clerk/
Special Assistant to the Staff Director; Kayla Pennebecker,
Staff Assistant; Veronique Pluviose, Staff Director; Banyon
Vassar, Deputy Director of Information Technology; Joshua
Weisz, Communications Director; Cyrus Artz, Minority Staff
Director; Courtney Butcher, Minority Director of Member
Services and Coalitions; Rob Green, Minority Director of
Workforce Policy; Georgie Littlefair, Minority Legislative
Assistant; John Martin, Minority Workforce Policy Counsel;
Hannah Matesic, Minority Director of Operations; Audra
McGeorge, Minority Communications Director; Carlton Norwood,
Minority Press Secretary; Ben Ridder, Minority Professional
Staff Member; and Taylor Hittle, Minority Professional Staff
Member.
Chairman DeSaulnier. The Subcommittee on Health,
Employment, Labor and Pensions will come to order. Welcome
everyone. I note that a quorum is present. The Subcommittee is
meeting today to hear testimony on Meeting the Moment:
Improving Access to Behavioral and Mental Health Care.
This is an entirely remote hearing. All microphones will be
kept muted as a general rule to avoid unnecessary background
noise. Members and witnesses will be responsible for unmuting
themselves when they are recognized to speak, or when they wish
to seek recognition. I also ask that Members please identify
themselves before they speak.
Members should keep their cameras on while in the
proceeding. Members shall be considered present in the
proceeding when they are visible on camera, and they will be
considered not present when they are not visible on camera. The
only exception to this is if they are experiencing technical
difficulty and inform Committee staff of such difficulty.
If any Member experiences technical difficulties during the
hearing, you should stay connected on this platform, make sure
you are muted, and use your phone to immediately call the
committee's IT Director, whose number was provided in advance.
Should the Chair experience technical difficulty, or need
to step away to vote on the floor, Mr. Levin, as a Member of
this subcommittee, or another majority Member if I am not
available, or if he is not available, is hereby authorized to
assume the gavel in the Chair's absence.
Again, this is an entirely remote hearing and as such, the
committee's hearing room is officially closed. Members who
choose to sit with their individual devices in the hearing room
must wear headphones to avoid feedback, echoes and distortion
resulting from more than one person on the software platform
sitting in the same room.
Members are also expected to adhere to social distancing
and safe health care guidelines, including the use of masks,
hand sanitizer, and wiping down their areas both before and
after their presence in the hearing room.
In order to ensure that the committee's five-minute rule is
adhered to, staff will be keeping track of time using the
committee's field timer. The field timer will appear in its own
thumbnail picture and will be named 001_timer. There will be no
one-minute remaining warning. The field timer will sound its
audio alarm when time is up. Members and witnesses are asked to
wrap up promptly when their time has expired.
While a roll call is not necessary to establish a quorum in
official proceedings conducted remotely, or with remote
participation, the Committee has made it a practice whenever
there is an official proceeding with remote participation for
the Clerk to call the roll, and to help make clear who is
present at the start of the proceeding.
Members should say their name before announcing they are
present. This helps the Clerk, and also helps those watching
the platform and the livestream who may experience a few
second's delay.
At this time I'd like to ask the Clerk to call the role.
The Clerk. Chairman DeSaulnier?
Chairman DeSaulnier. Here.
The Clerk. Mr. Courtney?
Mr. Courtney. Courtney present.
The Clerk. Mr. Norcross?
Mr. Norcross. Here.
The Clerk. Mr. Morelle?
Mr. Morelle. Morelle present.
The Clerk. Ms. Wild?
Ms. Wild. Present.
The Clerk. Mrs. McBath?
Mrs. McBath. McBath present.
The Clerk. Ms. Stevens?
Ms. Stevens. Stevens is present.
The Clerk. Mr. Levin?
[No response]
The Clerk. Mr. Mrvan?
[No response]
The Clerk. Mr. Scott?
Mr. Scott. Chairman Scott is present.
The Clerk. Ranking Member Allen?
Mr. Allen. I was on mute, OK. All right. I'm present. I
think I'm unmuted.
The Clerk. Mr. Wilson?
[No response]
The Clerk. Mr. Walberg?
Mr. Walberg. Walberg present.
The Clerk. Mr. Banks?
[No response.]
The Clerk. Mrs. Harshbarger?
Mrs. Harshbarger. Harshbarger is present.
The Clerk. Mrs. Miller?
[No response.]
The Clerk. Mr. Fitzgerald, excuse me? Mr. Fitzgerald I
think I see you.
Voice. Yes we're still working on the audio.
The Clerk. Understood. Mrs. Foxx?
[No response.]
The Clerk. Chairman DeSaulnier that concludes the roll
call.
Chairman DeSaulnier. Thank you. Pursuant to Committee Rule
8(c), opening statements are limited to the Chair and the
Ranking Member. This allows us to hear from our witnesses
sooner, and provides all Members with adequate time to ask
questions.
I recognize myself now for the purpose of making an opening
statement.
I want to thank you all. I want to thank Chairman Scott and
Ranking Member Allen. I'm very excited and enthusiastic about
this subcommittee and the work we're going to pursue, and
particularly the subject matter that we will discuss today. And
I want to thank all the panelists and the staff for the
terrific job they've done putting this meeting together.
I want to thank Ranking Member Allen for the time we had
the last few days to catch up, and to talk about how we can
collaborate. And again I want to thank Chairman Scott. So with
that, one thing about this issue is in our conversations with
other Members and with our staff, this is an issue that is of
importance personally and professionally to many of us.
And it's my hope that we work aggressively on the
subcommittee and with the Chairman and the Ranking Member of
the full committee to make sure that we're doing everything we
can to be knowledgeable and to help get valuable behavioral
health and mental health services to Americans.
Today in this meeting we are here to discuss the importance
of improving access to behavioral health and mental health
services. This morning's hearing comes amid a pandemic-driven
surge in the demand for mental health services. Across this
country essential workers are grappling with the trauma of
working through the pandemic.
Millions of workers are struggling with the loss of their
livelihoods, and countless people have been unable to
appropriately grieve the deaths of their loved ones. Overall,
the number of individuals reporting symptoms of depression or
anxiety has increased from 11 percent before the pandemic to 41
percent now. I'm going to repeat that: 11 percent before the
pandemic, 41 percent now.
As with nearly all consequences of this pandemic, the
mental health and behavioral health challenges, some
communities have it harder than others. This is particularly
true for people of color who entered the pandemic with
disproportionately limited access to affordable health care and
stable employment.
Regrettably, individuals seeking affordable mental health
services are facing significant barriers for far too long that
have kept quality mental health care out of reach for far too
many people, and unfortunately make their individual situations
more challenging and much more difficult to overcome.
And, with the addition of the pandemic, have made them more
isolated. In fact, even before the pandemic, less than half of
individuals with mental illness, and only 11 percent of
individuals with a substance abuse disorder received services
and treatment. And those services and treatment the quality was
varied to say the least.
This is due in part to the high cost of care and nationwide
shortage of mental health providers. However, the most glaring
barrier to these critical services is a health insurance system
that still does not provide true and equal coverage for both
mental health services and medical health services, known as
mental health parity.
This barrier is particularly frustrating given the
significant steps Congress has taken to get insurers to cover
both behavioral and medical health services. In 2008, for
example, Congress passed the Mental Health Parity and Addiction
Equity Act, which prohibited employer-sponsored health plans
from placing restrictions on benefits for mental health and
substance abuse disorder than are greater than those applied to
medical and surgical benefits.
And in 2010 of course, Congress passed the landmark
Affordable Care Act to extend this protection to the individual
insurance market. Despite these efforts, our Federal agencies
still do not have the resources they need to protect and
oversee millions of people's health benefits.
The Employee Benefits Security Administration investigates
workplace benefits issues on behalf of more than 150 million
Americans, yet its enforcement and consumer assistance budget
has been frozen at less than $150 million dollars for several
years now, meaning that the agency has only about one dollar to
protect the health benefits of each person.
Even when they do find wrongdoing, the agency lacks the
authority to penalize insurers who restrict coverage for mental
health services. In other words, our communities, particularly
underserved communities, have been left to deal with the
lasting and potentially fatal mental health consequences on
this pandemic on their own.
This in spite of exponential research and knowledge about
behavioral health and substance abuse, and evidence-based
research that would help Americans if we provide these
services. I'm going to have to pause for a second because I
told by staff that we've got some livestream issues.
Mr. Vassar. Mr. Chairman, I believe we're good to go sir.
Thank you everyone for your patience.
Mr. DeSaulnier. Thank you. Sorry for that interruption. Oh,
I left off about the difficulty in getting these services. This
is unacceptable. One of our basic responsibilities as elected
officials is to care for the well-being of our constituents,
and that means providing--means ensuring people have sufficient
access to affordable behavioral and mental health care.
The first step is enforcing the laws we have already
passed. We should all be able to agree that this is a step
worth taking to ensure that all Americans have access to the
care that they need, and we all benefit from. And we must take
additional steps to build upon these laws to ensure that they
more fully protect consumers and are as efficient in delivering
services as is possible.
I also know that many employers, unions, health plans and
providers are rising to the challenge to meet the unique needs
of workers and families during this time, and we look forward
to the benefit of what they are doing after the pandemic.
I also look forward to hearing from our expert witnesses
about solutions to securing access to equitable mental and
behavioral health care for all of our constituents, all
Americans.
I now would like to recognize the distinguished Ranking
Member for the purpose of making an opening statement.
Congressman Allen.
[The statement of Chairman DeSaulnier follows:]
Statement of Hon. Mark DeSaulnier, Chairman,
Subcommittee on Health, Employment, Labor, and Pensions
Today, we are meeting to discuss the importance of improving access
to behavioral and mental health care.
This morning's hearing comes amid a pandemic-driven surge in the
demand for mental health services. Across the country, essential
workers are grappling with the trauma of working through the pandemic;
millions of workers are struggling with the loss of their livelihoods;
and countless people have been unable to appropriately grieve the
deaths of their loved ones. Overall, the number of individuals
reporting symptoms of depression or anxiety has increased from 11
percent before the pandemic to 41 percent this year.
As with nearly all consequences of the coronavirus pandemic, the
mental and behavioral health challenges have hit some communities
harder than others. This is particularly true for people of color who
entered the pandemic with disproportionately limited access to
affordable health care and stable employment.
Regrettably, individuals seeking affordable mental health services
are facing significant barriers that--for far too long--have kept
quality mental health care out of reach for far too many people.
In fact, even before the pandemic, less than half of individuals
with mental illness--and only 11 percent of individuals with a
substance use disorder--received services and treatment.
This is due, in part, to the high cost of care and the nationwide
shortage of mental health providers.
However, the most glaring barrier to these critical services is a
health insurance system that still does not provide true, equal
coverage for both mental health services and medical health services--
known as mental health parity.
This barrier is particularly frustrating given the significant
steps Congress has taken to get insurers to cover both behavioral and
medical health services.
In 2008, for example, Congress passed the Mental Health Parity and
Addiction Equity Act, which prohibited large employer-sponsored health
plans from placing restrictions on benefits for mental health and
substance use disorder that are greater than those applied to medical
and surgical benefits. And, in 2010, Congress passed the landmark
Affordable Care Act to extend this protection to the individual
insurance market.
Despite these efforts, our Federal agencies still do not have the
resources they need to protect and oversee millions of people's health
benefits.
The Employee Benefits Security Administration investigates
workplace benefits issues on behalf of more than 150 million people.
Yet, its enforcement and consumer assistance budget has been frozen at
less than $150 million for several years, meaning that the agency has
about one dollar to protect the health benefits of each person.
Even when they do find wrongdoing, the agency lacks the authority
to penalize insurers who restrict coverage for mental health services.
In other words, our communities--particularly underserved
communities--have been left to deal with the lasting and potentially
fatal mental health consequences of this pandemic on their own.
This is unacceptable. One of our most basic responsibilities as
elected officials is to care for the well-being of our constituents--
and that means ensuring people have sufficient access to affordable
behavioral and mental health care.
The first step is enforcing the laws we have already passed. We
should all be able to agree that this is a step worth taking to ensure
that all Americans have access to the care they need and we all benefit
from. And we must take additional steps to build upon these laws to
ensure that they more fully protect consumers and are as efficient at
delivering services as possible. I also know that many employers,
unions, health plans, and providers are rising to the challenge to meet
the unique needs of workers and families during this time and we look
forward to the benefit of what they are doing after the pandemic.
I look forward to hearing from our expert witnesses about solutions
to securing access to equitable mental and behavioral health care for
all of our constituents and all Americans.
I now recognize the distinguished Ranking Member for the purpose of
making an opening Statement.
______
Mr. Allen. Thank you Chairman. We're having a little
anxiety and behavioral problems with technology today. It makes
us all a little anxious doesn't it. But I want to thank
everybody for joining us here today for this important
discussion about the quality and accessibility of mental health
and behavioral health services for American workers.
The well-being of America's workers have always been a
priority for committee republicans, that's why Congress is
engaged in ongoing efforts to address worker's mental and
behavioral health needs, including efforts to improve access to
high-quality and innovative treatment and services.
Sadly, due to the COVID-19 pandemic and related lockdowns,
this past year has been very trying for families across the
country. Almost overnight schools and workplaces closed
upending American's lives, and creating barriers to key mental
health services.
While upsetting, but perhaps not surprising, these events
triggered an increase in symptoms of anxiety and depression in
the United States. In 2020 four in 10 adults reported symptoms
of anxiety or depression up from one in 10 in 2019. More
Americans are struggling with substance abuse disorder leading
to rising overhead death rates.
In response to growing mental health needs Congress in a
bipartisan manner, increased funding to the Substance Abuse and
Mental Health Services Administration through the Care's Act in
2021 appropriations, which include additional money for
emergency grants for behavioral health services to states and
other grantees.
The COVID-19 pandemic also accelerated the use of
telehealth services, and in response to the increased need,
Congress provided additional temporary flexibility for
employers to provide telehealth benefits to more workers.
Congress should strongly consider permanent expansions of
telehealth coverage that may improve access to quality care,
including behavioral health care. As a committee of
jurisdiction over employer sponsored healthcare, republicans
understand that employers want what is best for their
employees, which means having the flexibility to provide
quality healthcare and addressing workers' mental and
behavioral health needs.
Ensuring workers have access to high-quality treatment
services is key to maintaining a healthy and successful
workplace. And I add that that is what employers want. Thank
you very much and that concludes--I yield my time.
[The statement of Ranking Member Allen follows:]
Statement of Hon. Rick W. Allen, Ranking Member,
Subcommittee on Health, Employment, Labor, and Pensions
Thank you all for joining us here today for an important discussion
about the quality and accessibility of mental and behavioral health
services for American workers.
The well-being of America's workers has always been a priority for
Committee Republicans. That's why Congress is engaged in on-going
efforts to address workers' mental and behavioral health needs,
including efforts to improve access to high-quality and innovative
treatments and services.
Sadly, due to the COVID-19 pandemic and related lockdowns, this
past year has been a very trying one for families across the country.
Almost overnight, schools and workplaces closed, upending Americans?
lives and creating barriers to key mental health services.
While upsetting, but perhaps not surprising, these events triggered
an increase in symptoms of anxiety and depression in the United States.
In 2020, four in 10 adults reported symptoms of anxiety or depression,
up from one in 10 in 2019. More Americans are struggling with substance
use disorder leading to rising overdose death rates.
In response to growing mental health needs, Congress, in a
bipartisan manner, increased funding to the Substance Abuse and Mental
Health Services Administration through the CARES Act and 2021
appropriations, which included additional money for emergency grants
for behavioral health services to States and other grantees.
The COVID-19 pandemic also accelerated the use of telehealth
services, and in response to the increased need, Congress provided
additional temporary flexibilities for employers to provide telehealth
benefits to more workers. Congress should strongly consider if
permanent expansions of telehealth coverage may improve access to
quality care, including behavioral health care.
As the Committee of jurisdiction over employer-sponsored health
care, Republicans understand that employers want what is best for their
employees, which means having the flexibility to provide quality health
care and addressing workers? mental and behavioral health needs.
Ensuring workers have access to high-quality treatment services is key
to maintaining a healthy and successful work force.
According to a 2020 Congressional Budget Office estimate, 151
million Americans receive health insurance through employer-provided
plans which is the largest single source of coverage. Yet, Democrats
are seeking to eliminate employer-sponsored health care through their
socialist Medicare-for-All scheme, which would force millions of
Americans into a one-size-fits-all, government-run system and cost more
than $30 trillion dollars over the next decade.
A 2018 survey by American's Health Insurance Plans reveals that 71
percent of Americans are satisfied with their current employer-provided
health coverage. By all metrics, satisfaction with employer health
coverage outpaces public support for the Democrat's Medicare-for-All
scheme.
Employers around the country continue to make concerted efforts to
meet the mental and behavioral health needs of workers through
implementation of coordinated care programs, employee wellness
programs, use of telehealth services, and additional employee
assistance programs, though Democrats will ignore this fact and
unjustifiably assume that employers are short-changing their employees.
House Republicans want to empower America's job creators to expand
access to quality care and mental health services for workers and their
families. While the system can be improved, we also recognize employers
are attuned to the needs of their employees, as I know firsthand. For
37 years, I ran a construction business where we provided staff
benefits. I knew my employees? needs and what benefits and services
were best suited to meet them. That is why I believe employers play a
critical role in enhancing the system moving forward, which will
benefit workers by ensuring that effective mental and behavioral health
services are offered.
______
Chairman DeSaulnier. Thank you, Mr. Allen. Without
objection all other Members who wish to insert written
statements into the record may do so by submitting them to the
Committee Clerk electronically in Microsoft Word format by 5
p.m. on April 28, 2021.
And now I'd like to welcome and again thank our witnesses.
We are just delighted that you would take the time to share
your experience and your expertise with the committee. It's a
really important endeavor that we are about to embark on.
Dr. Brian Smedley is Chief of Psychology in the Public
Interest at the American Psychological Association. He is a
psychologist by training, and an expert in the field of healthy
equity. Thank you Doctor for being here.
Dr. Christine Yu Moutier, and if I mispronounce your name
please forgive me. It's happened to me many times in my life,
and correct us all--correct me I should say, when you start
your comments. Dr. Moutier is Chief Medical Officer at the
American Foundation for Suicide Prevention. She is a
psychiatrist by training and a leader in the field of suicide
prevention.
James Gelfand is Senior Vice president for Health Policy at
the ERISA Industry Committee. He works on the development of
policies that support employer-sponsored health plans.
Dr. Meiram Bendat is the founder of Psych-Appeal. He is a
licensed psychotherapist as well as an attorney who has
litigated numerous cases on behalf of consumers and behavioral
health providers. Welcome to all of you.
Instructions--we appreciate the witnesses for participating
again today and look forward to your testimony. Let me remind
the witnesses that we have read your statements, and they will
appear in full in the hearing record.
Pursuant to Committee Rule 8(d) and the committee practice,
each of you is asked to limit your oral presentation to a five-
minute summary of your written statement. Before you begin your
testimony, excuse me, please remember to unmute your
microphone.
During your testimony, staff will be keeping track of time
and a timer will sound when time is up. Please be attentive to
the time, wrap up when your time is over, and re-mute your
microphone.
If any of you experience technical difficulties during your
testimony or later in the hearing, you should stay connected on
the platform, make sure you are muted, and use your phone to
immediately call the committee's IT Director whose number was
provided to you in advance.
We will let all of the witnesses make their presentations
before we move to Member questions. When answering a question
please remember to unmute your microphone.
The witnesses are aware of their responsibility to provide
accurate information to the committee and therefore we will
proceed with their testimony.
I will first recognize Dr. Smedley. Dr. Smedley please go
ahead.
STATEMENT OF DR. BRIAN D. SMEDLEY, CHIEF OF
PSYCHOLOGY IN THE PUBLIC INTEREST OF THE
AMERICAN PSYCHOLOGICAL ASSOCIATION
Dr. Smedley. Thank you Chairman DeSaulnier. Chairman
DeSaulnier, Ranking Member Allen, and Members of the
subcommittee, thank you for the opportunity to testify today.
I'm Dr. Brian Smedley and I'm the American Psychological
Association's Chief of Psychology in the Public Interest.
APA's public interest directorate, which I lead, fulfills
APA's commitment to apply the science and practice of
psychology to the fundamental problems of human welfare and the
promotion of equitable and just treatment of all segments of
society through education, training and public policy.
The COVID-19 pandemic has contributed to what we have
called a mental health tsunami in this country. APA's Stress in
America survey series shows that over the past year COVID-19
consistently exacted a higher emotional toll than other common
stressors.
We also know that patient's coping mechanisms for the
public health and economic impacts of the pandemic are serious,
and highly individualized, including undesired weight changes,
increased use of alcohol and other drugs, or even suicidal
behaviors and ideation.
Our Member clinicians continue to see an increase inpatient
demand for treatment of anxiety disorders, depressive
disorders, and stress or trauma disorders than before COVID-19.
Research suggests that we may be grappling with the mental
health impact of this pandemic long after the pandemic itself
ends.
However, we also know that not all Americans are equally
affected. The mental health impact of COVID-19 is especially
prominent in black, indigenous and other people of color
communities, which are more likely to report anxiety about
contracting the virus, in addition to other stresses related to
the virus like economic instability, social and economic
inequality, racism, discrimination and stigma are at the root
of mental and behavioral health inequities experienced by BIPOC
communities.
I'd like to mention two other highly impacted groups.
First, children and younger adults are experiencing higher
rates of stress, anxiety and fear than older generations.
School closures and social activity suspensions are a factor,
but we're particularly concerned about the potential for
increased rates of abuse, neglect, or other household trauma
occurring in the home.
Second, frontline health care providers, including
psychologists, are also exhibiting more frequent symptoms of
post-traumatic stress disorder, depression, anxiety, sleep
disorders and burnout due to the workplace stress occasioned by
the pandemic.
APA urges action in two key areas in response. First, the
2008 Mental Health Parity Law has in some ways fallen short of
its promise. Congress can do more to ensure adequate oversight
and enforcement of insurers' compliance with the law, and close
gaps permitting states to exempt their own employees, including
essential frontline workers such as police officers and
firefighters from the law's provisions.
The second area is telehealth, which has been a rare silver
lining of the pandemic. Congress and CMS have greatly expanded
access to telehealth services, including audio only telehealth
under Medicare. We urge the subcommittee to support measures
that would ensure that ERISA plans equally cover and reimburse
for these services.
We also believe Medicare's telemental health coverage
flexibilities should extend beyond the pandemic. Specifically,
we urge Members of the subcommittee to support the bipartisan
Parity Enforcement Act of 2021, H.R. 1364, introduced by
Congressman Norcross to strengthen the Department of Labor's
ability to enforce the parity law by giving it the authority to
levy civil fines.
We also urge that we close the loophole in the Federal
Parity Law that allows states to opt out of parity requirements
for State employees. We also urge that we support increased
funding to enable better oversight and stronger enforcement of
insurers' compliance with the Federal Parity Law.
And we urge you to support measures such as the bipartisan
Tele-Mental Health Improvement Act, H.R. 2264, that would
increase private coverage of telebehavioral services, including
audio-only services, and establish permanent Medicare coverage
of essential mental and behavioral health services by audio-
only telehealth.
I applaud the committee for examining the long-term
behavioral health effects of the pandemic and urge you to
support an approach to this crisis that provides equitable
access to care and preventive interventions to avert worse
patient outcomes further downstream.
APA would welcome an opportunity to collaborate with the
subcommittee on efforts to address inequitable access to care,
and the ongoing mental health impact of his pandemic. Thank you
for the opportunity to testify today, and I look forward to
answering any questions you have.
[The prepared statement of Dr. Brian Smedley follows:]
Prepared Statement of Dr. Brian Smedley
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Doctor. That was terrific.
We will now go Dr. Yu Moutier. Doctor? There you go.
STATEMENT OF DR. CHRISTINE YU MOUTIER, MD, CHIEF
MEDICAL OFFICER, AMERICAN FOUNDATION FOR SUICIDE PREVENTION
Dr. Moutier. Sorry about that. Great. I am Dr. Christine
Moutier, Chief Medical Officer for the American Foundation for
Suicide Prevention, the Nation's largest non-profit dedicated
to saving lives and bringing hope to those affected by suicide.
My message today about the growing gap between mental health
needs and accessible care is critically serious, hopeful and
actionable.
Thank you Chair DeSaulnier, Ranking Member Allen and
Members of the subcommittee for your time today. The pandemic
has clearly been a time of increased attention to mental health
and very real heightened distress in our Nation.
However, even pre-pandemic we have seen changes in the
landscape around mental health. We've seen a 35 percent
increase in the national suicide rate from 1999 through 2018.
One in four Americans has a diagnosable mental health condition
in their lifetime, and yet less than half of those are
receiving care.
The degree of suffering experienced by millions of
Americans and families is enormous with barriers still impeding
mental health, being approached on par with physical health. We
say there is no health without mental health because research
shows the brain and the body are connected.
People with mental illness have higher risks of suffering
disability and die 15 to 20 years younger than their
counterparts, mostly due to medical causes, and for people with
mental illness of course the risk of dying by suicide is also
much higher, as much as 30 times higher than the general
population.
Health system delivery in the U.S. was oddly designed
without mental health in mind. The public, including people
with lived experience of mental health conditions and suicide
loss, and suicidal experiences, have been making change at the
grassroots level.
But until the health system improves and makes mental
health a real priority, the gap between the demand for quality,
timely, culturally competent treatment, and the ability to
access those mental health services will only grow larger
because attitudes are opening up among the public.
Research shows that when primary care and health systems
embrace mental health, and substance use disorders as integral
targets of health care delivery, many health outcomes improve.
And there are enormous economic benefits for societies that
prioritize mental health--a proven return on investment for
each dollar spent on mental health promotion and prevention.
So, in many ways, we cannot afford inaction. To put it
succinctly, with all of our advances in science, systems design
and technology, we can, and we must reconcile the growing
mismatch in our Nation's mental health needs with the ability
to access services and support.
During the COVID-19 pandemic, data show that upwards of 40
to 50 percent of the population report elevations in
experiences of depression, anxiety, trauma, loss and increased
substance use. Suicidal thoughts are also much more prevalent
during this time, especially among young people, with one in
four young adults reporting suicidal ideation.
As the pandemic has progressed, the proportion of
respondents to these surveys with detrimental effects on their
mental health continue to rise, and there are reasons to be
especially concerned about particular populations.
Minoritized communities, essential and frontline health
workers, caregivers, youth, rural residents, and LGBTQ people.
Despite the evident need for broad and equitable access to
mental health care, many are having trouble accessing care.
These challenges have worsened during the pandemic despite
greater access via telehealth services.
The subcommittee is asked to consider efforts that would
support enhanced mental health parity enforcement, to ensure
that coverage for mental health care is no less restrictive
than medical or surgical care. Recent analyses found evidence
of lack of parity and behavioral health services, compared with
med/surg in terms of higher out of network use, and lower
reimbursement for behavioral services.
And these disparities are trending in the wrong direction.
There must be much more accountability and oversight of parity
to ensure that mental health conditions are not being
discriminated against.
In closing, I urge the subcommittee to consider legislation
and policies to: one, ensure effective enforcement of mental
health parity and broaden access to mental health care
generally; two, support a robust, diverse mental health
workforce; and three, integrate mental health and suicide
prevention in health systems, workplaces and schools as
critical touchpoints that can establish a culture that is
responsive to mental health needs.
The steps we take in the aftermath of the pandemic will set
the trajectory for the Nation's mental health for years to
come. Parity must be enforced, and disparities must be
addressed to ensure equitable access and care for those in
need.
I thank the subcommittee for appreciating the gravity of
the situation and look forward to hearing your comments and
answering your questions. Thank you.
[The prepared statement of Dr. Christine Yu Moutier
follows:]
Prepared Statement of Dr. Moutier
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you Doctor that was terrific. We
will now go to Mr. Gelfand. Please go ahead, Mr. Gelfand.
STATEMENT OF MR. JAMES GELFAND, SENIOR VICE
PRESIDENT, HEALTH POLICY, THE ERISA INDUSTRY
COMMITTEE
Mr. Gelfand. Thank you Chair DeSaulnier, Ranking Member
Allen and Members of the subcommittee for this opportunity to
testify today. I'm James Gelfand, Senior Vice President for
Health Policy at the ERISA Industry Committee or ERIC, a trade
association representing large employer plan sponsors.
ERIC Member companies are the Nation's top employers in
every sector of the economic, every region in industry, and in
every congressional district. These employers offer
comprehensive health benefits. Our Member companies pay around
85 percent of healthcare costs on behalf of beneficiaries, and
that would be a gold or a platinum plan if bought on an
exchange.
And every one of them includes a substantial mental and
behavioral health program to protect employees and their
families. Employers know all too well the challenges that
patients face. Too often patients lack access to the providers
they need, not enough low-cost in-network doctors available,
unacceptable wait times, gaps in information about quality and
efficacy.
The system is leaving many patients behind. And this is on
top of an opiod epidemic, and COVID exacerbated the problem for
many--the isolation, the disruption of routine, reduced access
to medical care, and other interventions, all combined to make
things harder for patients.
Employers are committed to being part of the solution, and
we have acted. Employers offer health insurance to help our
employees, so when we see unmet needs we address them.
Employers worked hard to stop the opioids crisis from
limiting prescription drug fills to more carefully scrutinizing
the facilities and providers in their networks, to offering new
programs to help employees get counseling and care.
Employers have innovated many new programs and strategies
to increase access to mental health from enhancing paid time
off to beefing up employee assistance programs, mindfulness
campaigns, sleep management programs, crisis hotlines and much
more.
Many employers hire vendors specifically to enhance and
manage mental and behavioral health benefits. When COVID hit,
telehealth really shined, securing care for employees isolated
at home. Telehealth vendors compete not just on cost and
quality, but on metrics like how quickly they can get a patient
access to an appropriate provider.
Employers moved quickly to expand telehealth, offering care
for free, even to patients in high deductible plans, and
offering telehealth benefits to part-time workers and others
who are not eligible for full benefits. And employers who have
worksite health centers often went virtual, offering more
mental and behavioral health options to employees, but there's
much more we can do.
ERIC Members have convened a mental health task force, and
will soon be issuing a report, including dozens of policy
proposals Congress could implement to improve access and
affordability without compromising quality. Here are three
options to consider today.
First, promote cross State medical practice, especially in
ERISA plans. You can instantly improve mental health access for
tens of millions of people by allowing some of the excess
volume on the coast to serve patients in other parts of the
country. Start by passing the TREAT Act to at least solve this
during COVID.
But long-term we need a comprehensive solution to connect
willing and able providers to patients in need.
Second, make the private sector gains in telehealth
permanent. Allow employers to offer telehealth benefits to all
of our employees. This isn't a replacement for comprehensive
health insurance, but it can be a lifeline for mental and
behavioral health. Many employers, especially retailers, and
others with large part-time, hourly or seasonal workforce have
done amazing work expanding telehealth during COVID. But unless
Congress acts soon, these gains will disappear due to
antiquated rules.
Third, fix the rules in the high deductible plans. In the
CARES Act last year Congress temporarily allowed dollar
coverage of telehealth. We should make it permanent, and add
coverage of worksite health clinics too. If Congress doesn't
act starting on January 1, tens of millions of patients will
have to pay their entire deductible before employers can
subsidize these benefits.
And one quick caution--these problems won't be solved via
penalties and mandates. It might make more money for trial
lawyers, but patients will be hurt with higher premiums, lower
value networks and the loss of quality, accessibility and
safety within their plan.
Congress has repeatedly told the Department of Labor to do
a better job explaining and investigating mental health parity
requirements, including more new rules that were passed in
December. Let's see how those rules work before piling on.
In conclusion, employers are acutely aware of the
challenges patients face in accepting quality, affordable,
mental and behavioral health treatment.
We are leading from the front, innovating, and finding ways
to help our beneficiaries, but policy changes are needed,
especially to ensure that millions can continue to have access
to telehealth.
We hope to work with Congress to advance meaningful
legislation to help our employees and their families. Thank you
for this opportunity to testify.
[The prepared statement of James Gelfand follows:]
Prepared Statement of Mr. Gelfand
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Mr. Gelfand. I look forward
to working with you for just that purpose. And our last
panelist is Dr. Bendat. Please go ahead, Doctor.
STATEMENT OF DR. MEIRAM BENDAT, JD, Ph.D.,
FOUNDER, PSYCH-APPEAL
Dr. Bendat. Good morning Chairman DeSaulnier, Ranking
Member Allen, and Members of the subcommittee. Thank you for
the opportunity to testify at today's hearing. I'm Meiram
Bendat, founder of California-based Psych-Appeal, a law firm
exclusively dedicated to mental health insurance advocacy.
I am by education, training, and practice, an attorney and
psychotherapist. Since 2011 I have spearheaded cutting-edge
litigation against managed care barriers to mental health and
substance use treatment. Most of my cases have been brought
under ERISA.
ERISA establishes uniform, albeit limited, protections for
approximately 136 million people covered by employer sponsored
health plans, two-thirds of which participate in self-funded
plans, entirely exempt from State insurance laws and
regulation.
This renders the Department of Labor's role critical. Since
2014, ERISA has required fully insured small group plans to
provide essential mental health benefits. Due to historic
discrimination, the Federal Parity Act amended ERISA to
prohibit health plans and fiduciaries from imposing disparate
lifetime or annual limits, financial requirements, and
treatment limitations on mental health and substance use
disorder benefits.
Unsurprisingly, treatment limitations expressed
quantitively are easier to identify and challenge than
undisclosed, as applied non-quantitative treatment terms, which
include medical necessity and network access standards.
Consequently, ERISA was recently amended to require health
plans to robustly analyze and disclose their non-quantitative
treatment limitation comparability analyses. While ERISA
provides for essential mental health benefits, it does not
define medical necessity, a core term of coverage.
And while the Federal Parity Act requires non-quantitative
treatment limitations, such as medical necessity, to be applied
comparably to mental health and medical benefits, it does not
require medical necessity determinations to comport with
generally accepted standards of clinical practice or GASC.
Thus, absent ERISA expressly conditioning medical necessity
and adherence to GASC, health plans are free to create and
operationalize self-serving, overly restrictive medical
necessity definitions that undermine access to essential mental
health benefits.
Even when ERISA plans include medical necessity
definitions, adhering to GASC, coverage decisions and mental
health cases are all too often based on deficient, non-
transparent utilization review criteria, developed or licensed
by risk-bearing health insurance issuers who also act as well-
compensated claims administrators for self-funded group plans.
This dynamic was fleshed out in a landmark class action Wit
v. United Behavioral Health, in which a Federal court found
that over a 7-year period the Nation's largest managed
behavioral health company developed and applied pervasively
flawed utilization review criteria to wrongly deny nearly
70,000 claims for outpatient, intensive outpatient, and
residential treatment by ERISA participants.
While mental health and substance use disorders are largely
chronic and pervasive, UBH's utilization review criteria
operationalized an acute care utilization management model that
myopically focused on short-term crisis stabilization, rather
than treatment of underlying conditions.
The lack of a uniform definition of medical necessity is
not the only impediment to coverage of mental health treatment
under ERISA plans. Since ERISA does not establish network
adequacy standards, self-funded ERISA plans generally do not
provide participants with any notice of timeliness or
geographic access standards in plan documents.
Absent notice of such standards or remedies for the
unavailability of in-network services, ERISA plan participants
must often wait protracted periods, or travel extensive
distances to receive mental health treatment to obtain
inconsistent authorizations for out-of-network care.
Given the prevalence of narrow and phantom networks, it is
unsurprising that mental health treatment at disproportionately
rendered out-of-network or forsaken altogether.
In light of the low and disparate reimbursement rates set
by health insurance issuers and claims administrators, it is
equally unsurprising that mental health providers balk at
joining their networks.
ERISA's remedial scheme should be updated to account for
the modern reality that health plan issuers who serve as claims
administrators are the actual fiduciaries who adjudicate mental
health benefits based on self-selected uniform criteria, and
who sell network access to group health plans.
While these fiduciaries enjoy annual profits in the
billions, ERISA's deferential standard of judicial review and
exclusion of extracontractual damages against them, continue to
reward and incentivize their brazen self-dealing.
To truly guarantee meaningful access to mental health care,
I urge Congress to pass the Parity Enforcement Act of 2021, and
consider legislation that conditions medical necessity and
adherence to GASC, eliminate the differential standard of
judicial review in benefit cases, permits damages against
health insurance issuers and claims administrators that
discriminate, and protects access to open courts by exempting
ERISA claims from binding arbitration. Thank you.
[The prepared statement of Dr. Meiram Bendat follows:]
Prepared Statement of Dr. Bendat
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman DeSaulnier. Thank you, Doctor.
Under Committee Rule 9(a), we will now question witnesses
under the five-minute rule. I will be recognizing subcommittee
Members in seniority order. Again, to ensure that Members'
five-minute rule is adhered to, staff will be keeping track of
time and the timer will sound when your time has expired.
Please be attentive to the time, wrap up when your time is
over, and remute your microphone.
As chair, I now recognize myself for five minutes.
Dr. Bendat, I apologize for the mispronunciation, Dr.
Moutier and my high school French. Forgive me for silencing
your name. So, I wanted to ask you a question about California,
my home state's parity law that was recently passed, SB 855.
The law included a new definition of the term medical
necessity.
It requires insurance companies to cover behavioral health
based on generally accepted standards of care. Could you
explore--you did explore this concept of medical necessity in
your testimony when you discussed the United Behavioral Health
case.
I was wondering if you might be willing to briefly give us
an assessment of the California law, and what lessons can we
learn from it?
Dr. Bendat. Sure. So, I would hold that the California
legislation that's now law as of January 1 should serve as
model legislation around the country, and I would urge Congress
to consider adopting the definition of medical necessity in SB
855.
Essentially, the law defines medical necessity to mean,
among a few other things, that services that are offered for
mental health and substance use disorders must be consistent
with generally accepted standards of care.
And it requires health insurers who operate in the State of
California to make decisions about medical necessity utilizing,
or based on utilization review criteria that are in fact
consistent with generally accepted standards of care.
These standards are generally set by non-profit clinical
specialty associations with familiarity over subject matter and
peer reviewed research. In California, the law requires
exclusive application of the non-profit professional society
guidelines for determining the level of care--meaning
outpatient, intensive outpatient, residential treatment--that
patients seek.
And it limits the ability of insurers to apply self-serving
criteria that they developed or licensed, that may not at all
be consistent with generally accepted standards of care that
may have boilerplate references and footnotes to underlying
standards but that deviate markedly from them.
Chairman DeSaulnier. Thanks. Clearly a challenge as the
science evolves to make this as understandable as possible, and
benefits the consumer, also benefits the employers and the
consumers as well in a balanced way.
One of the big challenges is of course the concept of
mental health parity and putting it in the reality of the
consumer level is dealing with the issue of non-quantitative
treatment limits, or NQTL. These are restrictions that plans
place on benefits through medical management, have a number
associated with them, and so it can be tricky to compare
between behavioral health and medical and surgical cases.
Dr. Bendat how has the newly enacted law, the Strengthening
Behavioral Health Parity Act, helped improve oversight of NQTLs
and can you think of any ways that we should further strengthen
it?
Dr. Bendat. So, the law is wonderful in that it really
shines a light on the most complicated part of parity, which is
enforcement and compliance with the non-quantitative treatment
limitation rules. As I mentioned in my testimony, non-
quantitative treatment limitations can be written, but often
they are just applied.
In other words, you don't get advance notice of what they
are. They are not spelled out for you in the plan documents. So
a plan sponsor, an employer may write a really nice package, or
benefits into a plan, but then these plans, especially in the
ERISA context, the self-funded plans are effectively
administered day-to-day by claims administrators, not the
employers, not the plan sponsors.
These claims administrators employ all sorts of internal
policies and procedures to effectuate their administration of
plans across entire swaths of group plans and market sectors.
And the law that has been enacted essentially requires a robust
analysis of these, as applied, as well as written, non-
quantitative treatment limitations.
The issue historically has been that although ERISA
requires disclosure of the non-quantitative treatment
limitations, employers are generally stumped when asked for
these, and must obtain them from health insurance issuers.
Chairman DeSaulnier. Can I ask you to wrap up, Doctor?
Dr. Bendat. Sure. These aren't often disclosed, so to the
extent that the law really takes into account disclosure from
health insurance issuers, and puts it into the hands of
consumers, all the better.
Chairman DeSaulnier. Thank you. I appreciate that. I now
want to recognize the Ranking Member for the purpose of
questioning the witnesses. Mr. Allen.
Mr. Allen. Thank you Mr. Chairman. Mr. Gelfand the COVID-19
pandemic has completely disrupted many American's way of life.
Business closures have caused Americans to relocate, to find a
job, and students returning home to live with parents and
attending classes online.
In relocating many have unfortunately lost access to mental
health care during a time they need it most. Patients may face
provider shortages in their new areas, government lockdowns may
prevent them from finding a new provider, and they may be
unable to visit their old provider remotely due to barriers
created by State licensure laws.
How do you propose we overcome these barriers to preserve
and expand access to care?
Mr. Gelfand. Thank you Representative Allen. While
employers support long term solutions to increase the supply of
mental and behavioral health providers throughout the country,
many employees need help right now. They don't have the luxury
of waiting for 50 states to sign interState compacts, or for
providers to be coaxed into moving from the coast.
So to help them right now employers propose focusing on
telehealth. There are willing and able providers out there.
Telehealth is interState commerce, and we should eliminate
State barriers by allowing providers who are practicing via
telehealth within one uniform framework to see patients in
other states.
There are a half a dozen different ways Congress could do
this, but one might be to say that a provider participating in
an ERISA plan, or a service contracted by an ERISA plan, can be
subject to one uniform framework.
Mr. Allen. Well Congress recently added additional mental
health parity requirements as part of the Consolidated
Appropriations Act of 2021. Mr. Gelfand can you update this
committee on the implementation status of these new provisions.
In your view is it premature for Congress to consider
additional mandates, or to suggest monetary penalties for
parity violations?
Mr. Gelfand. Yes. So in the December Omnibus Bill for
probably the third time, Congress told Department of Labor to
be clear about parity rules, and non-quantitative treatment
limitations, ordered more audits, and clarified that employers,
not vendors, need to have documents ready to explain all of the
limits in their plans.
So this triggered a process by which the employers are now
working with vendors to produce a huge amount of documents
explaining any limitations on mental behavioral health and
benefits, analyzing how they compare to the medical side,
explaining a lot of very in-depth info.
DOL is going to start selecting plans and asking to review
this info. So we think it would make sense to see what DOL
finds, and how employers do on compliance before piling on new
requirements for punishment. It's our opinion that employers
are doing a good job of compliance, and that violations are
concentrated outside of the large group self-insured market.
It's imperative that we see the results of these new
requirements before we invent new ones or create penalties.
Mr. Allen. Well as I said in my opening statement, it's
obvious we're in the middle of a mental health crisis. This
COVID-19 pandemic and lockdown have taken a toll on employers,
workers, and their families. How are your Member companies
helping their employees cope with the stress created by the
pandemic and associated lockdowns?
Can you elaborate on programs or best practices that
Congress should support?
Mr. Gelfand. Sure. Employers have been part of the solution
stepping up to improve access for our employees and their
families. We've contracted with companies that specialize in
this area, created many new programs for employees. Employers
also realized that the pandemic created mental health needs
that were beyond just insurance coverage.
For instance, people needed time off, and we actually
needed management to lead by example and show that it was OK to
take their time off. We set up virtual challenges to sort of
gamify and get people engaged on these issues.
Employers offered online classes and more. But the best
thing Congress could probably do would be to give employers
more space to experiment and innovate. So right now the rules
related to mental health parity, the ACA, Americans With
Disabilities Act, GINA, COBRA and other laws, they make it
super complicated to try anything new.
So what if Congress was to say you know so long as an
employer has a plan that meets the requirements under these
rules, they could experiment with a new, more limited benefit
that could be offered on a supplemental basis, not subject to
all of those complicated new rules.
That would get new ideas and new money on the table to
potentially help employees.
Mr. Allen. Well thank you so much. I'm about out of time,
but I do understand the importance of price transparency, and
if you could address this maybe with another Member. We should
use every dollar wisely. The employees enrolled in high
deductible health plans with health savings accounts are
rightly cost conscious and seek to make healthcare choices that
work best for their families and their budget.
The CARES Act allows employees participating in such plans
to benefit from first dollar coverage for telehealth, but only
through 2021. And what I'd like you to address is how do you
explain further how does first dollar coverage of telehealth
services help these patients?
And we'll be able to do that with the next question and I
yield back.
Chairman DeSaulnier. Thank you, Mr. Allen. We're now going
to go to Chairman Scott for five minutes, Chairman Scott.
Mr. Scott. Thank you, Mr. Chairman. And I'd like to point
out that in introducing Dr. Smedley you left out a substantial
portion of his distinguished resume, and that is the fact that
a long time ago he served as an American Psychological
Association Fellow in a congressional office--mine.
Mine. He did a great job and it's great to see him now.
Chairman DeSaulnier. Dr. Smedley. I need an intervention on
my behalf with the Chairman.
Mr. Scott. So, Dr. Smedley we've heard a lot about
stretching out the providers we have. What initiatives do we
have to increase the number of providers? I understand in terms
of psychiatrists, if the VA staffed up appropriately with
psychiatrists, there wouldn't be any left for anybody else.
And obviously, that is a great problem. What are we doing
to increase the number of providers?
Dr. Smedley. Well thank you, Congressman. It's good to see
you again. You are absolutely right that in terms of the mental
health and behavioral health workforce, we are sorely behind.
We need to dramatically increase the number of well-trained,
culturally competent providers that are available, and we need
to increase the diversity of these providers to better reflect
the demographics of the U.S. population.
At the APA we're very proud of programs such as the
Minority Fellowship Program, which has done a tremendous job in
increasing access to behavioral health and mental health
careers for diverse populations.
These are talented individuals who are often going into
underserved communities and providing those services. But we
certainly need to increase and expand these kinds of programs.
As has been indicated, we are woefully under prepared to
address the mental health challenges that are before the
country now, so we urge expansion of these kinds of important
programs.
Mr. Scott. Are there scholarship programs, or something
that can get people on track through college and professional
schools to get them on track to be providers?
Dr. Smedley. Certainly, there are some resources. Yes, the
Minority Fellowship Program helps to provide some of those
resources, but it's also true that the National Health Service
Corps and other programs have been vitally important in
providing access to training, often with service payback
agreements whereby those trainees go into underserved
communities for a number of years, provide high-quality
services in exchange for government assistance with their
tuition costs.
So, again, these programs need to be expanded. They are
vitally important, and we certainly call for more
psychologists, behavioral health and mental health
professionals to be able to access these important programs
such as the National Health Service Corps.
Mr. Scott. Thank you. Dr. Bendat it's true that the
Department of Labor has enforcement over ERISA programs in
terms of mental health parity. Isn't there a private
enforcement right by consumers?
Dr. Bendat. So, there is in fact a private enforcement
right for consumers. The problem however is that it is a very
limited right. Consumers are not able to generally recover
anything more than their benefits, and while $5,000, $10,000
may seem--and actually be--a lot of money to most Americans, if
that's the size of your claim you're generally not able to
pursue it because there are very plaintiff's attorneys around
the country who are able to bring claims of that sort.
So, the end result is that you have lots and lots of people
who are out precisely amounts in this kind of range, and are
unable to vindicate their claim. So essential that the DOL
steps in. Also essential that Congress consider bringing in
again the opportunity for extracontractual damages to be
obtained from fiduciaries, namely claims administrators, TPA's
that improperly deny claims and disincentivize people from
getting the care they need.
Mr. Scott. And what arbitration clauses do to the right to
bring a claim even if you could bring it?
Dr. Bendat. Well, for one they make things secret. So DOL
doesn't find out about potential allegations and findings.
Arbitrations don't always follow the law in a way that courts
do, and arbitrations can also potentially limit the types of
relief sought, so a real danger.
Mr. Scott. Thank you, Mr. Chairman.
Chairman DeSaulnier. Thank you, Mr. Scott. I apologize for
that omission. Next we go to Mr. Walberg. Mr. Walberg?
Mr. Walberg. Thank you Mr. Chairman. And before I begin my
questioning I would like to ask permission for unanimous
consent to put into the record a letter from the partnership
for employer sponsored coverage if that would be allowed?
Chairman DeSaulnier. Without objection.
Mr. Walberg. Thank you Mr. Chairman. And thanks for the
hearing today. And thanks to the witnesses for being here. We
all know, and as we've heard already on this hearing that the
COVID-19 pandemic has exacerbated barriers to care as people
have become fearful or discouraged from traveling to seek the
care they need.
If there's one bright spot that we've discussed even this
morning from the pandemic it's been the expansion of telehealth
services which really has become a lifeline for ensuring access
to healthcare during the pandemic.
However, State licensing restrictions can hinder a
patient's ability to receive care from health professionals
that are not licensed in the patient's State. Occupational
licensing reform has been an issue of particular interest of
mine, and I recently cosponsored the TREAT Act, which would
provide temporary State licensing reciprocity for licensed
practitioners during COVID-19 public health emergency.
And so, Mr. Gelfand, in your written testimony you note
that encouraging interState provider license reciprocity would
improve access to mental health services. Can you please
describe the regulatory barriers providers face when they seek
to treat patients from across State lines?
Mr. Gelfand. Absolutely. Thank you Mr. Walberg. So there is
a financial cost for providers to get licensed or certified in
different states. That cannot be overlooked. We've estimated
the cost for a doctor just to practice in the 28 states that
participate in the InterState Medical Licensure Compact, at
nearly $12,000.00 payable every 2 years or so.
However, that is only one of many complicating factors.
Every State has its own set of rules which could include
different continuing education requirements, different
renewables, different financial systems et cetera.
Some states might require applications to be completed in
person. Others might have fingerprinting requirements. The list
just goes on. The problem is particularly extreme for patients
with rare or complicated diagnoses who need to see a very
specialize provider like those who practice at academic medical
centers, but there are many other examples like a patient who
travels a long distance for highly specialized care, but isn't
well enough for whom they could travel, or traveling would be a
major inconvenience.
We recently heard a story about a spouse who was left with
no other option than to drive his wife, the patient, across the
State line into Maryland to receive post-surgery telehealth
from her car, parked in Maryland, rather than from her home in
Delaware because of the differing rules.
So this isn't serving patients, and it's certainly causing
a lot of barriers for doctors.
Mr. Walberg. Amazing, amazing, but glad we're finding these
things out now. How are employers that operate in multiple
states navigating these barriers? And especially as they relate
to telehealth?
Mr. Gelfand. Right. So an employer sponsored ERISA plan
will offer pretty much identical benefits to all of our
beneficiaries all over the country no matter where they live,
where they work, or where they receive medical care, except not
for telehealth.
Telehealth is governed at the State level, which means that
an employee in one State may be able to do all kinds of
telehealth visits, whereas in another State they may be
required to do video only. So unless they have broadband
internet access, they're banned from telehealth.
In some states the patient can simply pick up their smart
phone and find a doctor, while in other states you can only do
telehealth with a provider who is already your doctor. In some
states they don't allow prescriptions over telehealth. In some
states they still have super antiquated originating site rules
as if it was 1992, and to use to the internet we had to go to a
cybercafe.
So that's why ERIC is calling for a national set of rules
for telehealth, so that our plan's beneficiaries can get one
set of rules and we can end this mismatched set that is
creating a fundamental unfairness for our employees and their
families.
Mr. Walberg. Mr. Gelfand following that track a bit as you
are well aware, this committee has jurisdiction over the
Employer Retirement Income Security Act, ERISA, which was
enacted way back in 1974, long before the internet or concept
of telehealth.
Does Congress need to take a look at ERISA or other laws if
we want to encourage expansion of telehealth services and
promote states to adopt licensing reciprocity?
Mr. Gelfand. It is our belief that ERISA is one avenue
through which a national framework could be made such that an
ERISA plan could contract with providers, and those providers
could see their patients in that ERISA plan no matter where
they worked.
There are still going to be details that will have to be
worked out to ensure that a patient has somewhere that they can
go if there's a problem. If they have an authority that is
regulatory in nature, but Congress can absolutely work those
problems out. It's not a question of whether. It's a question
of how.
Mr. Walberg. Thank you my time has expired. I appreciate
your input. I yield back.
Chairman DeSaulnier. Thank you, Mr. Walberg. Nicely done.
We are now going to the distinguished gentleman from New York,
Mr. Morelle.
Mr. Morelle. Thank you very much, Mr. Chairman, for hosting
this hearing on obviously one of the most important questions
coming out of the pandemic, and I appreciate everything my
colleagues said, and appreciate the witnesses.
I did want to follow up a little bit with Mr. Walberg's
questions regarding telehealth. I spent a fair number of years
in the State legislature, and was a big advocate for telehealth
and telemedicine, and I've been I think pleasantly surprised by
some of the information that's come out about how people have
received treatment and services through telehealth, and it may
be just auditory with just telephonically.
And I know Dr. Smedley had mentioned in his opening
comments. Just aside from the public policy issue, we're
talking to constituents and taxpayers about telehealth. They
may have some hesitancy. They may wonder how this could be
successful.
Do you have any thoughts on first of all the degree to
which people are compliant with going to actual appointments
and not missing appointments--which I gather happens in the
physical arena--as well as mental health arena with some degree
of frequency--how that's worked in the pandemic.
And also just the efficacy of treatment either through
telehealth on sessions like this, or that are purely
telephonic. Could you just comment on that anything that you
gleaned, or any information that would help us talk to people
about the efficacy of this treatment?
Dr. Smedley. Congressman is that for me?
Mr. Morelle. Yes sir.
Dr. Smedley. OK yes thank you. Yes, we certainly know that
telehealth services has been indicated, can be an equity
enhancer in terms of ensuring that people have appropriate
access to culturally appropriate mental health services,
reducing geographic, cultural and linguistic barriers by
increasing the pool of available providers to patients is
critically important.
Certainly, it has great potential to reduce the number of
no-shows, and we're certainly looking to compile research on
efficacy, but to date all the indications are that telehealth
can provide high-quality services that importantly improve
patient outcomes just as the case for the traditional in-person
service.
Mr. Morelle. Well I appreciate that, and I look forward to
working with some of my colleagues to expand opportunities for
the telehealth services. A different topic, Dr. Smedley. I
wonder, we talked about the disproportionate impact of the
pandemic in communities of color, older Americans, and people
with disabilities, particularly those who receive long-term
care in congregate settings have also been particularly hard
hit by the pandemic.
This does not get as much attention from my perspective,
but can you talk about the impact that it's had on older
Americans and people with disabilities, and what you think, if
anything, the recommendations for us on how we can address this
lack of service?
Dr. Smedley. Sure. Congressman you are correct that there
are many populations that have been disproportionately impacted
by the COVID pandemic with the combination of physical
distancing, social isolation, economic anxiety, fears of
transmitting the virus, and for many in communities of color we
are facing a resurgence of overt expressions of racism,
xenophobia and intolerance, which adds to stress, fear and
anxiety in many communities of color.
What can we do? Certainly, No. 1 for me would be to enforce
the Mental Health Parity Act, particularly for the Medicaid-
eligible patient population, ensuring that we have adequate
networks, ensuring adequate reimbursement will be a huge step
that can be taken to ensure that these patients have access to
needed high-quality services, and then as we've discussed
expanding and ensuring the continuation of audio-only
telehealth will be a significant opportunity for patients to
receive services that they might not otherwise receive.
So these are important steps that Congress can take now
addressing the needs of these vulnerable populations.
Mr. Morelle. And what's your sense in terms of the
underserved population, you talked about communities of color.
We now just talked about older Americans, people with
disabilities. What are the long-term consequences of this?
What should we expect in terms of additional healthcare
costs, et cetera of going forward as a result of the lack of
services during the pandemic?
Dr. Smedley. Sure. As the other witnesses have described,
we certainly know that there's a strong relationship between
mental health symptoms and distress, and other physical health
symptoms. We absolutely need to address both and ensure that we
have a holistic approach to treating the needs of patients, and
particularly for those populations that you indicated which
have been historically underserved and marginalized in our
health care systems.
Mr. Morelle. Thank you. Thank you, Mr. Chair. I yield back.
Chairman DeSaulnier. Thank you, Mr. Morelle. We're now
going to Mrs. Harshbarger.
Mrs. Harshbarger. Thank you Chairman and Ranking Member
Allen. I appreciate the witnesses being here today. I do have
experience with this. I've been a pharmacist for 34 years and I
absolutely have seen the increase in mental health, you know,
drug therapies, the increase in opiod abuse, especially during
COVID-19.
I just came back from the border. I hear my counties
talking about how methamphetamine use is up by 40 percent. It's
unbelievable. And I think brain health is the last frontier,
and I talked to psychologists that say it's absolutely an organ
that we treat that we cannot see.
One of the few professionals that do that. You know Mr.
Gelfand I live in an area that's very rural, and we have a
deficiency and a limited amount of behavioral health and mental
healthcare providers. And you know I've talked to counties that
absolutely have to wait a year to get one applicant to treat
patients in their communities, and I'd like to know what
Congress can do as a whole to increase the number of behavioral
health providers.
I understand telehealth has exploded during COVID, and it's
here to stay. And we need to have reciprocity rules. As a
pharmacist I know that every State has different rules, and if
I want to reciprocate to another State that's a large fee. You
know there's different rules, State laws, all that.
We know that we need to make that cohesive across State
lines, but how do we recruit these individuals, especially into
rural areas where they are the hardest hit with the opiod
crisis, and you know we need those mental health providers
there.
What can you tell me, and what can Congress do to help with
that issue.
Mr. Gelfand. Thank you Representative. In the long-term
employers very much support efforts like targeting education
funds and loan forgiveness to mental and behavioral health
providers, but that's a long-term solution. And it's not going
to help your constituents today.
So if you want to do something today, the No. 1 thing that
Congress should do is just pass the TREAT Act. You pass the
TREAT Act, you instantly open up an immense supply of providers
to these patients, both via telehealth and in-person, but it's
only temporary right?
So if we want to sustain the gain we have to explore
permanent solutions to allow cross State practice. And you know
we have to be honest about this that it's not at all clear that
increasing you know pay for providers you know, $30.00-$40.00
an hour is going to get them to close up shop and move, right,
and change where they're practicing.
So we need to think about you know this committee has
jurisdiction over ERISA, and could potentially give our plans
and their vendors the ability to contract with providers
elsewhere and beam them him via telehealth. ERISA is not the
only way to do it, but it's a way that this committee could do
it and could do it quickly.
Mrs. Harshbarger. OK. Well I appreciate that verse. Like I
said we've seen that uptick in opiod abuse. You know people
they're anxious, and it's those younger people that we see the
most, and we've seen an uptick in that. And it's because they
haven't been on the job. They haven't been able to get out and
socialize. That's a huge problem.
And I think we would benefit if we did get things opened
up. You know as more people get vaccinated, hopefully that will
happen, but addressing this real shortage of healthcare
providers is key, especially in my district. And I'm here to
help in any way I can, and I appreciate all the witnesses
today.
I know this is a problem. This is something that like I
said it's the last frontier and we need to address these
situations, and I appreciate you being here, and I yield back.
Chairman DeSaulnier. Thank you. We are now going to
recognize Mr. Norcross from the great State of New Jersey.
Mr. Norcross. Thank you, Chairman. And it's good to see you
there. I really appreciate your insight and quite a legacy
coming from George Miller and what he's done for this great
committee. Dr. Smedley, thank you for your opening comments,
particularly in dealing with the parity issue.
By giving this additional support tell me how the
Department of Labor can use this to change the way that some of
the bad actors are playing now. If you can give us some context
of why this is relative and important.
Dr. Smedley. Sure. Thank you, Congressman. So, as we
discussed earlier what's lacking with the current mental health
parity law is teeth--enforcement. And so for the Department of
Labor clearly capacity has been part of the problem.
There are an enormous Member of insurance plans to regulate
a few investigators, and an analogy would be that if we had
only one State trooper patrolling I-95 between Washington, DC
and Richmond that would not suffice to adequately police that
highway.
So, we need better enforcement, more teeth, we need to
ensure adequacy of networks. We need to ensure adequacy of
reimbursement, and so your legislation would give the
Department of Labor that capacity to ensure that insurers are
complying with the law.
Mr. Norcross. I would certainly appreciate that. I thought
you were going to comment about my driving techniques, but the
idea we believe, even without police, that they'll do the right
thing is simply not happening across the board and we
appreciate.
Dr. Bendat tell me the ways that the insurance companies,
as you see them, try to circumvent the Parity Act. What are
common areas that you've been involved in, or that you've seen
that you can share with us.
Dr. Bendat. Sure. So, as I mentioned earlier the easiest
way to circumvent parity is to adopt non-quantitative treatment
limitations that are not disclosed, or that are discrepant. In
other words, incomparably applied to mental health and
substance use benefits.
The most prominent NQTL of them all is medical necessity.
Medical necessity is generally again something that has to be
set by law or a plan, and it can be interpreted in different
ways if it isn't properly structured, so I would say medical
necessity and utilization review criteria that interpret
medical necessity, those are tremendous ways in which insurers
can deny coverage without triggering any oversight or alerting
the public that there is something really foul going on.
Mr. Norcross. Well, when you look at the capacity for the
Department of Labor in its present configuration to go after
this and there was a letter circulated today by my colleague
Joe Courtney about increasing the funding to the Department of
Labor. Right now, it seems that the balance is extremely far
off.
Our capacity to look at this and those to come into
compliance willingly. Are there some more subtle ways? The two
that you mentioned obviously, are out there and easier to see.
What are some more of the subtle ways that some of this is
going on?
Dr. Bendat. Well, apart from medical necessity and network
adequacy, which are huge in their right, and probably the
biggest impediments to access to care that health insurance
issuers control, you all--and reimbursement figures into the
equation. In other words, how are reimbursement rates set? That
is not a transparent thing.
How are in-network reimbursement rates set? That's
particularly not transparent. So, when we get more answers to
those questions, we'll have a lot more insight as to kind of
the methodologies that are being applied and the
incomparability. I would also say that you know apart from
these you've got potential deductibles and plan specific things
that can drive people not to receive benefits.
Mr. Norcross. I very much appreciate it. And it's the
context of which we live in and the pandemic. You never want to
suggest that there's a silver lining, but the idea that mental
health is so important, and so many people who have not really
been challenged by it are now seeing it across the board, and
we have to get that to them, that's why this legislation is so
important.
Mr. Chairman, I yield back and thank you for the time.
Chairman DeSaulnier. Thank you, Mr. Norcross. And having
ridden with you, I want to confirm your observations about your
driving skills. We will now go to Congresswoman Miller.
Mrs. Miller. Sorry.
Chairman DeSaulnier. No worries.
Mrs. Miller. Yes. Mr. Gelfand thank you again for your
thought provoking testimony. It's wonderful to hear about the
great work that companies across the country are doing to
support the health and well-being of our employees. And I have
witnessed what we are discussing as I travel the district, and
people are struggling to fill their--get workers.
But anyway back to the opiod epidemic. I would like to know
you shared testimony that some actions that employers have
taken to combat this terrible epidemic, you've already
explained some, but could you expand on any other unique
approaches that your Member organizations have taken?
Mr. Gelfand. Thank you Representative. You know
unfortunately COVID did cause a lot of disruption, including
for many employers opiod mitigation efforts. The economic
squeeze separated a lot of employees from these programs, made
it impossible to do a lot of things that we were doing in
person, and activities that we have rolled out, plus mental
health toll taken on workers because of COVID and because of
isolation and lockdown have led some back to dependency.
So this is very real for us. The good news though is that
many of these programs that we implemented before COVID, we
were able to sustain because they were cultural changes within
our health benefits. For instance, we're not going back to
unlimited fills for opioids.
I mean should we dispense the amount that they need for
immediately relief? And this should be monitored and re-
evaluated, and when possible a patient should be steered to
other options. These are just lessons learned, and we're never
going to let those go.
And many of the programs that we developed like educational
sessions, group counseling, this can and has gone virtual, and
maybe that will change back when we can meet in person again.
But for now it seems sustainable to use these online platforms.
Mrs. Miller. I do have another comment. Do I have time?
Chairman DeSaulnier. Yes, you do.
Mrs. Miller. OK. I don't know if this would be the
appropriate place, but actually my son-in-law is an orthopedic
surgeon, and of course he prescribes these. But he brought up
how Americans want to be pain free and they demand pain relief.
But then when physicians don't give them what they want, then
they turn a bad report in on the physician.
And so they're kind of caught in between on that.
Chairman DeSaulnier. Any of you care to comment?
Dr. Smedley. Mr. Chairman, I would if you don't mind. This
speaks to the importance of non-pharmacologic behavioral
treatments. There are many behavioral treatments that are
highly effective in reducing pain and increasing patient
comfort, and of course they're much healthier coping responses.
So, doing what we can to ensure the promotion of non-
pharmacologic behavioral treatments can be an important and
effective alternative.
Mrs. Miller. Well getting the doctors to use those and then
get that out to the patients.
Chairman DeSaulnier. Absolutely. Anyone else?
Mrs. Miller. Thank you
Chairman DeSaulnier. Thank you Representative, is that it?
I appreciate it. We will now go to Representative Wild.
Ms. Wild. Thank you, Mr. Chair. My question is for Dr.
Moutier, but I'm happy to have any of the panelists respond. As
many of you know I am proud to be a leading advocate in
Congress for, excuse me, suicide prevention.
I am extremely concerned about the rise of suicide among
young people and children and the deterioration of their mental
health. And although many have claimed and argued that school
closures have adversely affected children's mental health, and
I'm sure that is true, we know that this problem existed long
before COVID-19.
The number of children ages 6 to 12 who visited children's
hospitals for suicidal thoughts or self-harm has more than
doubled since 2016, according to data released earlier this
month from children's hospitals across the country. They
documented 5,485 emergency room or inpatient visits for
suicidal thoughts and self-harm among 6 to 12 year old's at
these hospitals in 2019, which is notably pre-pandemic, which
is up from 2,555 in 2016.
And visits for teenagers with suicidal thoughts or self-
harm at these hospitals also rose from 2016 to 2019 by a
staggering 44 percent. According to the most recent data we
have from the CDC, suicide is now the second leading cause of
death among young people ages 15 to 24.
How can making sure that our kids get the mental health
care they need, including mental health care covered by their
health insurance the same way they cover physical health
issues, prevent these suicides, and address these suicidal
thoughts?
And how do we ensure, and I know this has been touched on
already, but it's such an important issue. How do we ensure
that robust mental health care receives parity in insurance
coverage? And with that Dr. Moutier I'm going to turn it over
to you, and if anybody else would like to weigh in on this very
important topic I'd be happy to hear them. Thank you.
Dr. Moutier. Thank you, Congresswoman Wild. Yes, the
suicide crisis in our Nation has been on the rise and that
actually is true for all age groups, but certainly for youth.
The rise in not only suicidal ideation attempts but rates, has
been tremendous pre-COVID.
What we know so far during COVID is that during 2020 the
number of suicides compared to 2019 actually went down by 5.6
percent around the Nation. We don't know the demographic
breakdown of that yet by age, or by race ethnicity. And we know
that the pandemic is affecting all people, but affecting
different groups differently.
So, I am very concerned about what we will ultimately see
in terms of not only the demographic breakdown for suicide
rates during 2020, but also now what is coming here now in 2021
because the effects of trauma can be delayed.
So, the big picture is that we have had a broken system
when it comes to accessing mental health care. There has been
stigma, internal and external, cultural barriers, but now that
that is going down, I believe that that is one of the reasons
we see help-seeking so much more on the rise, but the access to
care has not been there to meet it.
And so, parity is essential when it comes to suicide
prevention. It is one of the most concrete and powerful things
we could do to potentially prevent suicide and drive suicide
rates back down, and particularly now that mental health needs
are being expressed by everyone, as has been pointed out.
That's a good thing. People can talk about their internal
experiences now. But it's not a good thing if we don't have
care that is ready to meet that. And that is certainly
incumbent upon the legislative tool that we have to enforce
parity.
But it also means that parents in schools, in workplaces,
that we have to build cultural competency and capacity around
being able to dialog about these things and get people the help
that they need.
Ms. Wild. Thank you. And I'm going to just take the last 30
seconds and ask you Dr. Moutier. Can you comment on the new 988
line for suicide prevention that will be available I believe
within the next year? Would that help adolescents and children?
Dr. Moutier. Yes, it absolutely will. That will come into
effect. It's planned for July 2022. It's an extension of the
suicide prevention lifeline. What will happen is that volume
will go up tremendously more. Right now we have capacity
limitations due to funding as well as having culturally
appropriate providers available, but yes, that is an enormous
opportunity for us as a nation to build a new system that is
ready to meet the demand.
So, the 988 legislation is a critically important piece,
but we have to pay attention to how we resource it and staff.
Ms. Wild. How we fulfill that need. Thank you so much, Dr.
Moutier. I look forward to continuing the work with you on this
very important topic.
Dr. Moutier. Thank you.
Ms. Wild. I yield back Mr. Chair.
Chairman DeSaulnier. Thank you. And thank you for your
advocacy on this issue in particular. We next go and recognize
Representative Fitzgerald.
Mr. Fitzgerald. Sorry about that.
Chairman DeSaulnier. There you go.
Mr. Fitzgerald. Sorry about that. Yes Mr. Gelfand and maybe
some of the other witnesses would like to comment as well. But
a challenge over the last year continually trying to stay in
contact with some of the healthcare systems within my
congressional seat, and even before that in my State Senate
seat that I had represented for a number of years, but the one
hospital is Children's Hospital in Milwaukee.
And there was this kind of constant drum beat about trying
to find qualified providers for kids who were experiencing
behavioral health care issues, and obviously issues related--
not just for the pandemic, but family situations, school
situations.
And I'm just curious if some of the things that ERIC or its
Members have done or are currently doing on the provider
shortage front, because it seems to be something that you hear
about quite a bit.
Mr. Gelfand. Thank you Representative, and Children's
Wisconsin is well-known to be an outstanding hospital. So if
even they are having trouble attracting these professionals,
there should be little doubt that this is a market-wide
problem. This is a problem that exists all over the United
States.
Employers know that sometimes throwing more money at the
problem just isn't enough, and in this case you may be able to
double the amount that you're paying per hour, and you still
may not get those child psychologists to leave New York and LA.
So we think that you have three options here.
Option one is focus on increasing the number of these
providers that exist. And we should do this, but it takes a lot
of time. So that alone won't suffice. No. 2 is we can do more
with the providers that we do have with more resources, tools,
education, collaborative care and colocation efforts, we can
enhance access to care by equipping more professionals to
practice in this space.
So for instance, you know funding, perinatal psychiatry
access programs. But third, and perhaps most immediate, to help
patients right now is we've got to be able to bring those
providers from out of State to Wisconsin and into your
district, and to do that we just need more access to
telehealth, and we need to be able to facilitate across State
practice period.
Mr. Fitzgerald. Thank you Mr. Chair I yield back.
Chairman DeSaulnier. Thank you, Mr. Fitzgerald. We will now
go to Mrs. McBath. Lucy, the floor is yours.
Mrs. McBath. Thank you, Chairman DeSaulnier. Thank you so
much for convening this group of experts today to discuss the
issues of access to mental health services. Almost a year ago
we began social distancing in order to stop the spread of this
deadly pandemic, but social distancing has really taken a toll
on our mental health and feelings of isolation and
disconnection that has affected just absolutely everyone.
And it's been inspiring to see so many people across
America kind of come together to actually help and support and
service one another. And the mental health and recovery
community has really been a shining example, I believe, of how
people can really come together to overcome this terrible
disease.
However, you know these communities have not always been
able to access the care that they need, and we've talked about
that today. And COVID-19 has just truly laid bare many of the
inequities of our health care system. And you know I have seen
a host of disparities develop and worsen with the onset of this
pandemic, even within my own constituency.
So, as the increased isolation of the pandemic has taken
its toll on people with mental health issues, I've observed how
barriers to coverage and access to care have just contributed
to increased rates of severe mental illness and even suicide.
Dr. Bendat, in your testimony you talked about the issue of
the adequacy of provider networks, and the importance of making
sure that you have enough doctors in your plan, and in your
plan network to make sure that parity is meaningful.
Can you tell us what are some of the issues that lead to
relatively narrow behavioral health networks?
Dr. Bendat. Well so you've got narrow networks that are
narrow by design. In other words, there are insurance plans out
there that intentionally sell access to networks that are meant
to be narrow. Nonetheless, these types of plans are supposed to
cover all of the benefits that they promised to offer.
So, the problem of course is that when it comes to mental
health care, oftentimes they don't. We also have networks that
on the surface appear to be robust. They're not limited. Plans
sell them as PPO's, essentially large group products that they
offer the promise of wide coverage.
But when patients try to access in-network care for mental
health and substance use disorders they can't. Largely the
issues they confront have to do with not being able to get
timely care, so if there's an urgent situation patients are not
able to access the type of provider within a reasonable period
of time, or they can't find someone that is available and
accepting patients within a particular distance.
The problem is that insurers typically, or thus far at
least, have failed to update their provider directories. And
so, patients are just told go take a look at our directory.
Find yourself a provider. That is not a very helpful stance to
take when someone is in crisis or in distress. And so, and
especially when patients have to call multiple providers and be
told no, we're full or no, we no longer are with this insurer.
That's just terrible.
So, I would say that putting the onus in the hands of the
patient who's already struggling with distress, having that
patient look for providers instead of telling them here is
where they're available, here is where they are, here's their
availability window. That really creates a major barrier to
care.
Mrs. McBath. So, then let me ask you how do some states
like California for example address the issue of network
adequacy for insurance, and if you can give us a very brief
explanation as to why laws do not apply in self-insured ERISA
plans.
Dr. Bendat. Sure. So, there's ERISA preemption for self-
funded plans which means that they are just not subject to
State laws period. That is something that only Congress can
address. So, your committee has absolute jurisdiction over this
issue. The way that California deals with fully insured plans
is by telling them hey, you've got to arrange for example
coverage within 15 miles or 30 minutes to a patient's home.
You've got to do it within a certain period of time. If you
don't, you must let the patient go out of network and subject
the patient to no more than in-network cost-sharing. So in
other words, if there's a balance, you're on the hook for it--
you the insurer, not the patient.
That's going to create an incentive for insurers to broaden
their networks and to raise reimbursement rates to attract
providers.
Mrs. McBath. Thank you, Mr. Bendat. And Mr. Chairman I
yield back the balance of my time.
Chairman DeSaulnier. Thank you, Representative. Now we're
going to go to the Ranking Member Representative Foxx.
Ms. Foxx. Thank you Mr. Chairman. I want to make a quick
comment before I ask my questions. It's so frustrating when we
focus these hearings on bashing employers, bashing providers,
or bashing healthcare networks.
Mr. Gelfand has given us some great alternatives that don't
require money, and I think it would have been wonderful if we
could have heard more about how the private sector is handling
these things and looking for ways. Employers want to help their
employees, not harm them.
Mr. Gelfand thank you for being with us today. On June 23,
2020, the Department of Labor issued temporary guidance
allowing employers to offer stand alone telehealth coverage to
certain employees ineligible for any other group health plan.
Had this guidance increased access to mental health services
for employees, should Congress consider expanding this
flexibility to all employees and making it permanent?
Mr. Gelfand. Thank you Dr. Foxx. The guidance temporarily
allowing stand alone telehealth has been a huge success.
Millions of part-time workers and others have deemed coverage
that they didn't have before, largely at the employer's
expense, and employers celebrate this.
But as you know though, when the emergency ends, so too
does the guidance, and so those benefits will disappear. And
keep in mind that the temporary nature of the guidance caused
some employers to hold back. So we think that if we were to
permanently allow stand alone telehealth benefits, a lot more
employers would roll it out since they could do it for the
long-term.
And we ought to help even more patients, and we do that by
broadening the eligibility to include unenrolled workers--for
instance young adults that are on their parent's plan.
Ms. Foxx. Thank you. Mr. Gelfand the Mental Health Parity
and Addition Equity Act requires employers to offer mental
health and behavioral health benefits, do not place more
stringent limitations such as visit limits or preauthorization
requirements on those benefits than they do on medical or
surgical benefits.
Your testimony explains the Department of Labor's parity
regulations are especially subjective and difficult to
interpret. What steps can Congress, or the administration take
to ensure that plans are able to comply with mental health
parity requirements?
Mr. Gelfand. So Congress has more than once directed DOL to
better explain the most complicated part of parity which is the
non-quantitative limitations, but for some reason DOL has given
many examples of what is not allowed, but continually failed to
give clear guidelines on what is allowed.
There is now an extremely complicated self-compliance tool
that just seemed to further confuse folks. Considering that
these NQTL's did not exist in the legislation that Congress
passed, and were invented by President Obama's Department of
Labor, the least that the department could do is to give a more
complete and comprehensive explanation, not just on how to
violate the rules, but on how to affirmatively comply with
them.
Perhaps the most important thing that Congress can do is to
continually support DOL's compliance-driven, rather than
penalty-driven approach. Right now when there's a problem DOL
helps the employer to get it right and re-adjudicate claims to
make patients whole.
This doesn't make much money for trial lawyers, but it
ensures that our workers actually get the care that they need.
Ms. Foxx. Thank you. Mr. Gelfand 151 million Americans are
covered under employer-sponsored coverage, which is more
individuals than are covered by Medicare, Medicare or the
exchanges.
Knowing that employer-sponsored plans are the largest
single source of coverage, can you discuss how health benefits,
including those related to mental and behavioral health are
mutually beneficial for workers and employers?
What actions have employers taken to manage the increasing
costs of coverage?
Mr. Gelfand. Thank you Dr. Foxx. Employers are committed to
offering quality affordable mental and behavioral health
benefits. Remember that parity is not a mandate. Employers are
choosing to offer this benefit, and thus choosing to become
subject to these very complicated rules, but they do it because
it's the right thing to do, and it's integral to keeping our
employees healthy and productive, and providing peace of mind.
Now as with any employee benefit, there are always
tradeoffs. Some limitations are needed to keep coverage
affordable because if costs go up health employees start opting
out which makes costs go up even more.
Now employers work hard to develop strategies focused on
improving health and safety, which can also help to control
costs, but in the end if we're not able to employ sophisticated
medical management and offer reasonable reimbursement to
providers, or make decisions to exclude certain low-value
facilities or treatments, this will just make it impossible to
offer affordable coverage to our workers.
Ms. Foxx. Yep. Has the COVID-19 pandemic changed the way
employers deliver mental health care, and what innovations
would you highlight that they have put into place?
Mr. Gelfand. So it's safe to say that the past 13 months
have seen more innovation and experimentation in employer
coverage than ever before. And here are the three big
takeaways. First, telehealth is crucial.
We can overcome a lot of provider shortages, we can
overcome access and wait time problems, and already some are
advocating that we need to tear it down by having the
government mandate reimbursement rates in telehealth.
Second, a lot of people are getting their mental and
behavioral health needs met in the primary care setting. We've
got to support this, from enhancing worksite health clinics, to
providing education and resources. This should be an easy one.
And third, a lot of our employees are getting support
that's not traditionally thought of as medical care right?
Whether that's attending AA meetings, or care giving by family
Members, or they're engaged in meditation, mindfulness type
programs.
Employers are going to pivot even more to support these
activities, but there are some areas in which law and policy
really needs to catch up to help us do that.
Ms. Foxx. Mr. Chairman I thank you very much. I want to
make one more quick comment. My husband was having a problem
with terrible indigestion about 3 months ago, and he was able
to do a telehealth meeting.
He had an appointment with the doctor. The doctor got sick,
and was afraid to see him in person. And so, he had my husband
do it through telehealth, and he was able to diagnose--maybe
not completely, but help him a lot. So I really am an advocate
for the telehealth opportunities that are out there.
So thank you Mr. Chairman for your dispensation here.
Chairman DeSaulnier. I'm always happy to dispensent you,
Ranking Member, and as a friend, I just want a brief comment
that I was just saying to my staff how happy I was at the tone
of this conversation and very hopeful that we can work together
so.
Ms. Foxx. Thank you.
Chairman DeSaulnier. With all due respect I didn't hear the
bashing, although I have heard it in the past. And I do
appreciate Mr. Gelfand's comments and look forward to
continuing conversation about how we get these needed services,
which I hear a consensus about from everyone, as efficiently as
possible, and on that I agree with you.
Ms. Foxx. Thank you.
Chairman DeSaulnier. The best of employers do it. We just
want to make sure that they do. With that we go to the
distinguished gentleman from Michigan, Mr. Levin.
Mr. Levin. Thank you so much, Chairman DeSaulnier for this
really important hearing. And thanks to all the witnesses. Dr.
Smedley, let me start with you.
In your testimony you discussed the structure of mental
health parity enforcement, and you point out there are a lot of
problems--Federal oversight of ERISA plans is weakened by
several factors, the requirements for insurance laws vary
state-by-State, and for State and local government employees
plans can simply opt out of the system altogether.
What long-term consequences could patients experiencing
COVID-19 related trauma face if they have limited mental health
coverage due to weak enforcement?
Dr. Smedley. Well thank you, Congressman. As I indicated in
my testimony, we are witnessing a mental health tsunami. It is
upon us. And so, it is critically important that we do all we
can to ensure access to appropriate behavioral and mental
health services.
As some of the other witnesses have indicated, the absence
of culturally appropriate high-quality services can make these
conditions worse, leading to far more debilitating illness and
worse case, you know, suicidal ideology, et cetera.
And also, has been indicated these mental health issues are
not limited to psychological stress and anxiety. They also
manifest as physical health problems as well. So, we need to do
all we can right now to get out ahead of these challenges
starting with things like putting teeth into the parity law.
Mr. Levin. Well so, let's focus in particular on you know
sort of the meat of this question of better enforcement. And
given our committee's jurisdiction, which is ERISA, what are
your top recommendations to improve enforcement for ERISA
plans? Lay that out for us.
Dr. Smedley. Sure. There are a number of steps we can take,
and I actually would like to respond to your question more
fully with a written statement, but certainly.
Mr. Levin. I would appreciate that.
Dr. Smedley. Yes. The legislation offered by Representative
Norcross is an important start toward ensuring that we have
adequate capacity for enforcement, and that plans are aware of
the consequences of not ensuring appropriate access to mental
and behavioral health services.
Mr. Levin. OK. Let me ask you about a different thing which
is peer support for people with mental health issues. I'd like
to ask you to speak about the importance to that, and you know
whether there are challenges to ensuring that people are able
to access the peer supports that may be critical to their
ability to build resilience during these difficult times.
Dr. Smedley. That's a great question, Congressman. Thank
you for that. Certainly, there are a number of risk factors
that people are facing in terms of building and enhancing
social support. So certainly, the need to be physically distant
during this time is one of those, but we have encouraged people
while we are physically distancing, to be socially--to not
socially isolate.
Because it's important that we build those connections.
Doing things like training people in psychological first-aid,
and skills for psychological recovery, offer ways of helping to
train lay individuals, non-professionals to provide health
coping skills and mechanisms to others.
And certainly, there have been other very impressive
developments. Like mutual aid societies that again provide
social support without the risks associated with physically
coming together. So, it is critically important that we address
peer support. These informal sources of support, and often
based in communities, drawing on sources of community-based
resiliency are critically important, and we should do all we
can to help enhance and support those efforts.
Mr. Levin. Thank you very much. Mr. Chairman let me end
with a couple comments. One is the reflection on this whole
thing, the immense complexity of achieving parity for mental
health services.
I just want to emphasize that those of us who support
Medicare for all, are not just talking about giving the current
Medicare program, with all its limitations to everybody, but
having a full system of health care, including dental, vision,
and mental health, you know to all Americans.
And second, I want to emphasize how strongly I feel that we
have a new opportunity to permanently expand telehealth
services. I've been on the hearing the whole time, and I think
I'm going to try to partner with my colleague from Michigan,
Mr. Walberg on this, because his questioning was really great
on it, and it would be wonderful for Mr. Walberg and I to be
able to collaborate.
With that I yield back, Mr. Chairman, with more thanks for
your leadership on this.
Chairman DeSaulnier. Thank you. And I do note the
disproportionate number of Members from the State of Michigan
on this subcommittee. I'm glad to have you all here. Speaking
of which, we have a great State. We will now go to the
distinguished gentleman from Connecticut, Mr. Courtney.
Mr. Courtney. Thank you, Mr. Chairman. I have not
unfortunately, been able to attend the full hearing as much as
Andy did, but you know I actually just wanted to follow up on
his last question with the other witnesses where again, I
thought, you know, Dr. Smedley got right into really the crux
of the issue, which is what does non-compliance mean to the
patient.
And Dr. Moutier and Dr. Bendat if you wanted to sort of
comment on you know what we're really talking about here is the
impact on people.
Dr. Moutier. Absolutely. Thank you, Representative
Courtney. What it means is that in the moment when an
individual or a family is realizing that their loved one may be
struggling with a mental health condition, may be suicidal. And
so, the need becomes dire, that they go to figure out how to
access a mental health professional.
And there are more external barriers in the way of that
than probably any other type of health situation. So, you know
I think it does boil down to the way it's playing out in day to
day real people's lives and families, is presenting enormous,
and honestly unnecessary barriers that should not be there.
It is an absolute form of discrimination right now, the way
that mental health conditions are not being addressed in
actuality, even though there's a lot now of kind of open-
mindedness. I don't want to say lip service, but until we fix
this issue, we can say that mental health is valid, critically
important, that suicide is a complex, but a health issue at the
end of the day.
But we will only get so far because in every instance of
every suicide prevention effort that is shown to be effective,
it drives people who have those needs to a health professional.
And so, this really is the crux of the matter, and I appreciate
you bringing it up in terms of the impact on real people and
real families.
Mr. Courtney. All right thank you. And Dr. Bendat?
Dr. Bendat. Yes, so ultimately non-compliance with parity
and with the essential health mandates is that patients either
are undertreated, or not treated at all, and ultimately end up
far worse than they began, if not dead. And it's very simple.
Mr. Courtney. Well thank you for your clarity and bluntness
because I do think that that's really important for people to
realize that you know this is not sort of a you know, kind of a
bureaucratic, you know, political argument. This is really
about saving lives, so thank you.
You know assuming you know we were able to put in again a
better sort of regulatory structure, someone has to regulate
it, OK, at the Department of Labor. And the agency, you know,
Mr. Norcross's bill you know would appropriately designate is
the Employee Benefit Security Administration, EBSA, and you
know it's a big job.
You know if we're going to put in a new sort of effective
regulatory structure that requires you know boots on the ground
and resources. Again, the American Psychological--sorry,
American Psychiatric Association has worked with my office
about trying to get EBSA's budget actually increased in this
year's Fiscal Year budget, which again is not sort of our
portfolio.
But you know, Mr. Chairman, I would like to ask that the
Psychiatric Association's statement be added to the record
regarding again this important piece of the puzzle if we're
able to again enact smart legislation.
Chairman DeSaulnier. Without objection, Mr. Courtney.
Mr. Courtney. Thank you. And again, I don't know if any of
the witnesses would want to talk about that because again, you
know obviously having you know a cop, you can pick up the phone
and call when there's a non-compliance issue, is kind of a
critical piece.
And you know obviously the Psychiatric Association I think
flagged this for Congress, and I don't know if any of you
wanted to sort of join in with any comments.
Dr. Bendat. Well I would add that there's absolutely no
doubt that strengthening EBSA's ability to enforce parity in
ERISA, particularly with respect to mental health benefits is
critical. Again, it's a large department, but by no means
substantial enough in order to be able to take on 136 million
people.
You can imagine at least one-fifth at least, have mental
health and substance use disorders. That's a national
statistic. So, think about what that means for EBSA's
regulation and the importance of being able to effectively
address issues that States cannot touch because of preemption,
again critical.
Mr. Courtney. Thank you. You get the final word Dr. Bendat,
and again I appreciate the witnesses--really, you know, great
testimony on such a critical issue. I yield back Mr. Chairman.
Chairman DeSaulnier. Thank you, Mr. Courtney. I'll now go
to Ms. Stevens.
Ms. Stevens. Well thank you so much, Mr. Chairman for this
critically important hearing, particularly as it's something
that I hear from constituents and stakeholders in my district,
on the regular, from the Livonia Chamber of Commerce, President
Dan West who asked me about what we are going to do to meet the
moment to improve access to behavioral and mental health care.
And, to our panelists who have done just a great job today,
and I want to recognize you, Dr. Moutier, for your testimony
and your expert asking, answering of questions. Although the
last 2 years have seen an overall reduction in suicide rates,
the number of young people who have reported suicidal ideation
has increased dramatically since the pandemic.
And I know you have been touching on this throughout
today's session, but over the past year communities in my
district have just experienced countless tragedies of young
people dying by suicide. Sometimes, oftentimes with no warning.
No warning indicators, and no recognition that they might be
depressed, or might be in need of help.
Going out with their friends or family the night before
such a tragic incident takes place. So, Dr. Moutier can you
just speak a little bit to the importance of either early
recognition, or community conversation that we could take, the
accessing of care, and maybe the ways in which we can broach
this topic as community leaders more effectively.
And if there's anything that we need to know about trends,
or maybe not fully developed brains that are also contributing
to these tragic incidences.
Dr. Moutier. Thank you so much. This is such a huge part of
the pandemic experience as well. Because young people, as you
mentioned, our brains don't finish all the way developing until
we're in our mid-20s. So it means the primitive part of our
brain, fear, anxiety, stress, fight-or-flight, is fully
developed, but the thinking part, the planning part, the part
that allows us to see the long-term future, and see through the
crisis moment is not fully in place for most people until their
mid-20s.
And so, impulsivity can be a much greater factor for young
people when they're in suicidal distress, and that is something
that we are gravely worried about. Again, stigma going down is
fantastic, but that has to be just the start.
And so we have to build capacity for parents, communities,
faith leaders, school personnel, workplaces, to have dialog
about these experiences because the truth is while it always
feels out of the blue, and like you're blindsided by a suicide
attempt or a death, the truth is that person was experiencing
something that we as a society have not provided ways for them
to express and have their needs met.
And that's what we're building. And we are doing that. But
much more is needed in that regard.
Ms. Stevens. Right. And just as we say that we have been
working really closely with stakeholders on removing the stigma
of depression and trauma, and needing help, or asking for help
in providing those spaces, we also want to send a message that
we don't want you to kill yourself, and that it is, you know,
that we want you to get the help.
And so, looking at you know the role that mental health
services play or just the understanding of, for an
underdeveloped brain, what actually happens when you do kill
yourself, and the results of it.
Dr. Smedley, COVID-19 has had devastating consequences for
millions of people, but there are you know also just some
lessons that have been learned from this pandemic that will
allow us to improve health care moving forward, including the
advancement of telemedicine and making mental health services
available in communities that might traditionally lack access.
Could you just walk us through some of the things that
we've learned during the pandemic about the different ways that
mental health services can be provided? I know we've been
covering that at length today.
And also, do you have any other recommendations for
Congress so that we can ensure high-quality mental health
services are available, including communities that might be
lacking sufficient access to the internet for example?
Dr. Smedley. Thank you, Congresswoman. I will try to speak
very quickly because I know time's running short.
Ms. Stevens. Yes.
Dr. Smedley. And I would love to offer a full written
response as well, but you are absolutely right that we need to
ensure that culturally appropriate community-based services are
available. I would point out that suicide rates are
particularly escalating among African-American and Native
American youth. We need to have services in communities for
those young people, and so we will be very happy to provide a
fuller written response to your question given the time.
Ms. Stevens. Thank you. And I yield back, Mr. Chair.
Chairman DeSaulnier. Thank you for yielding back. Very
artfully getting that last question in was good work. Excuse
me. So, that is our last testimony unless I've missed someone.
I'm going to before we go to the Ranking Member for closing
comments and conclude, I just want to thank everybody again.
Thank the Members, terrific, terrific hearing, and an
important one that we intend to pursue on this committee and
would love to work with all of you, all of you, in a bipartisan
way. I'm sure we're going to have some differences in terms of
the deployment, but what I hear is so encouraging and just
following up the last conversation.
It's striking to me, having been involved in this field for
a long time, personally and professionally that the lack of
stigma, and it's really beyond my expectation when I started in
this 30-35 years ago. That we don't have more stigma, so a
wonderful thing I thought it would--I'm encouraged by that.
Having said that, it's very frustrating to see the richness
of the research, and the ability to get that research deployed
to individual Americans, and we're losing people that we don't
need to lose if we get the infrastructure up, and get the
performance standards right so Congress can provide the
necessary oversight.
So, I want to remind my colleagues that pursuant to
committee practice materials for submission for the hearing
record must be submitted to the Committee Clerk within 14 days
following the last day of the hearing, so by close of business
on April 28, 2021, preferably in Microsoft Word format.
The materials submitted must address the subject matter of
the hearing, obviously. Only a Member of the subcommittee or an
invited witness may submit materials for inclusion in the
hearing record. Documents are limited to 50 pages each.
Documents longer than 50 pages will be incorporated into the
record via an internet link that you must provide to the
Committee Clerk within the required timeframe.
Please recognize that in the future that link may no longer
work, so just we'll work with you as best we can, but we wanted
to give you some warning.
Pursuant to House rules and regulations, items for the
record should be submitted to the Clerk electronically by
emailing submissions to [email protected].
Member officers are encouraged to submit materials to the
inbox before the hearing or during the hearing at the time the
Member makes the request. We will furnish that email to anyone
who has trouble getting it.
Again, I want to thank the witnesses. Really terrific
hearing, thanks for your vocation, your commitment to these
issues. It's certainly an exciting time to be in your field
with your expertise, and we intend to take advantage of your
expertise. And I would include all of those, the witnesses.
Mr. Gelfand, I really appreciate your perspective. And
Members of the subcommittee may have additional questions and
we ask witnesses to please respond to those questions in
writing. The hearing record will be held open for 14 days in
order to receive those responses.
I remind my colleagues that pursuant to committee practice,
witness questions for the hearing record must be submitted to
the Majority Committee Staff, or the Committee Clerk within 7
days. The questions submitted must address, again, the subject
matter of the hearing.
I now recognize Mr. Allen for any closing comments that you
have. Go ahead, Rick, if you could unmute.
Mr. Allen. OK we'll try again. Thank you Mr. Chairman. And
I want to thank all the witnesses for their testimony today.
This has opened my eyes a great deal to the complexity of this
issue. I would like to ask unanimous consent to enter in the
record statements from the American Benefits Council and the
H.R. Policy Association.
Chairman DeSaulnier. Without objection.
Mr. Allen. Thank you Mr. Chairman. And to just highlight a
couple things that I think are important, particular with
listening to the discussion today that we need to consider is
according to a 2020 Congressional Budget Office estimate, 151
million Americans received health insurance through employer-
provided plans, which is the largest single source of coverage.
Yet the democrats are seeking to eliminate employer-
sponsored healthcare through their socialist Medicare for all
plan which would force millions of Americans into a one-size-
fits-all government-run system, and cost more than 30 trillion
dollars over the next decade.
A 2018 survey by America's Health Insurance Plan reveals
that 71 percent of Americans are satisfied with their current
employer-provided health coverage. By all metrics, satisfaction
with employer health coverage outpaces public support for the
democrats Medicare for all scheme.
Employers around the country continue to make concerted
efforts to meet the mental and behavioral health needs of
workers through implementation of coordinated care programs,
employee wellness programs, use of telehealth services, and
additional employee assistance programs.
The democrats will ignore this fact and unjustifiably
assume that employers are short-changing their employees. I
encourage Members to talk with companies about this, and find
out exactly what they are doing, so we can get to the root of
the issue.
House republicans want to empower America's job creators to
expand access to quality care and mental health services, for
workers and their families. While the system can be improved,
we also recognize employers are attuned to the needs of their
employees, as I know first-hand.
For 37 years I ran a construction business where we
provided staff benefits. I knew my employee's needs, and what
benefits and services were best suited to meet their needs.
That is why I believe employers play a critical role in
enhancing the system moving forward, which will benefit workers
by ensuring that effective mental and behavioral health
services are offered.
I believe that employers truly know that their employees
are the most important factor in the success of their business,
and they want to take care of them. Again I thank the witnesses
for participating today, and I yield back.
Chairman DeSaulnier. Thank you, Mr. Allen. I look forward
to continuing the conversation, discussion with you. We have
mutual experiences as former employers. You, in the
construction industry, and I admire that, and myself in the
restaurant business, as I have explained many times in this
committee.
One of my big concerns about employer-based wages and
benefits is not that the employers are bad, or inherently bad,
but some of them are. So, I think the discussion is, and I
always--some of my colleagues on the left, sometimes they're
surprised that I actually admire some of the work by Francis
Fukuyama at the Hoover Institute, in particularly his work
about trust, about the most efficient way to deliver services.
Having said that, and government isn't always that
provider, what we want to do, and what I've heard clearly from
everyone's testimony, and I hope we can focus on, is the
importance of these services. Being able to have metrics so we
could measure them both at the clinician level through the
employer relationship, and the health provider relationship.
But most importantly, for Congress and the Department of
Labor, for us to be able to clearly evaluate the quality and
the access for Americans to get these services. Because my own
belief is over the next 30-50 years as all this research
evolves, we're going to learn a lot, and we're going to save a
lot of people's lives, and allow them to be able to live great
lives, even if they've been challenged either genetically, or
through their environment.
So, I'm really excited about this. I really hope, and I
appreciate the testimony and the tone, that for me, I want to
focus on the deliverables of these important resources as we go
through. And I know you do too, Rick, and I'm looking forward
to focusing on that.
We'll have our disagreements, and I respect that, but you
and I share a perspective. In my case we both ran low profit
margin businesses. The restaurant business is historic, so it
was just getting the services that my employees needed, that I
wanted them to get.
And then the challenge of competing against other employers
who weren't doing the things that you and I did and tried to.
And in California we had a big initiative that was bipartisan,
yet at the underground economy, to incentivize employers who
needed those incentives.
So, I agree with you. The hammer is not always the best
tool to reach for in the toolbox. So, I'd love to work with you
to figure out ways to get those, to reward those good
employers. And Mr. Gelfand, I'd be happy to have those further
discussions, but also to be mindful.
Human nature being what is it, that not everyone, whether
they be employers or employees, or providers, always have those
best interests. So, how we do that, I think is really
important. And it would really be wonderful I think for this
country to know that this little subcommittee really focused on
those things and accepted the fact that we're going to have
some disagreements.
But the delivery of these services are so important, and
we're losing. We've lost 87,000 Americans to overdoses in this
country. When you look at diseases of despair, Deaths of
Despair, a wonderful, but sad book, a recent book on this
subject matter.
And there really is an emergency. We're losing too many
people every day. For me this is personal. As I've mentioned,
on April 20, it will be the 32d anniversary of when I found out
that my father took his life. He had had chronic problems with
substance abuse, and depression.
He was actually the first behavioral health substance abuse
counselor. He went back to college, got a master's degree at
Rutgers, so he could give substance abuse counseling to the New
England Patriot's players and staff.
He was terminated after a couple of years because they got
a new coach who said in Sports Illustrated--editorialized
against this. The next coach said, ``These are professional
athletes. They don't have substance abuse problems.''
So, we can look back on that comment and that culture, and
say that clearly isn't true either for them, or for the general
public. So, as I reflect on my dad's experience and having lost
him, and the years I've spent dealing with that, but also
discovering the things that we could do, and the wonderful work
you all do, but particularly Ms. Moutier and a bill that we've
worked with your group on that we helped provide for services
that will help with suicide.
But there's so much to be gained, and I think back on my
dad, and think, you know if we knew then what we know now, and
got him the services he wouldn't have done what he did, and he
would have lived a full contributing life where he could help
other people who dealt with depression and substance abuse.
So, I'm not depressed by that. I am encouraged by how far
we've come. But I do feel the urgency, and we're going to work
on this in this committee.
And last, just an observation. The jurisdiction of this
committee and the relationship of employer-employee benefits of
course came up historically during out of the Depression. And
to some degree it is the jurisdiction of this committee, we'll
focus on that.
But be mindful that although this is a key component,
there's so many other areas, and I think of a field hearing
that then Chairman Foxx had in the Bay Area about 5 or 6 years
ago when we dealt with the gig economy, and how we get benefits
to people who don't have traditional employer-employee
relationships.
So, I'll conclude there and just say again how encouraged I
am, and, Mr. Allen, I hope you share this, the tone, the tenor
of this conversation and all of our witnesses. And I want to
thank the staff again, and look forward to really delivering
for the United States on a bipartisan level to get these
services to people out there in the community, so there will be
less suffering tomorrow, next month, and years to come by
people because we delivered these services to the American
people.
Thank you so much. We are now adjourned.
[Additional submission by Chairman DeSaulnier follow:]
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[Additional submission by Mr. Allen follow:]
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[Additional submission by Mr. Courtney follow:]
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[Additional submission by Mr Walberg follow:]
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[Questions submitted for the record and the responses by
Ms. Bendat follow:]
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[Questions submitted for the record and the responses by
Mr. Gelfand follow:]
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[Questions submitted for the record and the responses by
Dr. Moutier follow:]
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[Whereupon, at 12:30 p.m., the subcommittee was adjourned.]
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