Bill Targets Medicare’s Discriminatory Copayment

APA is applauding new legislation that would end the Medicare program’s long-standing discriminatory 50 percent copayment requirement for outpatient mental health services.

The Medicare Mental Health Copayment Equity Act of 2003, introduced April 10 by Sens. Olympia Snowe (R-Maine) and John Kerry (D-Mass.), would require Medicare patients being treated for mental illness to pay the same 20 percent copayment charged for all other medical treatment, instead of the 50 percent copayment now required by law.

To address budget concerns, the legislation would phase in the reduced copayment over six years.

“This legislation helps fulfill APA’s historic efforts to end Medicare’s discriminatory outpatient coverage of treatment for mental illness,” said APA President Paul Appelbaum, M.D. “It gets us where we need to go in a way that is fully responsive to the needs of Medicare beneficiaries while being fiscally responsible, given Medicare’s budget picture. It’s a creative approach to problem solving that amply warrants our thanks and strong support.

“The current Medicare system imposes a policy of discrimination by diagnosis that inflicts a heavy toll on Medicare patients who, by no fault of their own, happen to suffer from mental illness,” Appelbaum continued. “This is a shameful policy to have written into federal law. This legislation would end this statutory discrimination by requiring that Medicare patients pay only the same 20 percent copayment for mental illness treatment that they pay when seeking any other medical treatment, including, for example, treatment for diabetes, cancer, heart disease, or the common cold.”

According to a report from the U.S. surgeon general, up to 20 percent of older adults in the U.S. and nearly 40 percent of older adults in primary care settings experience symptoms of depression. Substantial numbers of disabled individuals also qualify for Medicare by virtue of their long-term disability. Of those, the National Alliance for the Mentally Ill reports that some 400,000 disabled Medicare beneficiaries who are not elderly become eligible by virtue of mental disorders. These are typically individuals with severe and persistent mental illnesses, such as schizophrenia.

“Medicare’s intrinsic discrimination adversely affects the elderly and disabled by increasing their cost of care and creating major financial disincentives for them to seek care when needed,” said Appelbaum. “All we are asking is that Medicare treat patients with mental illness just like any other patients. APA commends Sens. Snowe and Kerry for their tireless dedication to ending discrimination against persons struggling with mental illness. We pledge to work with them and all members of Congress to see that this landmark bill becomes our national law.” ▪