Congressman Pushes Mental Health Equity

Congressman Jim Ramstad, republican from Minnestota, explains why he is sponsoring a bill to increase access to mental health care.

MICHEL MARTIN, host:

For many Americans, mental illness is a life and death matter. Depression, addiction, eating disorders often prove as fatal as physical illnesses like cancer. Yet millions of citizens find they can't get the same level of insurance coverage for mental health treatment as for other ailments. Several members of Congress have worked for years to close that gap. One of them is Minnesota Congressman Jim Ramstad. He's the chief Republican sponsor of the Paul Wellstone Mental Health and Addiction Equity Act in the House of Representatives. It's a companion to the Senate bill that's already passed, and sponsors hope the bill will finally, after more than 10 years of effort, become law.

Congressman Jim Ramstad joins us now. Thank you so much for speaking with us.

Representative JIM RAMSTAD (Republican, Minnesota): Good to be with you, Michel.

MARTIN: How did you get interested in this topic?

Representative RAMSTAD: Well first of all, I'm a grateful recovering alcoholic. I'm alive and sober today only because of the access I had to treatment following my last alcoholic blackout on July 31st, 1981 when I awakened in a jail cell in Sioux Falls, South Dakota. And in 1996, Paul Wellstone, who authored the original parody bill, got me involved on the House side, and I worked with Paul almost every day on this legislation prior to his tragic and unfortunate death.

MARTIN: Why was he so committed to this - to this issue?

Representative RAMSTAD: Because Paul had a family member who suffered from mental illness. I think, you know, when you think of 54 million Americans suffering the ravages of mental illness and 22 million suffering from chemical addiction, there aren't too many families who aren't touched in some way, either directly or indirectly, by these diseases of the brain. And that's exactly what they are. And for too long, we've let insurance companies discriminate vis-a-vie physical diseases or diseases of the body.

MARTIN: Do you think that many Americans still have trouble accepting the idea that these are diseases, addiction particularly?

Representative RAMSTAD: Despite the fact that the American Medical Association, Michel, in 1956 classified addiction as a disease, I think the answer to your question is yes. There still is a stigma attached, certainly in many parts of the country. But I think with more education, with more courageous public figures like Betty Ford, like Patrick Kennedy, and some of the popular singers going public with their addiction, it humanizes addiction. And people learn more about it and if you learn more about addiction, you'll know it's a disease, like other diseases.

MARTIN: But you have to be counted among them, too. I remember that you actually spoke about this on the House floor. And I think that it was very moving, and I think it was also perhaps a surprise to some people that you were able to be so open about it. I wanted to ask if you were ever tempted to not talk about this because there are people who just don't buy it. I think it's an issue of character.

Representative RAMSTAD: And I understand that, but it's anything but a moral failing. It is a fatal disease if not treated. Actually, I was a young state Senator, just having finished my first year in office, when I was literally brought to my knees in that jail cell after my last alcoholic episode and charged with several misdemeanor offences.

But for that incident, but for taking my first step and realizing my powerlessness over alcohol, and the fact my life had become unmanageable, and but for the press exposing my situation, I probably wouldn't have gone public, Michel. I probably would have tried to hide it.

MARTIN: But as you point out, the medical profession has been of one mind on the question of mental illnesses being a disease for half a century. You've been working, and other advocates have been trying to get some sort of parody in health care coverage for mental illness for more than a decade. And it's still not quite there yet. You're working on it. You're close. Why do you think it's taken so long?

Representative RAMSTAD: You know, I used to ask this question of Paul Wellstone, and he'd call me, you know, late at night usually. And how many co-sponsors did you get in the House today? He'd ask. And I'd say, only one. And I'd sound like, dejected, and Paul would say many, many times to me, listen, cheer up! We're going to do better tomorrow. Just remember, it took 40 years in this country to pass the Civil Rights Act of 1964. 40 Years from the time that was first conceived. And we're going to get this done before 40 years lapse.

And believe me, if Patrick Kennedy and I have anything to say about it, we're going to get it done this year.

MARTIN: What do you think the scope of the problem is, of people who are not able to get access to the kind of treatment that was so important to you because of this lack of parody?

Representative RAMSTAD: Well, most health plans discriminate against mental health and addiction treatment with higher deductibles and co-payments and also limited treatment stays. Right now, the average treatment stay allowed for chemical addiction is seven days. Ask any professional in the field of chemical dependency treatment, and he or she will tell you that nobody can get on the road to recovery from heroin addiction, or methamphetamine addiction, or alcoholism in seven days.

So what this legislation does is say no more inflated deductibles or co-payments that don't apply to physical diseases. It says no more limited treatment stays that don't apply to physical diseases. In other words, no more discrimination against people with mental illness or chemical addiction. We just want a level playing field.

MARTIN: Well, they do stay, though - I mean there are limitations on the treatment that people can get for some physical diseases. Like just for pregnancy, for example, which is not a disease but a disability. I mean hospitals have really cracked down on the amount of time, or insurers, I think it has to be said, on the amount of time people can stay and recover in the hospital. They say this is just necessary because of cost. What do you say?

Representative RAMSTAD: Well, this legislation, as every - as all the empirical data show is cost effective. We have every actuarial study that's been done, and every study shows that equity for mental health and addiction treatment will save, literally, billions of dollars each year. At the same time, it will not raise premiums more than two tenths of one percent. That's according to the Congressional Budget Office study.

In other words, Michel, for less than the price of a cup of cheap coffee per month, several million people on health plans could receive treatment for chemical addiction and mental illness.

MARTIN: I understand, Congressman, but there are those who would argue that, first of all, that the most pressing issue, health issue, in this country today is the lack of insurance for millions of people who don't have any insurance at all for physical ailments. And the opponents then argue that this is actually going to make this problem worse because insurers having to cover a variety of other ailments in a more expansive way than they had previously are going to be even less inclined to extend coverage.

Representative RAMSTAD: First of all, let me…

MARTIN: How do you address that question?

Representative RAMSTAD: Well, you make a very good point. We're talking in this legislation only about addicts, alcoholics, people who are mentally ill, who are in health plans, who have health insurance. This is a first aspect of dealing with America's number one public health crisis, and that's what I think all the evidence shows. We've got to deal with Medicare parody. Pete Stark on the Ways and Means Committee, my good friend from California, has legislation that's moving forward to establish parody for Medicare seniors.

You look at the demographics in this country - we all know about the aging population with the baby-boomers, and the incidents of alcoholism among people over 65 is, there's a direct correlation between an increase in age and an increase in alcoholism, and we're not treating that. We're also not spending enough for Medicaid, for people who qualify for Medicaid.

You know, it's ironic, Richard Nixon was the first president to declare war on drugs. And even though I don't like that metaphor, at least he had the foresight to direct 60 percent of the funding, of the federal funding, to the demand side, to treatment, prevention, and education. You know what that is right now?

It's down to 30 percent. And 70 percent is spent on the supply side, interdiction efforts that don't work. Crop eradication efforts that are fruitless, and so forth. But after Medicaid, we've also got to deal with treating our veterans. One out of three, or one out of four veterans, coming back from Iraq is suffering from Post Traumatic Stress Disorder, PTSD. And then the uninsured, the 47 million uninsured. We've got to deal with them. We've got to cover everybody. I think we should make, as former Governor of Massachusetts did…

MARTIN: Mitt Romney.

Representative RAMSTAD: Mitt Romney, how soon we forget, Michel. As Mitt Romney did in Massachusetts, make health insurance mandatory. And for the working poor, we need to provide refundable tax credits or vouchers. And then, that must be used to buy basic coverage, basic health insurance, which would be cheaper for all of us.

MARTIN: I do feel I have to ask that a president of your party has been in office for almost eight years now, is coming up on the end of his second term, Republicans controlled the Congress for a good bit of the time that he served in office. Why didn't you get these things done then? I'm just wondering if you ever had this conversation with him, or with the leadership of your party, and why do you think you couldn't get it done then?

Representative RAMSTAD: You bet I have. In fact, this idea, this proposal, this bill was first introduced by the first President Bush. It came from the Heritage, it's a Heritage proposal. And then the current President Bush dusted it off, and he also has a bill up there to do just what I explained, to provide coverage for the uninsured through refundable tax credits. Unfortunately, it's the best-kept secret in Washington.

Can you imagine if this President Bush, President George W. Bush, had spent one fifth as much time talking about expanding health care coverage to the uninsured as he did social security, maybe we'd have this passed by now. Unfortunately, the administration ignored it. And yes, I have had those conversations with many members of the administration and staff over at the White House as well.

MARTIN: So Congressman, you're trying to make a decision about whether you stay or go. You're considering retiring because you had, I think, you had said to the constituents that you were only going to serve a certain number of terms. So I certainly want to thank you for your service, whatever your decision is. When you look back over your time in Congress and getting so close on an issue like this, not quite there yet, how do you think about the time that you spent? Do you think it was well spent? Are you going to feel that you achieved what you set out to do? If this isn't done by the time you decide to go, if you do decide to retire…

Representative RAMSTAD: Well, I plan on seeing this signed into law by the time I leave. I'm going to be in Congress until December 31st of this year, and I fully expect mental health parody to become the law of the land by that time.

MARTIN: Do you think that when you were sitting on the floor of that jail cell so long ago, that you would have envisioned this day?

Representative RAMSTAD: Certainly not. At that point in time, when I was at rock bottom, when I reached my bottom as an active alcoholic, I wanted to be dead. I thought it was for sure the end of my career. I just assumed that. I mean, who was going to vote for a drunk? And instead, Michel, it was just the beginning. Once I got into treatment, and I got into the program of recovery, I realized it was just the beginning of a new way of life - a life based on honesty, a life based on a fellowship with the most wonderful people in the world.

Going to meetings with people every week, and getting to know people from all walks of life with the same disease. It's just been the greatest experience in the world. Of course, I thought anything but that at the time I was in jail, back when I started on the road to recovery.

MARTIN: Congressman Jim Ramstad, Republican of Minnesota. He's joining us from the studios of Minnesota Public Radio in St. Paul. Thank you so much for speaking with us.

Representative RAMSTAD: Thank you, Michel.

MARTIN: And that's our program for today. I'm Michel Martin, and this is Tell Me More from NPR News. Let's talk more tomorrow.

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