Congress Hears Impassioned Testimony On Substance Abuse

Sen. Dale Bumpers, D-Ark., called it the most compelling testimony he'd
heard during 24 years in the Senate.

What he heard Tuesday was Apollo 11 astronaut Buzz Aldrin declare that it
was easier to walk on the moon than it was to get a grip on alcoholism.
Actress Mackenzie Phillips told about the drunkenness that got her fired
from job after job. Television journalist Bill Moyers and his son William
Cope Moyers of the Minnesota-based Hazelden Foundation talked about the
family anguish in William's battle against addiction to drugs and alcohol.

The hearing in Washington, D.C., before the Senate Appropriations
Subcommittee on Labor, Health and Human Services and Education was part of
the buildup for legislation proposed by two members of the Minnesota
delegation: Sen. Paul Wellstone, a Democrat, and Rep. Jim Ramstad, a
Republican. It also served as an advancer on the five-part PBS series,
"Moyers on Addiction: Close to Home," which premières March 29.

The legislation would require group medical plans that cover substance
abuse to provide the same levels of coverage for that problem as for most
other illnesses. The bill has 39 cosponsors, including Minnesota Democratic
Reps. Bill Luther, David Minge and Bruce Vento.

The bill would prohibit group health plans from imposing annual or lifetime
limits, copayments, deductibles or visit limits for substance abuse
rehabilitation unless similar requirements exist for other medical
benefits. Businesses with fewer than 51 employees would be exempt, as would
employers whose premiums jumped by more than 1 percent as a result of the
coverage.

The witness list for the hearing did not include health insurers, and the
testimony supported the legislation. But many of the recovering addicts
testified to how complicated the issue can be. "What is the mystery behind
why some people can stay with recovery and some people have to fall back
again and again and again?" musician Shawn Colvin asked during her testimony.

Some insurance companies are worried that the proposal will drive up health
costs.

"We support what they're trying to do in terms of helping alcoholics and
drug addicts get the help they need," said Tom Lehman, lobbyist for Blue
Cross and Blue Shield of Minnesota. But, he said in an interview, "We're
forced to make some tradeoffs. The tradeoff is more benefits for fewer
people. And is that a tradeoff that we think is a good [one]? We would say
no at Blue Cross."

Lehman said Minnesota's experience proves that point. "We have more benefit
mandates on the books in Minnesota than any state other than Maryland," he
said. And they have driven up the cost so much, he said, that most
companies have switched to self-insured plans, which are exempt from state
mandates.

"The lesson from the Minnesota experience is as you add on benefits and you
add on mandates, it drives up costs," he said.

In Minnesota, a two-year-old state law already requires health plans to
treat chemical dependency like any other medical problem.

But there are some loopholes: Health plans still have the power to approve
or deny treatment on the basis of what they consider "medical necessity."
And the state law applies only to people in state-regulated health plans,
which leaves out the more than a million Minnesotans covered by
self-insured plans.

The bill before Congress follows legislation enacted in 1996 to create
limited parity for mental health coverage. Effective this past January,
insurers must provide the same annual and lifetime spending limits for
mental health care as for other medical problems.

A federal report released Tuesday estimates that the combined cost of
creating full parity for mental health and substance abuse coverage would
increase health insurance premiums by 3.6 percent on average. Mental health
care would account for most of the increase, according to the report by the
Substance Abuse and Mental Health Services Administration, part of the
Department of Health and Human Services. Substance abuse alone would bump
up the premiums by an average of 0.2 percent, it said.

Minnesota was one of five states chosen for case studies in the report.
Premiums in the state increased only slightly as a result of the 1995 state
law, the report said.

Wellstone and Ramstad argue that society pays one way or another for
addiction and that the costs of treatment are a bargain compared with the
costs of letting the problems go untreated. Ramstad cited studies saying
that alcohol or drugs contribute to 80 percent of all crimes and that the
side effects of addiction -- from loss of productivity at work to health
care for related problems -- far outstrip the premium increases projected
in studies.

Wellstone added the untold cost from "the negative effects drug and alcohol
abuse can have on the lives of our families and loved ones."

Several of the witnesses added yet another measure: their lives. Aldrin
said he doubted he would be alive if not for his recovery in the 1970s.
Said Moyers, "There's no question in my mind that I would be stone dead
today."