I'm always I fear with my tweets sometimes because sometimes will be an event that we step in you know it's just user that's not Katie but your sceptile they're not doing so yeah but she's not okay good morning everyone and welcome to the California State Capitol I'm Scott Weiner the honor of representing San Francisco and northern San Mateo County in the California State Senate and I'm joined here today by a coalition members and advocacy organizations to announce a major mental health and substance use bill package to expand access to mental health care and for people who have substance use disorder we have a huge huge challenge in California not just with our homeless population but with everyone and we need better access and this these bills in combination will move us in that direction without further ado I want to ask congressman Kennedy to come up he is I've just been an extraordinary leader on mental health issues of every variety he's been very brave and talking about his own experience and in 2008 he was the lead author of the groundbreaking mental health parity and addiction Equity Act of 2008 so someone who's a real hero in the fight for expanded access congressman Kennedy appreciate your leadership on this and today I'm so grateful for your leadership in helping us work to implement the federal law had the honor of co-sponsoring when I was in Congress over ten years ago which has yet to be fully implemented because frankly there aren't the political constituencies out there given the shame and stigma towards mental health and addiction that will come forward like they would if it were any other health care issue and demand that these issues no longer be discriminated against that the people who are suffering from these illnesses no longer be treated as pariahs in our medical system and no longer are marginalized in the way insurance coverage is provided for them such that they have such difficulty accessing care that if it were any other form of care they wouldn't have the same barriers in front of them in terms of accessing so this is a medical civil rights bill because what it's saying is no longer can people with mental illnesses and addictions be treated in a separate and unequal manner and that as far as California law is concerned we fix these huge loopholes where tens of thousands and millions of Californians fall through those loopholes and are not covered and are not protected under state law and in addition to that we need to hold the payers accountable just to suggest one additional way of holding payers accountable last year as you know the united healthcare was had a huge judgment against them here in Northern California otherwise known as the width decision where United was found to substitute their own medical management criteria for that that was generally accepted medical criteria in other words United had decided that they would cook it up in their own back room forgetting whatever American Society for addiction medicine said forgetting whatever the lead Medical Society said American Psychiatric Association other professionals who understand the medicine and the treatment and the evidence base no no United decided to do it on their own because it served their financial interests and they gotten away with it for too long and frankly all insurers have gotten away with it and we have a public health crisis of our time that is unparalleled and overdoses and suicides are taking over twice the number of Americans then were claimed during the height of the hiv/aids crisis and yet we're spending less than one-fifth the amount of money to tackle this crisis that we spend spent tackling the hiv/aids crisis even though we're losing twice as many people so there are all kinds of ways where the government has failed to step up for these vulnerable populations of those who through no fault of their own have to have ended up ill because of a genetic predisposition just like they would if it were cancer or heart disease but unfortunately these people who are stricken with these conditions are blamed for their own illnesses as if my mother who suffers from alcoholism up every day and decided what am I gonna do to bring shame on myself and my family like anyone else who has one of these illnesses like they go out there and say how can I jeopardize my safe housing what can I do to lose my job and the affection of my friends and family no one chooses that voluntarily and we need a cultural shift in the way we look at this and just like the civil rights movement it happens through laws because the laws create new norms so we have an eradicated racism but we've ended discrimination because we said in the law in the Civil Rights Act of 64 that to practice discrimination is illegal well that's the case with mental illness and addiction when it comes to the parity law we have said it's illegal to discriminate and yet payers still discriminating I want to say it's all payers have been found liable you look at New York Attorney General's case several payers were stung pretty hard there you look at what Pennsylvania Insurance Commissioner has done and in Rhode Island when we had this case of United we said maybe we want to ask United was the biggest insurer in Rhode Island it had the state workers contract so after the wid decision we decided to say maybe insurance a commissioner ought to investigate whether they're employing the same medical management practices in Rhode Island as they were applying out in California and you know what the United did is they got the Speaker of the House in Rhode Island to eliminate the investigative arm of the insurance department within Rhode Island and you know what ended up happening that spurred the state legislature to say enough is enough and United lost their contract the most lucrative contract in the state of Rhode Island all I would say is penalizing insurers with a couple hundred thousand dollars here and there's not going to change things barring them from being able to sell insurance in your state is going to get their attention and that might be one of the things that you add to your list of ways to hold payers accountable now for the benefit of the payers now they have had a struggling time trying to get enough providers because frankly no one's paid for providers for years and so we have to have a partnership because our interests are frankly aligned with payers in getting more providers and making sure that those providers practice the evidence-based treatment which is often not expected because unfortunately we've never applied the same expectations for quality outcomes for mental health and addiction that we've applied to other illnesses so there's a lot to be done and I know we also have companion legislation to end pre-authorization for medical assisted treatment and frankly the evidence form of treatment for addiction m82 pre-authorize that it is an absolute outrage it is the evidence-based form of treatment that saves lives it curbs the obsession the compulsion by having an opioid and yet it also provides the antagonist and I can speak to that because I myself was treated with m84 an opioid addiction so we cannot have people denied that treatment because what we're consigning them to is death because if they don't get that treatment many of them are going to fall victim to their addiction and use and with the power of the kinds of opioids that are out there on the street today it's a matter of time before they take their life so this is a life-and-death issue and I want to thank all of the legislators for doing what they can to address this issue and I want to thank particularly a former legislator Darrell Steinberg I have been so honored to work with a real hero nay why because when we look at what happened in California with proposition 63 and the new money that that provided for people with mental illness it was a game changer because the thing that really has been missing in this field is enough resources to begin to bring the care to people who need it and prop 63 really began to change all of that and Senator Steinberg you're a hero to the whole mental health community for what you've done and I'm happy that I'm here with you and all of your colleagues to continue the fight thank you and I now I get to introduce the guy that always continues the fight Jim Bell and he as Senator Bell has been a real champion for us he's been a champion and the committee which marks up all these bills he's a champion because he gets these bills written and out on the floor and he's a champion because he never gives up and we love him for it senator Bell Thank You congressman Kennedy I wanna I want to thank everybody here today we do this thing as a collaborative with all the legislators we have assembly members senators Republicans Democrats conservatives liberals we all agree weld agree that we need to do something and we need to do something now this is important and it's a exercise that's going to it's one of the few areas with all the tension of the election year you're probably going to see a great effort to have a bipartisan supported package of legislation so I'm really pleased about that and I thank all our co-authors for signing up and helping us you know you know I've been fighting for mental health parity and quality care since I was a member of the Santa Clara County Board of Supervisors and I introduced my first mental health parity bill in 20 2007 so that was the first one and we we have to have laws in California that implement the federal law on parody so we need to have legislation here that implements all those federal landmark legislations that that Patrick Kennedy and the others instilled but it's an empty promise really if we're not treating people with a sense of urgency and care people when they actually need the care they can't wait they can't go through prior authorization have to go have somebody approve the care that's that's nonsensical if you're bleeding you have to be patched up right then and there if you have a mental health crisis you have to be dealt with right then in there it's common-sense medicine so we have a system that's not doing that because of stigma and discrimination and it is a civil rights issue a system where a person has to jump through all these hoops to get help and and and right now central to our mental health crisis is we have it as we we know an addiction crisis we have an addiction crisis all over it's even in this building we have people here in the building that have addiction problems and substance abuse disorders are common to reoccur in they're often serious but they can be treated and managed and that's why we have introduced in my bill SB 8 five four we just got the number today and this is focused on life-saving medical medication assisted treatment or Matt the clot Matt it's it's in honor of all those of us that lost friends and relatives and loved ones that lost their lives due to addiction and it doesn't have to be that way the Matt will is to use FA fda-approved medications combined with counseling behavioral therapies to treat substance abuse disorders and Matt works it's one of the most effective ways to treat addiction so effective that our state has now had developed the public relations campaigns about about Matt but it doesn't it doesn't work if doctors prescribe it and the patients can't get it or they can't get it fast enough last year our Attorney General issued a statement he said nearly 90% of patients in need of addiction treatment do not have access to it California 90% don't have access when they need it and somebody who needs treatment even if they're willing to try is going to run into all these problems and one of the problems is they they have their insurance they put like things like the step therapy or fail first therapy processes you have to try this group therapy program first you have to fail before you get the medication even though your doctor says you need the medication we think that we're talking about death when that occurs a lot of people died this is unacceptable from a moral standpoint from a medical standpoint and when a person is struggling with addiction is willing to work with their doctor to get better we need to jump at the chance just think about it if they're willing to help themselves and work with their doctor don't we want to make that happen isn't that just the magic moment that we need to support rather than say well we got to check with your insurance company before you get this medication so there's something wrong with that and we're going to fix it with SB 854 it requires commercial insurance companies to provide Matt for substance abuse disorder without prior authorization or step therapy somebody with a mental illness or addiction should not have to fight for care we need to fight for them and you know how hard it is for somebody with addiction to actually admit they need help and actually go in and and and talk about actually getting the therapy and solving their problems with their doctor it's so difficult to get them to even do that well I put other barriers in front of them so it will make a difference and I'd like to have senator Weiner now present his part of our package in senator thank you for doing this and great programs are stepping up as a champion of getting involved in this as he has for many years actually and supporting mental health parity so senator I turned it over to you I'm glad we're working together on this with the others and thank you for your work I'll turn it over to Senator Scott Wayne thank you Thank You senator Bell I just want to really publicly thank Jim Bell for not just his leadership but his absolute I would call it ferocious tenacity if that's a if that's a phrase around mental health issues I've been in the legislature three years now and although mental health is a priority for a lot of members of the legislature no one has stepped up in the way the Jim Bell has and he as he has done for many many met this is sort of a and in many ways the work of his of his life and he has left an a huge mark on California law and I know that Senator before the end of this year before the end of the term that we will get this done and your your your work will be realized so thank you senator for your work I also want to thank our co-authors this is going to be a team effort and I know we'll be broadly bipartisan Assemblymember Associate Broker you hear from next senator Steve Glazer senator Jerry Hill Assemblymember Buffy wicks and mainshine as well as Assemblymember David Chiu so thank you – and I want to acknowledge our assembly Minority Leader Murray Waldron for being here today and for joining us someone who also fights very hard for healthcare access so today I am or let me rephrase that today I introduced Senate bill 85 and Senate bill 855 will require the health insurance industry to cover all medically necessary mental health care and addiction care not just crisis care not just emergency room care not just care that someone needs after they are in crisis but mental health care and addiction care that people need in order to stay healthy in order to avoid going to the emergency room in order to avoid being hospitalized in order to avoid becoming homeless now I have the honor of representing the greatest city on earth San Francisco in the California State Senate there are a lot of great cities but San Francisco is at the top and they can disagree but we mental health and addiction are huge challenges around California and around the country but in San Francisco it plays out in a very visible way and we see it on our streets with people who are in such dire straits with severe mental health and addiction challenges people who have become homeless as a result people who are spiraling towards death and it is a tragedy that unfolds on our streets every single day but it's not just our homeless population we know that so many people who are housed who have jobs who appear from the outside to be doing just fine but they're not doing just fine and they are suffering often in silence with mental health and addiction challenges and we are not doing enough for any of these residents of the state of California and it is not acceptable for the insurance industry to substitute its own medical judgment and to say we know that your doctor says that it is medically necessary for you to receive this care while you're working while your house while you are able to hold it together we're gonna make you wait until you have spiraled down to the point where you are at the emergency room where you have lost your job where you are heading towards homeless or already homeless we're gonna make you wait until you're in the deepest of crises and then we will authorize care that is not how we should be delivering health care in this country that is not how we should be treating residents of our community and so SB 855 will put an end to that nonsense and will require the health insurance industry to cover all medically necessary mental health and addiction care pursuant to the judgment of a physician or other health care professional and we're gonna fight very very hard to get this important legislation passed so it's now my honor to bring up our partner in both pieces of legislation and the assembly assembly members to say ugh we are curry good morning everyone and thank you very much and I want to thank congressman Kennedy for being here as well as my colleagues and Mayor Steinberg for moving this forward you know when I was elected the assembly three years ago I came to Capitol knowing we must address mental our mental crisis in California I stand here today for another reason as well last week I had to watch a really good friends they goodbye to their son they committed suicide and it breaks my heart so I'm going to be working really hard not that I wouldn't before on this issue you know as as legislators we look at health care delivery system all the time and we talk about the barriers to accessing and paying for physical health services I don't have to tell all of you here today how incredibly challenging it is to access mental health and health care even that even when that care is medically necessary and critically important to a person's well-being we have taken some important steps in recent years but California is not where it needs to be every person should have access to care and coverage for all mental health conditions and substance use of disorders I am proud to be a part of this bill package and I will bring this forward to the assembly along with the incredible leaders that are standing behind me we will ensure real parity measures that actually increase treatment I want to thank you all for your support we have a big fight ahead of us we need your help and I'm honored to be with my senators that are bringing this bill package forward and it will chain it would change lives that's what we need to do and now I'd like to introduce my good friend my colleague and visionary leader on providing mental health in California Sacramento mayor Darrell Steinberg thank you very much remember a real are thank you for taking on the mantle thank you to brave senators Weiner and Bell for once again putting yourselves out there on what is hard not easy but should be easy I'm grateful to you and to Patrick Kennedy oh my god what what an incredible I'm just glad I didn't have to go right after you that's all I can say yeah because what an incredibly passionate case for not only these two bills but for but for civil rights and for broader parody not only in our state in in our country I'm honored have the privilege to partner with you good sir I want also acknowledge Tom Insel who's in the audience here who is the governor's lead on mental health and of course the former director of the National Institutes of mental health and we're so lucky to have him in California helping lead the way as well Tom welcome to you so I don't know whether I want to do is passion speech or explain speech but I'm gonna I want to try to step back for just a moment here and put these two vital bills into context there are many undisputed facts about the mental health system but to stand out from me number one we have what we call a stage three and four system a mental health care in California and in this country analogous to cancer it may be an overstatement but not much you don't get help until you've suffered the worst of consequences and we need to build a stage one or two system where people get the help they need before they get really sick and secondly we have an undeniably fragmented mental health system people call it a broken system I call it a fragmented system we arguably have five separate systems in this state you've got a jail mental health system you've got realignment which largely funds forensic patience you have got the Mental Health Services Act generating 2.

4 billion dollars a year and spread like peanut butter across a lot of very important causes you have medical managed care and you've got commercial pay and while a lot of focus rightfully has been on the Mental Health Services Act and how it can be more focused and outcome based the truth of the matter is the debate that really needs to be had in California is about parity and it is not just parity can sometimes be seen in too narrow a fashion it's not whether the an individual deserves 6 mental health visits compared to 6 physical therapy visits that's not parity or at least it's only a very small part of parity it's whether or not these providers these for-profit providers are going to actually cover the kinds of innovation and benefits that are going to ensure that we are actually bringing more resources to the pot to serve more people and to free up some of these public dollars to be able to focus for example on unsheltered homelessness that's what's at stake here not just for the people suffering of course that's what's first you don't get the the desperate help that they need from but from a systems perspective the only way we fix the mental health system is is if we have as much focus on parity in the broadest sense of the word as we do on how to improve the public part of the system so I wanted to add my voice not only an obvious strong support of these vital bills but for the broadest abroad parity debate to be had in this state as part of ending the fragmentation and fixing the mental health system in California thank you I thank you so that concludes the press conference we're happy to answer any questions here or on the side and I again want to thank our entire coalition so thank you she referred to the governor's budget and the fact that he has parity in he talked about parity enforcement basically we need parity enforcement and we need to have that in the budget we did get some money in previously for parity enforcement it was tough to get that money in the first place and but it was put in now the governor says we ought to beef up that we completely agree with them however what we need is we don't need somebody to have to complain go through the process of following up on a complaint to complain about not getting adequate treatment we that that's too late too little too late it's good to have peri enforcement but we need to have a stiffer tougher approach on insurance insurance like our two bills do which is to deal with it upfront saying you can't require prior authorization you have to offer mental health services completely and fully and if we have a law that was is with that plus the parity enforcement I think that would make a good system it's kind of funny that quite frankly the medical system is turning into a much stronger mental health program than private insurances you want to be honest about it that's probably the case I think medical medical has is developing into a stronger system it's it's already agreed to full parity we need more staff we need more services we got our we got to cut the wait times but we don't need somebody telling you we don't go in and tell you you have to have a step therapy when you really need your medical assisted treatment okay so parity parity is a complicated thing about enforcement's requiring like like congressman said the licensing of the people in California to do health care and we need to have these laws changed so they can't hold up or delay treatment and I think I think those are the things we need it's a package approach we need that you know last year we passed a bill because President Trump did away with the individual mandate we did away with the they did away with that in terms of the health care law in the United States so what we did is we passed our individual mandate so we essentially gave the insurance company an individual mandate everybody in California has to have insurance so I think it's very natural and important that we follow it up with these tougher parity laws to make sure when they have everybody have to have health care insurance that everybody gets the right health care for mental health and all the other services they need for their families and loved ones know you went yeah I was just say we were all very happy to hear the governor you know emphasizing you for parity and we view the governor as an ally on these issues and we will be working very very closely with the governor on this legislation but although the governor certainly has a lot of latitude around enforcement and so forth which is very important the governor cannot by executive order mandate insurance coverage that requires legislation and so that's why we need to work hand and go up with the governor I mean yeah I don't want to speak for the governor we the governor's aware of what we're doing and it's very early just to introduce the bills today so it'll be a process in terms of working with you would think given this public health crisis that you'd get real political leadership and I travel the country and I can tell you we're very fortunate that Gavin Newsom is a leader in this and that he's taken this on and that he is wanting to lead his administration forward on this and I don't think it's a question of regs versus statutes we need everything we can get in this fight and I'm confident that you'll also see that we can't just depend on him we need to be able to know that come the day when Gavin Newsom is no longer governor that these protections continue and are not solely reliant on having a great governor in that office in order to push them forward and by the way let me just say on the this is corporate welfare its corporate welfare when insurance companies push all of their mental health patients on to the public system and at some point counties and the state have to take a look at the fact that how come these insurers have profits and they're subsidizing those profits by taking the costs of people they're obligated to take care of and pushing them off on the taxpayer so one of the things that I'm getting from more of my Republican friends in both the national level as you've seen here on the state level is that this is a an issue of fiscal responsibility and taxpayer protection who would imagine you'd have a bunch of liberal legislators up here talking about protecting the taxpayer but the reality is we do that to gyms right we do it all we do it all that's that we're all about but I wanted to make that note because it really is unfair that the California taxpayers subsidizing the care which is really as a result of payers not adherent to the parody law and and taking responsibility for covering folks who need it yes yes well anyone who's authorized to diagnose and treat and that would would have that ability well that's the argument every time we tell every time we tell the insurance industry you need to cover this but the reality is that the crisis care is so much is dramatically more expensive than actually engaging in early intervention and preventive care you know when we're saying you have to go to the ER and be hospitalized to get treatment and be and you know that that's very expensive and we also know that when someone suffers a break when someone actually goes into crisis it is much harder and more expensive to treat them whether or not they're in the hospital than it is if you can intervene early and say this person has an issue and let's treat it and prevent it from becoming a crisis not cover Cancer Care that's really expensive the insurance industry wants to say let's not cover this because it's too expensive well let's start going down the list of things that are very expensive on the physical health side and start making questions as to how much we want to cover those it would be outrageous if someone said we're not going to cover cancer care these are the illnesses that are greater and burden of illness than cancer diabetes and heart disease combined and we are asking about whether we're going to invest in taking care of the most biggest public health crisis of our time if this were war we'd have the equivalent of two Viet Nam's and some in a year a number of Americans that are dying if people could see all the caskets it's outrageous that we even have to have this press conference and have to introduce this legislation well Helen Thompson bill is what you're referring to is Assemblywoman Thompson did a wonderful job getting that bill passed that covers 12 specific serious mental illness there's a lot that that bill does not cover that's not a full parity for all mental illnesses and it doesn't deal with as Patrick Kennedy says it doesn't deal with that prevent the prevention moderate as people build up their mental illness problems it doesn't cover any of those things so so that bill is only covers serious mental illness of 12 specific topics okay and it was a B 88 and I think 98 I think I think our bill that we're talking about here the package is that we think that all illness it also also it doesn't cover the substance abuse that bill doesn't cover or substance abuse I don't believe you know you don't you didn't have any coverage for substance abuse there's such a stigma on those types of things you know I've been to 26 prisons I can say right now every warden I talked to says its substance abuse and mental illness is a big part of the cost of the prison population I could say the foster I've done the maybe 12 the foster care bills I've done ten foster care bills I could say that a large part of the abuse of children in the foster care system by their parents is because of their mental health and substance abuse and you'd go on on the criminal justice costs of social service costs the health cost if you have mental health problems your your multiple times more gonna be more costly in terms of solving your diabetes or heart disease your other your other illnesses so so the cost of not doing healthcare for for mental illness and substance abuse the same as other illnesses is an astounding number and we have although all the parity bills in the past you could look at the records the studies that were done on those bills and they validate that these bills have very little or no cost in fact the show that it is cheaper by far to do early intervention as opposed to wait to stage 3 inches Stage four so one final quick question well yeah we've gotten some mandates through I passed two so last year in the year before so that they are possible to pass and as we said before in terms of costs we have to look at the cost of forcing people to wait until they're in crisis to seek care which is extremely expensive and the cost when we when we when we say you can't have care until you have gone into crisis and are much harder to treat whether or not you're hospitalized it is much more cost effective to actually engage in prevention and early intervention which is what the trend is in physical healthcare as well what we shouldn't say you can't get treatment until you have diabetes or falling heart disease we should have preventative care that's the trend and it's a smart trend and it's a cost-effective trend but yet we're not doing that around mental health care and substance use care you know if someone is starting to use meth and in my community meth is a big problem as it is in other communities I would rather someone be able to go in and immediately start getting care the first or second time they use I don't want to see them emaciated on the street and only then can they get access to to care so I think it's much more cost-effective so but we will certainly have that conversation during the process when we do bills on that affect premiums there's a thing done by the University of California that's contracted with the legislature to do a study on whether or not has the impact on premiums so every bill that was done has a study you can read it it's a public document and they're filed under each one of these bills when they did Studies on these bills had no impact okay so so you look at those studies it's like in fact they even left out some of the fiscal benefits part of it to the state government so so just looking at a very narrow direct cost to premiums no impact whatsoever it's like it's like and this is all over the country every study that's been done on on this subject the same results come up no impact thank you [Applause].

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