Only if the great majority of the aged have health benefits through social security will the number who need public assistance be small enough so the State can help them adequately. Otherwise, sufficient funds and staff will not be made available. The Pennsylvania Legislature now is struggling to solve a massive problem of how to finance an improved educational system and to insure equally important benefits to our citizens.

Health benefits tied in with the social security program, at relatively minor contributions from workers and employers annually, similarly would assist our Pennsylvania private welfare agencies, hospitals, and nursing homes to do a better job. It would also enable our unions through prepayment and insurance plans to increase other protection for current and retired workers.

Pennsylvania AFL-CIO officers and members are strengthened in their determination that we are "on the right side" of this issue by publication in recent weeks of the findings of competent and respected national polltakers. These prove that the vast majority of our fellow Americans feel as we do on the need for passage of the Anderson-King legislation to provide medical care for the aged. Most significant of such polls, in our opinion, was the published report that Congressman Herman T. Schneebeli, Republican, from the 17th District, had made such a survey among his fellow citizens. He is a businessman from Williamsport and represents the counties of Bradford, Cameron, Clinton, Columbia, Montour. Lycoming, Potter, and Tioga. Few, if any, of these counties have been included in the discouraging list of "depressed areas" of this State. Residents in these counties might properly be termed "ultraconservative."

Congressman Schneebeli's poll, early in June, revealed that 59 of his constituents favor Federal aid to the aged through social security compared to 31 favoring matching funds to the State through the Kerr-Mills method.

His poll showed that 39 oppose the Kerr-Mills proposal compared to 27 opposing the principles of H.R. 4222.

Another 30 of his neighbors had "no opinion" on the Kerr-Mills proposal but only 24 said they had "no opinion" on the Anderson-King bill specifications. Statistics prove that Pennsylvania has every reason to urge Congress to adopt the Anderson-King bill as the fair and decent answer to this evergrowing problem of adequate medical aid to our aging citizens without making them cringe by submitting to "means tests," or affronting their dignity. There are 1,129,000 persons aged 65 and over in this State.

If the Anderson-King bill is adopted, it will enable an estimated 998,000 aged persons to receive health benefits in 1963. The estimated amount of such benefits in 1963 would be $66 million.

The average old-age benefit paid in Pennsylvania per month is $79.

This compares with an average hospital charge for bed and board of $17 a day in a semiprivate room and $14 a day if six or more adults are in one

room.

In conclusion, please accept the assurance of the officers and members of the Pennsylvania AFL-CIO that favorable action by you and your congressional associates on H.R. 4222 will be deeply appreciated by all of us and the many millions of members of our families.

We feel strongly that such approval by you and your fellow Congressmen and Senators will warrant including such supporters among the "immortals.” These lawmakers have gone down in history in the past 25 years for their courageous assistance in achieving the glorious record of similar legislation on behalf of the people and the preservation of our great democracy. Their contribution has given the final answer to the enemies of our system of government who are still active.

Approval of H.R. 4222 will insure another victory in this latest battle in the never-ending war to guarantee that the United States shall be strong and free.

RESOLUTION No. 10. MEDICAL CARE FOR THE AMERICAN PEOPLE

(Adopted May 24, 1961-Pennsylvania AFL-CIO convention at
Philadelphia, Pa.)

The prime immediate objective of the Pennsylvania labor movement in the field of medical care remains that of joining with their fellow Americans in securing for our senior citizens adequate medical care through a system geared to the Social Security Administration.

Any measure less than a system based upon prepayment during years of gainful employment will be demeaning charity or too expensive to continue premium payments during the years of retirement.

Such a system of medical care is not only simple justice for those of our senior citizens presently covered by social security, but a guarantee that future generations of Americans may reach their years of retirement without fear of catastrophic medical costs.

A total of more than $3 billion a year is now spent from all sources for health care for people over 65. It costs about $80 a year per aged person to pay for outpatient diagnostic hospital services, hospital care up to 120 days, and longer recuperative care in skilled nursing homes or through a community agency in the home.

A proposal which almost passed the Senate in 1960 would have provided such benefits to 9 million persons over 68. The total cost of $700 million a year would have been met by an additional payment of 2 or 3 cents a day by the average working person, matched by similar employer payments.

For about $1 billion a year, basic health benefits, including diagnostic, hospital, and nursing care, can be provided for all aged persons eligible for social security benefits.

More than 14 million of the 16 million persons over 65 would then have basic health protection through a Federal program other than public assistance. Thirteen million would be covered by social security, and another half a million by similar benefits under the railroad retirement system. Over 700,000 more are protected by veterans' programs or the new Federal employees' benefits. With this network of programs, every older person would be covered.

In this State, the labor movement must use its legislative power to implement any forthcoming Federal legislation. It must secure additional legislation which will provide adequate medical care for the indigent not now covered by social security.

While we seek this needed medical care for our aged, we must not lose sight of the fact that rising medical costs are denying the entire American people the protection they need for full and vital health.

For the American worker, and for many in Pennsylvania, health and welfare payments, negotiated through collective bargaining, are losing their value through inflated medical costs. In some instances full medical coverage through collective bargaining is only maintained at the sacrifice of economic demands such as wage increases.

The organized labor movement has become the largest single customer and use of voluntary nonprofit prepaid medical plans such as the Blue Cross and Blue Shield plans, yet it has very little to do with the actual direction and management of such plans.

Great advances in the field of medicine plus patient demands have, of course, been partly responsible for increased medical costs. High profits in the drug and medical supply business have also made a substantial contribution as revealed by the Kefauver committee. It is obvious to all, that much can be done to either hold the line or to reduce existing high medical costs: Therefore be it

Resolved, That this convention of the Pennsylvania AFL-CIO go on record with the following recommendations in the field of medical care:

1. That our efforts be renewed to pass a Federal medical care of the aged bill based upon social security payments.

2. That we seek State legislation which will permit the department of welfare to provide adequate care of the aged and others not now covered by social security.

3. That we call upon Blue Cross, Blue Shield, and other nonprofit agencies in the field of prepaid medical coverage to (a) enlarge their labor representation; and (b) to join with physicians, hospitals, and public health and insurance officials to seek cooperative studies and methods to lower medical costs without sacrifice of quality.

4. That as an alternative to such voluntary nonprofit plans the organized labor movement of this State be encouraged to further study the group practice of medicine through its own medical centers or hospitals as already developed by a number of international affiliates.

5. That we seek Federal prosecution for violation of the antitrust and pricefixing laws as they can be proven after investigation in the drug and medical supply industry.

6. That if the so-called voluntary nonprofit prepaid medical plans fail to meet the medical needs of trade union members and the American people, the Pennsylvania AFL-CIO call upon the National AFL-CIO to return to demand for passage of a national health insurance bill for all the American people on the principles of the former Murray-Wagner-Dingell bill.

STATEMENT OF MILES C. STANLEY, PRESIDENT, WEST VIRGINIA LABOR FEDERATION, AFL-CIO

PURPOSE OF STATEMENT

The general position of organized labor, the AFL-CIO in particular, on how adequate health and medical care for our aged citizens can best be secured and maintained has been given wide publicity and the committee has considered a statement by Mr. George Meany, president of the national AFL-CIO, during the course of its hearings on this matter. Therefore, this statement shall be confined to the aspects of the problem peculiar to West Virginia and observations based on experience under the current "medical aid for the aged" plan in effect in the State since October 1960.

STATISTICS RELATING TO THE PROBLEM IN WEST VIRGINIA

The 1960 census reports a population of 1,860,421 in West Virginia. Of this number 173,000 or 9.3 percent are 65 years of age or over. Directly related to the problem is the per capita income in the State which averaged $1,692 in 1960 or $574 below the national average of $2,266. Obviously, this substantially reduces the ability of the aged to pay for adequate medical care and militates against the ability of relatives to bear the added burden of financing the cost of such care. Moreover, the average old-age benefit paid in West Virginia is $72 per month and as a practical matter, this precludes the possibility of such persons affording to buy commercial insurance plans even if available. Conversely, hospital costs within the State rank well up with the national average. Figures compiled by the American Hospital Association show that the average per diem cost of all patients in general hospitals is $27.16 and the average inhospital stay is 7.4 days. Consequently, the average cost to the hospital patient in West Virginia is $200.98 per admission, excluding medical and surgical fees.

MEDICAL CARE FOR THE AGED IN WEST VIRGINIA

On October 5, 1960, West Virginia became the first State in the Nation to enact legislation authorizing participation in the Federal-State medical care for the aged program as enacted by the 86th Congress under H.R. 12580.

Since that date, wide publicity has been given to this program through various press media and the information service of the department of public welfare which administers the program. This fact notwithstanding, the record shows that only 3,617 claimants of the 102,000 aged persons estimated to be eligible, availed themselves of the services offered by the program from October 1960 through April 1961. The average payment to each recipient during this period was only $64.97.

These facts raise two very important questions. First, is the program as presently established being utilized to a sufficient degree to adequately meet the problem; and secondly, are the benefits afforded by the program broad enough to meet the total medical needs of the recipients?

Diligent inquiry has been made into the first question and the answer is definitely no. Welfare workers, hospital administrators, and others with knowledge of the program have voiced a considered opinion that the program has not been utilized by eligible recipients because of pride. Numerous potential claimants have refused to apply for benefits under the program because it required a full disclosure of assets or a means test. Others refuse simply because it is administered by the department of public welfare, which until recently was named the "Department of Public Assistance."

Enclosed for consideration is an article from a Charleston, W. Va., newspaper containing statements by the commissioner of public welfare. Although these statements deal with another matter, they are pertinent to the issue at hand and vividly point up the important role that pride and self-respect play in the actions and reactions of West Virginians and indeed of Americans.

These opinions, which are shared by the AFL-CIO in West Virginia, are supported by the fact that only a fractional number of estimated eligibles have thus far utilized the program and therefore, its intended purpose of providing medical care for the aged population, that is medically indigent is not being fully realized.

Whether or not over a period of time more and more of the older population who are not receiving old-age assistance "but whose income and resources are insufficient to meet the costs of necessary medical services," as defined in the act, will, out of sheer necessity and desperation, decide to become a welfare case in order to receive services is a matter of conjecture at this time.

In regard to the second question posed above, it is evident that the average grant per recipient of $64.97 is substantially below the average cost per hospital admission of $200.98. However, included in the average grant are other types of services, such as outpatient, medical, etc. This fact notwithstanding, it is interesting to note that in Michigan, with approximately the same number of cases, the average grant has been $310.70. Such a wide disparity between these two States would indicate that West Virginia's program is not adequate to meet the need or Michigan's cost of medical care is almost five times as great as in West Virginia. Of course, we do not accept the latter thesis and submit that the program in this State needs to be improved even if H.R. 4222 is enacted, and our organization shall strive to bring about such improvements.

FINANCING THE MEDICAL CARE PROGRAM IN WEST VIRGINIA

Germane to this problem is the ability of the States to finance their share of the program. West Virginia's share under the present Federal-State program is 30 percent of the total. It has been stated by authoritative sources that if the MAA program were fully implemented and utilized in West Virginia that it would literally break the State to finance its share. We do not submit this as a fact but we would submit that already this program, coupled with many others, is placing a severe strain on the State budget. So much of a strain that in the regular session of the State legislature in January of this year, in spite of new taxes being imposed in the amount of $30 million, which increased the general revenue budget almost 25 percent, the legislature was hard pressed to find money to finance the MAA program for only 6 additional months or through December 1961.

The attached article from the July 14, 1961, issue of the Charleston Gazette states the problem in a clear, concise manner. Those of us familiar with the revenue problems of West Virginia know that a continuation of the present program of medical care at a cost of $10 to $12 million annually is not possible. Therefore, it is a foregone conclusion that an already inadequate program will have to be drastically reduced if relief is not forthcoming by the passage of legislation at a Federal level such as H.R. 4222.

West Virginia has demonstrated its interest and concern for the welfare of its older citizens by moving quickly to take advantage of that which was made available. To what extent this action was promised on the assumption that Congress would forthwith pass a more comprehensive plan such as it is now considering, again would be conjecture. Several factors lead us to believe that such was the case. Be that as it may, pressures for additional and improved State services continue to rise and, therefore, the MAA program must compete in the political arena for the tax dollar. This, in our view, should not be so. Unquestionably, it makes this social and humanitarian program subject to changing political pressures and economic factors that would not be present in a soundly financed plan as proposed in H.R. 4222.

In brief, we would submit that it is not in the realm of a practical achievement for West Virginia to finance the present MAA program for a long period of time. It is our opinion that should utilization of the program increase substantially, or should per case cost rise appreciably, immediate action will be taken to reduce benefits or to discontinue the State's participation in the current Federal-State program.

SUMMARY AND CONCLUSION

In summarizing the information contained herein and certain opinions and conclusions we have drawn therefrom, we submit the following:

(1) The average older citizen in West Virginia cannot afford to pay for adequate medical care; nor can he afford to purchase protection against such costs in the commercial market.

(2) Cost of medical care in West Virginia closely approaches the national average while individual resources are substantially below the national average. (3) The present medical care program in effect in the State, as authorized by the Kerr-Mills Act, is not being utilized by eligible recipients because of its requirement for a means test and its stigma of being public assistance.

(4) The MAA program in effect is not comprehensive enough to provide adequate protection for those who are taking advantage of it.

(5) Financing the State's share of the program even with minimum utilization has placed a strain on the State budget, and maximum utilization would make the cost to the State prohibitive.

For these and many other reasons, which have previously been considered by the committee, the AFL-CIO in West Virginia vigorously supports H.R. 4222, and sincerely hopes it will be given favorable consideration by this committee and by the Congress.

[From Daily Mail, Charleston, W. Va., Aug. 10, 1961]

DEPARTMENT FEARS PARING BACKFIRED WERE NEEDY SCARED OFF LISTS? The State department of welfare expressed concern today that some persons who are eligible for and need surplus foods, actually are not getting them. Now in the midst of a full-scale recertification of all nonpublic assistance recipients receiving commodities, the department said:

"Tight control and prosecution of chislers on the rolls may have caused some eligibles to shy away from what is rightfully theirs."

Welfare Commissioner W. Bernard Smith said: "It is not our desire to show a great number of persons stricken from the commodity rolls, if any of them are needy West Virginians eligible for this food.

"For it is this group we are protecting in our investigation of commodity recipients. And punitive action will be taken against those, not eligible, who apply for and receive commodities."

The department said that any person who feels he is eligible may apply through the local county commodity warehouse.

There are three categories of recipients:

Public assistance recipients-those persons eligible under the public assistance programs of the department of welfare, or benefits under old-age assistance, aid to dependent children, aid to the blind, and aid to the permanently and totally disabled programs.

Private assistance recipients-persons who receive financial or other assistance from private charitable or welfare organizations.

Others those not receiving public or private assistance, but who, because of their economic circumstances, are determined to be needy persons. Eligibility in this last category is determined, the department said, by the number of persons in a household compared to monthly income.

Smith added that past records show in some cases the truly needy are the first to take themselves from the relief-giving rolls. And he added that pride and self-respect, to them, take a precedence over their need.

"For the most part the long hours of standing in a commodity distribution line have stripped them of this pride and self-respect," he said. "But there

are those who cling to these traits as dearly as life itself. It is for these that we are removing the thousands from the free food lists."

More than 15,000 persons have been removed from free food lists in the last 2 months. The department feels "there are still those who failed to reapply for one reason or another and are eligible to receive the surplus commodities."

[From the Charleston Gazette, July 14, 1961]

THOMAS F. STAFFORD'S AFFAIRS OF STATE-TROUBLE AHEAD FOR CARE PLAN When House Speaker Sam Rayburn said in Washington this week that the House wouldn't get around this year to acting on the Kennedy administration's aged care plan, he sounded a warning that reached all the way back to West Virginia.

Without passage of the administration proposal, which would shift financing to social security, this State will be hard pressed to meet its aged care obligations in the year ahead.