foregone, public assistance costs, retraining Measures for dealing with the involuntary unemployment problem must be improved. The methods suggested in Part G of Title XVI would be inadequate if utilized and, further, there is no certainty that institutions would, in fact, expend monies received as incentive payments in this manner. Therefore, we strongly urge the addition of another type of incentive payment which would be earmarked for handling potential unemployment problems. Part G of Title XVI should be appropriately amended to establish an incentive payment to other hospitals in the health service area which are willing to accept displaced hospital workers in their facilities. This should be a reasonable incentive structure that coupled with a strict attrition program would, within a reasonable period of time, return the hiring institution to appropriate levels of staff. (Tying the incentive payment structure to a strict attrition program would prevent permanent overstaffing). Furthermore, where immediate placement in other facilities in the area is impossible, these incentive payments should be expended for retraining and assisting displaced workers secure other suitable employment. These proposals would not totally remove the negative employment effects of discontinuing hospital services but would represent a positive program for efficient utilization of health manpower within the context of national employment goals. With respect to other portions of the bill, we heartily support the additional staff requirements listed in Sec. 105 for health systems agencies, to assure expertise in financial and economic analysis and public health and disease prevention. The full potential of HSAs as planning instruments can only be realized if proper analysis of the economic impact of various healthcare decisions is carried out and if HSAS concentrate on plans for improving the "wellness" of the members of their respective communities instead of merely looking at resources for dealing with illness. Greater involvement in health planning by major health care purchasers such as labor unions and corporations needs to be encouraged in order that planning agencies may benefit from the expertise and experience of such groups. Recognition of labor unions and corporations as major purchasers of healthcare in Sec. 110 should prove helpful toward that end. tional labor and management health planning input is likely Addi to be gained through the Sec. 140 proposal to allow consumers who serve on boards of other health organizations and agencies to be considered as consumers, rather than indirect providers. Many knowledgeable labor and management representatives currently fall into this category. In addition, the definition of indirect provider needs to be clarified. Current regulations interpreting the law would hold that an individual who receives (directly or through his spouse) more than one-tenth of his gross annual income from entities or associations or organizations composed of entities or individuals engaged in the provision of healthcare or in such research or instruction is an indirect provider. The definition is too broad in that, carried to extremes, it could possibly eliminate many potential labor or management consumer representatives. It would be helpful, in this case, if the entities, associations or organizations were so defined as to classify their employees as potential indirect providers only if a majority of their composing entities or individuals were engaged in the provision of healthcare. We believe that Sec. 113 which amends Sec. 1512 (b) (3) (c) (ii) to explicitly include nonprofessional health workers as provider members of the HSA governing body is long overdue. It is about time that a group that represents a majority of the healthcare industry labor force had a voice in planning healthcare delivery. At the same time we feel that consumers should constitute at least 60 percent of the membership of an HSA governing body. We recommend amending Sec. 1512 (b) (3) (c) appropriately. Finally, we strongly support Sec. 141 which amends the planning law to broaden State certificate of need requirements to include expensive equipment with a value over $150,000 regardless of location except when such equipment is utilized exclusively for patients of health maintenance organizations. Healthcare costs have been unnecessarily pushed up by the increasing price and proliferation of new technology. The proposec amendment will be of great benefit in discouraging circumvention of the health planning process. We thank the committee for the opportunity to present our views on the proposed health planning amendments of 1978 and we strongly urge you to consider our recommendations for strengthening the proposed legislation. 7 Senator CHAFEE. Thank you very much. I see Senator Leahy is here, and if you are ready to go, Pat, we are ready, We are delighted to have Senator Leahy here. Senator Clark, as you know, has testified previously, and mentioned that you and he had some amendments, and he outlined the six amendments briefly. STATEMENT OF HON. PATRICK LEAHY, A U.S. SENATOR FROM THE STATE OF VERMONT Senator LEAHY. Thank you, Mr. Chairman. I had planned to be here at the time when Senator Clark testified, and I apologize for being late. Yesterday morning, my wife and I were in Vermont. We decided to drive back, with a load of things from our home in Vermont to our home here. I just mention this briefly, because when we left Vermont, the snow on both sides of the drive leading up to our home was piled 10, 15, some places 20 feet high, and the temperature was 20 degrees below zero. We drove back with absolutely no problem whatsoever. This morning, I drove the 12 miles in from McLean, Va., and I understand that National Geographic is thinking of doing a special on the trip as part of their "High Adventure Series." [Laughter.] I have found that the snow in our part of the world, Mr. Chairmanyours and mine—and the snow down here is of a different nature. Senator CHAFEE. Well, there is no question about that. I think if you left at 7 this morning-I do not know how long it took you to get in Senator LEAHY. It took a long time. Senator CHAFEE. Well, we look forward to your testimony. Senator LEAHY. Thank you, Mr. Chairman. I will put most of it in the record, but I do want to commend you and the members of the submittee and Senator Kennedy for holding these hearings. Too often, we pass laws and nobody goes back to review them or do oversight on them. These hearings are good, because members of the subcommittee know the health of rural America is not good. Sixty percent of the medically underserved persons in this country live in rural areas. Nearly one-half of the poor and a disproportionate share of the elderly live in nonmetropolitan America. Despite these facts, rural America receives a disproportionately small share of the Federal health dollars. I think that it is time they receive a fair share, and that means funding which recognizes the special and unique needs of rural America. Senator CHAFEE. Senator, I apologize. I have to go over and make a brief statement at 10:45 on the floor, but Senator Javits will be taking over the Chair. I look forward to reading your statement. Senator LEAHY. Certainly. Thank you very much, Mr. Chairman. I appreciate that. Senator Javits, it is good to see you this morning. [Whereupon, Senator Javits assumed the Chair.] Senator LEAHY. The bill before the subcommittee, S. 2410, demonstrates an understanding of some of the present inequities in the federally supported planning program. I would strongly endorse the proposal for changing the funding mechanism of HSA's. Greater per capita funding for less populated HSA's recognizes the increased efficiencies of economies of scale. |