Federal grants-in-aid for public health services (appropriations, fiscal years Senator PURTELL. Have you any questions? Senator COOPER. I would like to ask a few questions. I would like to start out first with the total amount of money that might be appropriated by the Congress. Assume as an example that the Congress should appropriate $100 million for the complete program. Is there any provision in the bill, or is there any formula which would determine the apportionment of a lump sum of money by the Congress between support, extension and improvement and specific projects? Mr. ROCKEFELLER. The answer to your question is the money would not be appropriated in a lump sum, but in three separate sums, the amounts of which would be determined by the Congress each year. Senator COOPER. I know that. But there is no formula set up in the bill to determine the apportionment of the appropriation. Mr. ROCKEFELLER. There would be three appropriations. Mr. ROCKEFELLER. There would be one for support, which would be considered and justified and acted on by itself. Senator COOPER. And the Congress would determine what sum of money would go for support, what sum of money would go for extension and improvement, and what sum of money would go for special projects. Mr. ROCKEFELLER. If any. Senator COOPER. Assume the Congress appropriated $65 million for support, $25 million for extension, and $10 million-I think I am right-for special projects. Let us take the $10 million for special projects. There is no formula for the apportionment of that money to the States. Mr. ROCKEFELLER. That is right. Senator COOPER. Once it is in the State there is no formula for the way it shall be spent in the States. That is purely a determination by agreement between your Department and the States. Mr. ROCKEFELLER. The money would not be actually allocated to the States. Senator COOPER. I know. Any place in the United States. Mr. ROCKEFELLER. The money would go to a specific project or a specific program in a State, and only after the State health officer had been consulted, so that he was in concurrence with the allocation. But there would not be a general distribution of the funds to States. Senator COOPER. There is no formula. It is just a matter of determination by the Department. Mr. ROCKEFELLER. That is correct. Senator COOPER. Take the next one. Extension and improvement. Suppose you had $25 million appropriated by the Congress for that. I understand that the apportionment to the States would still be based on the population formula. Mr. ROCKEFELLER. Exactly. Senator COOPER. In the States you have a Mr. ROCKEFELLER. A State plan. Senator COOPER. Seventy-five percent and twenty-five percent. Senator COOPER. Over a 6-year period. Mr. ROCKEFELLER. That is correct. But each year there would be new money available to the State. Senator COOPER. Now, the support is the one I really wanted to inquire about. I do not understand the formula. Assume $65 million is appropriated by the Congress for support. The formula is changed from the present formula. Mr. ROCKEFELLER. The formula is changed. Senator COOPER. That applies to all of your grant-in-aid programs. Mr. ROCKEFELLER. The Secretary will be back tomorrow recommending or supporting legislation on vocational rehabilitation, and you will find the same formula recommended there. Senator COOPER. Without going into the details by which you arrived at the apportionment to the State, the theory is that the larger States now would receive smaller amounts and the poorer States would receive perhaps larger amounts. Mr. ROCKEFELLER. We did not develop a formula in the Secretary's office. This was a formula which, I think, one of your committee members is importantly responsible for having developed, Senator Hill. It is a formula on which I know Senator Taft spent a great deal of time. It is apparently the formula which the States feel across the board most effectively reflects what is sometimes called equalization to give special help to those States which have a lower per capita income. Senator COOPER. I am not from a rich State, but supposing you had a State like New York or Massachusetts, one where there are great hospitals and where they have perhaps started great programs in mental health, cancer, and heart disease. This would mean, I assume, that those States would receive smaller sums. Do you think that this would affect the programs which they may have already instituted in such fields? The Mr. ROCKEFELLER. I think this chart here is the best answer. matching formula, as it now exists, is two Federal dollars to one State dollar. This is the average Federal contribution to State and local contributions in the 48 States for general health. Therefore, it would be clear that the wealthiest States would be spending far more or a far larger proportion of Federal to State funds than the average. So what you really have in your general health programs and to a certain degree in the categorical is that in many cases the Federal money only represents 1 percent of their total expenditures, so that it becomes a very small factor really in the big States as far as the support is concerned. It is an important factor because any money is important these days, but it is a relatively small factor. However, the point Senator COOPER. I am thinking of a situation where, because of the facilities those States have, they probably have more advanced programs in those fields. Then, in a State like Wyoming do you think the cutting of their funds which would probably result from the change of this formula would possibly affect the programs which can perhaps only be carried on successfully in those larger States where they have better hospital facilities, like cancer control? Mr. ROCKEFELLER. I think the answer would be "Yes," if there would be only a support program based on the equalization formula found in the Hospital Survey and Construction Act. However, that is only a part of it. The extension and improvement grant is allocated on a population basis. Therefore the big States would get more money because of larger population, and that money would be applied for the improvement of their program. So that they will benefit proportionately more here because of the larger populations that they have. That will create a balance. Senator COOPER. It will correct inequities? Mr. ROCKEFELLER. That is correct. So the answer to your question is that the new formula would not adversely affect it. Senator COOPER. I have another question. Secretary HOBBY. May I add one thought there, Senator? Secretary HOBBY. In the application of the Hill-Burton formula, in the Hospital Survey and Construction Act our experience demonstrates that these so-called rich States were not deterred in their hospital construction. In the States with lesser fiscal capacities, however, the programs were greatly helped. That has been the experience in hospital construction as among the States. Senator PURTELL. Mrs. Secretary, may I say-and this may be helpful to Senator Cooper, although I am not sure that it will be-but it may be if I asked this question now: Is it not true in the long run, and in the overall picture, that every State will be better off financially, that is, the financial participation will be greater than it is today? Also have you some figures that will demonstrate that so that we can include them in the record? I believe you do have some. We have one set of figures which I received from your Department, and I think we ought to have it in the record. Secretary HOBBY. Could we submit that for the record? Senator PURTELL. Yes. I am sure it would be a help and it will be included, if there is no objection. I have one here and that is the reason why I mentioned it. (The document referred to is as follows:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, WASHINGTON NOTE. The attached tables have been prepared to show the fiscal effect of the President's recommendations in respect to Federal grants to States for health services and facilities, vocational education, vocational rehabilitation, and mater nal, and child health, and welfare services. The explanatory notes indicate the assumptions which have been made in the preparation of the tables. The budget levels for fiscal year 1955 have been used, for purposes of comparison, in the 1956 table. It should be particularly noted that the second table, labeled "Projected Impact of Legislative Recommendations-Fiscal Year 1956," is not intended to be a prediction of the budget recommendations of the President for fiscal year 1956 except in the case of vocational rehabilitation. The levels of appropriations in fiscal year 1956 will be determined through the regular budget process in the light of all circumstances existing at the time of the budget recommendation. The maximum authorizations for the five programs as proposed in the bills to carry out the President's recommendations are as follows: Hospital construction_. Public health services Maternal and child health and welfare_ Vocational rehabilitation. Vocational education. 1 No limit. $210, 000, 000 (1) 41, 500, 000 (3) 36, 000, 000 Projected impact of legislative recommendations, fiscal year 1956-Federal grants to States for health services and facilities, vocational education, vocational rehabilitation, and maternal and child health and welfare services (covers 5 programs which will use, if proposed legislation is enacted, the basic allotment formula of the Hospital Construction Act) Important: This table presents, upon the basis of certain assumptions, the fiscal effect of proposed new legislation covering Federal grants-in-ald for health services and facilities, Support Extension Total i |