Frankly, the view I get from CORVA, which might be different from the view of Baltimore, is that the consumer members are already led around by the nose by the staff, and if we want this to be a broadly representational function rather than a professional staff function, it seems to me we don't need any more messages to the field, whether informally or directly in the form of regulations empowering, essentially on a de facto basis, the planning staff to have even greater control.

I say that with some considerable experience. I was a staff member on Capitol Hill for 6 years. I know how dangerous they really are.

Ms. MIKULSKI. We're still feeling the impact.

Mr. STOCKMAN. So I would hope we would not send any message. I wonder what you meant by message.

Mr. CHAMPION. The message should be that the assistance should be sought, rather than offered.

Dr. FOLEY. We're not suggesting regulations, but we are suggesting that staff can be helpful. I assume some of those consumers are strong people, they're not going to be led around by the nose, but they have to have adequate information.

What I am objecting to is consumers that go into board meetings where that staff has held back information. We saw this in the EEO programs. We're liable to see it in health planning. There are many agencies and good executive directors who don't do that, but there are some out there who have been captured by the providers who are in fact holding back information. We think that information ought to be presented to all members of the board. That is the message I am talking about to the field. Let's make this an honest, healthy process so that we can get good results in the system. Mr. STOCKMAN. Fine.

Mr. WAXMAN. One clarification for the record. There has been an antitrust lawsuit in Michigan affecting the Detroit HSA. The court ruled that they were not in violation of their antitrust statutes. I want to thank both of you for your testimony, since there are no other members of the committee who wish to put any questions to you.

Thank you for your testimony. The committee is going to recess until 1 p.m. sharp, to continue with the agenda.

[Whereupon, at 11:55 a.m., the committee recessed, to reconvene at 1 p.m. the same day.]

AFTER RECESS

[The subcommittee reconvened at 1 p.m., Hon. Thomas A. Luken presiding, Hon. Henry A. Waxman, chairman.]

Mr. LUKEN. Mr. Waxman, our chairman, and other members are on their way, so that we can begin and expedite these proceedings. We will reconvene the Subcommittee on Health and the Environment of the Committee on Interstate and Foreign Commerce in the hearing on the Health Planning and Resources Development Amendments of 1979.

According to our schedule, the next presentation will be from a panel from the American Health Planning Association. It's Mr. Anthony Mott, Jacqueline Hanson, and Jacob Getson.

Are you all here? If you will take your places at the witness table.

Is there any particular order in which you wish to proceed or any manner in which you wish to proceed?

Mr. MOTT. I think we would like that probably I would go first and then Mrs. Hanson and Mr. Getson, and we will basically stay with the text but not completely. We will vary from it to a small extent.

Mr. WAXMAN. You're Mr. Anthony Mott, president of the American Health Planning Association, and you have presented testimony which, without objection, will be made part of the record and you may proceed then to testify independently of that written testimony.

Mr. MOTT. Yes, we are going to paraphrase it.

Mr. LUKEN. You will attempt to follow it but you will testify separately from it.

Proceed, Mr. Mott.

STATEMENTS OF ANTHONY T. MOTT, PRESIDENT, AMERICAN HEALTH PLANNING ASSOCIATION; JACQUELINE B. HANSON, PRESIDENT-ELECT; AND JACOB GETSON, MEMBER, BOARD OF DIRECTORS; ACCOMPANIED BY HARRY CAIN, EXECUTIVE DIRECTOR; ELLIOT STERN AND SHIRLEY WESTER, DEPARTMENT OF GOVERNMENT POLICY

Mr. MOTT. Thank you, Mr. Chairman. I am Anthony Mott, president of the American Health Planning Association, which is the national association for State and local health planning agencies, their volunteer boards, staffs, and for many additional individual and corporate affiliate members.

I am also the executive director of the Finger Lakes Health Systems Agency of New York State.

With me are Jacqueline B. Hanson, president-elect of AHPA and immediate past president of Mid-America HSA in Kansas City. Also with me is Jacob Getson, director of the Massachusetts Health Planning and Development Agency and a member of our executive committee.

With your permission, in order to conserve time we would like to vary a little bit from the testimony we have submitted. [See p. 171.] We have structured our testimony the way we have because of the nature of the planning process and the Planning Act as it exists and as it relates, to the Federal, State, and local levels. These are all critical components.

We have arbitrarily split up our testimony into three components, but more important than that, we have before you representatives of staff and HSA levels and also represented as consumers so we can respond to your questions from any direction that you prefer.

Our concern-I'm professional staff at the local level. Jabob Getson is professional staff from the State of Massachusetts and Mrs. Hanson is a consumer from Kansas City, Mo.

Mr. LUKEN. You have back-up staff with you? Do you want to introduce them at this time?

Mr. MOTT. We have Harry Cain, who is the executive director of our association, Elliot Stern and Shirley Wester, from the department of government policy of the national association.

Mr. LUKEN. OK, proceed.

Mr. MOTT. Our concern and that of our constitutents is for improving health care for all Americans through cooperative planning. Health Planning works to achieve goals and objectives which support this end through development of publicly responsive longrange plans, fostering appropriate multi-institutional systems, reviewing all new investment proposals, and a host of other concrete implementation activities. We are vitally concerned with restraining unnecessary costs in health care, and indeed provide a highly developed set of mechanisms for trying to do this, but we're trying to do a good deal more than this. Indeed, our cost containment activities, in our opinion, are done in concert with improving the health care delivery system and the health status of the population at the local and State level.

Our constituents need your immediate support and the support of the whole Congress in passing 3-year renewal legislation which will give long-range stability to their efforts to promote effective, credible health planning.

Mrs. Hanson will speak a little bit more to this subject in the next few minutes.

I wish to make two things clear at the outset. First, health planning is working. It is making an observable, documentable impact on health care communities all over the country. We submit data and case studies which show that even by conservative estimates, health planning saves the American public $8 for every $1 spent on it, without reducing in any documentable way the quality of health care available to Americans. In fact, health planning activities result in concrete improvements in the way health care is delivered and received in local communities.

We're delighted to see in addition to what we have submitted which was the result of a survey done by the national association over the last year, that additional material is being provided by the administration with some illustrative cases of the types of things that are being done at State and local levels, whether it be the development of multi-institutional systems, whether it be the attraction of doctors into underserved areas, whether it be the working with local providers to increase immunization levels, or an infinite number of things of that type.

So from our standpoint, yes, health care planning is working. With each passing year, the degree to which it is working will obviously improve.

The second point is, health planning is increasingly being accepted and supported by the public. In the last 2 years 50,000 volunteers have contributed innumerable hours, exclusive of travel and preparation time, in support of planning for better health care. They have demonstrated not just that planning is a good idea, but that planning is the best way to involve diverse groups in support of community-responsive decisionmaking regarding the allocation of health care resources.

Having said that, I'll reiterate what was said by Mr. Champion this morning. While it does have the increased support of the

public, obviously what health planning is dealing with frequently are controversial items, so it does not have at all times the active support of all elements of society, but it is working in terms of having the overall support.

Mr. Chairman, H.R. 3041, the Health Care Planning Amendments of 1979, is a good bill. The American Health Planning Association strongly supports it. It provides in almost all respects additional impetus for continuation of a health planning process that has been successfully initiated.

We would like to make a few extra points on this which will be the subject of Mrs. Hanson and Mr. Getson's testimony. In order to have a positive effect on health planning, H.R. 3041 must be passed by the House without delay.

And with that, I would like to turn to Mrs. Hanson.

STATEMENT OF JACQUELINE B. HANSON

Mrs. HANSON. Thank you, Tony, gentlemen.

Mr. LUKEN. Ms. Hanson?

Mrs. HANSON. Yes.

Mr. LUKEN. Your written testimony which was submitted was actually from the three of you?

Mrs. HANSON. Yes.

Mr. LUKEN. And the entire written document will be received if there is no objection.

Mrs. HANSON. This committee acknowledged, I think, this morning in the supportive statements that were made and the questions that were asked directly to the administration, seems to acknowledge the passage of H.R. 3041 without further delays, an important issue in the continuance of health planning, volunteers and staff members who are involved and agencies have for the past 2 years have functioned and participated under 1-year continuation, with continuing resolutions, without any increase in appropriation.

During this period of time, agencies have accepted an increase in expectation as a result, and they've accepted additional responsibilities. In spite of some difficult conditions, 80 percent of local HSA's are designated as operational.

Most State agencies are making good progress toward_State health plan development and certificate of need conformity. But as these agencies become more effective, they become more controversial. They must assume the burden of proof that their decisions, actions, and recommendations are technically sound, publicly supported, and further the public interest. They must reach out into their communities to involve groups broadly representative of community health concerns in active implementation of their plans. The boards and staff of these agencies have accepted this challenge.

Planning agencies must be given a mandate to operate for the next 3 years, and sufficient appropriations to allow all of them, including rurally based agencies, to perform up to this potential. Further uncertainty about their legislative mandates and funding authority will inhibit full public participation in the health planning process.

We ask, therefore, that you examine the record of these agencies to date and, based on the achievement and promise of local plan

ning and the unacceptability of alternate programs which impose solutions on communities, report H.R. 3041 from your subcommittee without delay and with a minimum, please, of fine tuning. If the planning amendments are not acted on by spring of this year, you risk losing the participation of groups from every sector of our society-labor and business, consumer and provider, needy and affluent-in a process that should serve as a model of local, State, and Federal partnership.

Along with this timing problem, the planning agencies also face a special funding problem. Due to the extension of this program for fiscal 1979 under a continuing resolution at the 1978 level of appropriations, combined with the unusual circumstance of some agencies not being designated, most agencies will face a serious cash flow problem unless a remedy is available by October 1979. Their actual level of per capita funding has dropped from 49 cents per capita last year to 44 cents per capita this year. Consequently, many are preparing to lay off staff at a time when the agencies responsibilities are dramatically increasing, for them to continue training staff.

We strongly urge either a supplemental appropriation for 1979, which would take a specific authorization in your bill, and may otherwise be difficult to achieve under the procedural rules of the Congress, or a significantly raised level of appropriations for 1980 with a specific authorization to spend some of those 1980 funds on all agencies this October 1979, regardless of the agencies' particular grant cycles, which as you know are on a rotating basis.

In particular, we would recommend that on October 1, 1979, using 1980 appropriations, all minimally funded agencies be raised to the new level and that all other agencies be raised to 50 per capita for the rest of their 1979 grant year.

Basically, that would return the above minimum-funded agencies simply back to their 1978 level. We would therefore urge that the 1980 authorizing level be higher than otherwise would be needed, to make up for 1979 as well as to allow some moderate increment for 1980.

In 1980 we are asking for $132 million for HSA's, and $35 million for State agencies which, with expected increases in minimumfunded agency levels, amounts to an increase of only 2 cents per capita per agency.

In this regard the administration bill, H.R. 3167, again contains a provision calling for total secretarial discretion in determining the amount of grant funds to be allocated to each HSA. This was commented on by the administration this morning. They recommended doing away with the per capita funding formula. Not only is the intent of this provision highly questionable, but it would in our opinion negatively impact on the ability of planning agencies to apply any reasonable management principles or sound fiscal program principles to their organization.

The implication that the HSA's and SHPDA's are considered by the Department as extensions of HEW, to be rewarded or punished as the Secretary chooses, makes no sense in terms of promoting the continuity of local effort. The great strength of these agencies is that they are community based, broadly representative agents of