year period may also be extended for good cause determined in accordance with regulations of the Surgeon General, and (D) the borrower may at his option accelerate repayment of the whole or any part of such loan; (2) such a loan shall bear interest, on the unpaid balance of the loan, at the rate of 2 per centum per annum except that no interest shall accrue before the date on which repayment of the loan is to begin; (3) such a loan shall be made without security and without endorsement, except that if the borrower is a minor and the note or other evidence of obligation executed by him would not, under the applicable law, create a binding obligation, either security or endorsement may be required; (4) the liability to repay any such loan shall be canceled upon the death of the borrower, or if he becomes permanently and totally disabled as determined in accordance with regulations of the Surgeon General; (5) such a loan by a hospital for any year shall be made in such installments as may be provided in regulations of the Surgeon General or the agreement with the hospital under this section and, upon notice to the Surgeon General by the hospital that any recipient of a loan is failing to maintain satisfactory standing, any or all further installments of his loan shall be withheld, as may be appropriate; and (6) no note or other evidence of such a loan may be transferred or assigned by the hospital making the loan except, upon the transfer of the borrower to another hospital participating in the program under this sec tion (or if not participating, is eligible to do so and is approved by the Surgeon General for such purpose), to such hospital; (g) After June 30, 1972, and not later than September 30, 1972, there shall be paid to the Surgeon General a capital distribution of the balance of the interne loan fund established under this section by each hospital, under regulations established by the Surgeon General or pursuant to the agreement with the hospital; after September 30, 1972, each hospital with which the Surgeon General has made an agreement under this section shall pay to the Surgeon General, under regulations established by the Surgeon General, the amounts received by the hospital after June 30, 1972, in payment of principal or interest on interne loans made from the interne loan fund established pursuant to such agreement. GRANTS FOR SCHOLARSHIPS AND INTERNE LOANS SEC. 805. The Surgeon General, in accordance with regulations, and upon the recommendation of the expert advisory committee, shall determine from time to time the amounts to be paid to each medical school, dental school, and hospital from appropriations under this title and shall certify to the Secretary of the Treasury the amount so determined. Upon receipt of any such certification, the Secretary of the Treasury shall, prior to audit or settlement by the General Accounting Office, pay in accordance with such certification. WITHHOLDING OR RECAPTURE OF PAYMENTS SEC. 806. Whenever the Surgeon General, after reasonable notice and opportunity for hearing to a medical school, dental school, or hospital, shall find, with respect to payments made from appropriations under this title to carry out any of the purposes of this title, that there is a failure by such medical school, dental school, or hospital to comply with the provisions of this title or the regulations promulgated thereto the Surgeon General shall notify such school that further payments will not be made to it from such appropriations until he is satisfied that there is no longer any such failure. Until he is so satisfied, the Surgeon General shall make no further certification for payments to such medical school, dental school, or hospital from such appropriations. REGULATIONS SEC. 807. All regulations under this title shall be made only after obtaining the advice and recommendation of the expert advisory committee. GENERAL PROVISIONS SEC. 808. (a) Nothing in this title shall be construed as authorizing any department, agency, officer, or employee of the United States to exercise any direction, supervision, or control over, or prescribe any requirements with respect to, the personnel, curriculum, or administration of any medical school, dental school, or hospital, or the admission of applicants thereto. (b) Nothing in this title shall be construed to authorize the Surgeon General to exercise any influence upon the choice, by an applicant for or recipient of a scholarship or loan under this title, of a course of training or study, or of the medical school, dental school, or hospital at which such course is to be pursued. TECHNICAL AMENDMENTS TO ACT OF JULY 1, 1944 SEC. 2. The Act of July 1, 1944 (58 Stat. 682), as amended, is hereby further amended by changing the number of title VIII to title IX and by changing the numbers of sections 801 to 814, inclusive, and references thereto, to sections 901 to 914, respectively. (b) Section 1 of the Public Health Service Act is amended to read as follows: "SECTION 1. Titles I to VIII, inclusive, of this Act may be cited as the 'Public Health Services Act' ". Hon. OREN HARRIS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Chairman, Committee on Interstate and Foreign Commerce, June 3, 1960. DEAR MR. CHAIRMAN: This is in response to your request for a report on H.R. 6906, a bill to authorize a 10-year program of grants for construction of medical, dental, and public health educational facilities, and for other purposes. The bill would amend the Public Health Service Act to add a new title VIII providing for a program of grants to assist in the expansion and improvement of existing schools and the construction of new schools of medicine (including osteopathy), dentistry, and public health. The bill would authorize appropriations of $50 million a year for a 5-year period for the purpose of making grants to expand existing schools; and $100 million a year for a 10-year period for grants for construction of new schools. Individual grant ceilings would be 50 percent of construction costs in the case of existing schools, and 66% percent of construction costs for new schools and for that portion of costs for construction at existing schools that could be attributed to expanded capacity for freshman enrollment. In addition, grants for initial planning would be authorized up to a maximum of $25,000. For existing schools, there would be an aggregate money ceiling (exclusive of planning grants) on total grants made to any one school during the 5-year program period. These aggregate ceiling amounts would be: $3 million for a medical school; and $1 million for a dental school or school of public health. As your committee is aware, impending shortages of professional health personnel, and the needs of the institutions which train them, have been matters of continuing concern to this Department for some years. In the 84th and 85th Congresses, the administration recommended enactment of a construction grant program to aid the schools in meeting their essential needs for both research and teaching facilities. No affirmative action was taken on these or other then pending proposals for Federal financial assistance in the construction of teaching facilities, but legislation was enacted in 1956 (Public Law 835, 84th Congress) and since extended (Public Law 85-777) to authorize grants, until June 30, 1962, to assist in the construction of research facilities. In addition to its earlier recommendations for a combined grant program to aid both research and teaching facility construction, the administration has recommended a new program-important to medical and dental schools, as well as to other branches of higher education-which would provide construction loan assistance to public and private institutions (H.R. 4217 and S.1017). Other recommendations of this Department-for omission of the limitation on appropriated funds which prevents payment of the full indirect costs incurred in the conduct of federally financed research, and more recently, for authority to make grants-in-aid for the general support of research and research training-will, we expect, reduce the drain on operating funds that has too often followed from the support of research exclusively through the project system. H.R. 10341, now before your committee for consideration, contains our recommendations for institutional research grant authority. These measures, if acted upon by the Congress, should result in freeing some funds for use for construction needs. Our requirements for additional numbers of physicians, dentists, medical scientists, and professional workers-and the special construction needs of the 58455-60- -2 schools offering training in these fields have been repeatedly documented, most recently, in the case of physicians and dentists, by a group of consultants called together by the Surgeon General of the Public Health Service. We are convinced that the public interest would be importantly advanced by inauguration of a temporary program of construction aid to enable schools of medicine, dentistry, osteopathy, and public health to undertake expanded training responsibilities. The administration's recommendations for such a program are embodied in title II of the draft bill proposing a "Health Facilities and Training Amendments Act of 1960," whch was transmitted to the Congress by letter to the Speaker on June 2, 1960. This draft legislation is addressed to the improvement of the Nation's health resources in the critical areas of facilities for patient care and professional health manpower. It would revise, consolidate, and improve the hospital and medical facilities construction program now authorized by title VI of the Public Health Service Act; amend title VII of that act to authorize construction grants for teaching facilities to expand the training capacity in schools of medicine, dentistry, osteopathy, and public health; authorize a 5-year program of project grants to strengthen and expand graduate public health training; and authorize a program of debt service guarantee contracts to encourage and stimulate the development of group practice. Title II of the bill would authorize appropriations for construction in each of the fiscal years in the 5-year period, beginning July 1, 1960, and ending June 30, 1965, up to aggregate amounts of $75 million for schools of medicines, osteopathy, and public health, and $25 million for schools of dentistry. Grants would be available to help meet construction costs of new schools and for the portion of costs of construction at existing schools that is attributable to increased training capacity. Thus-and in contrast to the program proposed by H.R. 6906-the construction aid program we are recommending would be less costly and would be limited to the high priority needs of expanding existing schools and developing new schools. A second major difference in the approach taken by the administration proposal is indicated by the emphasis placed in title II of the draft bill on the role of State and regional and other interstate planning agencies. There can be little disagreement with either the need or the desirability for more energetic State action in the field of medical school planning and construction. These responsibilities-for sharing in the planning and financing of needed construction--are necessarily intimately related to responsibilities for the continued operation of these schools at an effective level, and for the development of programs to assure the most effective use of these costly teaching facilities and to afford to the youth of each State adequate training opportunities in these fields. For these reasons, we consider legislation along the lines of that proposed in title II of the proposed Health Facilities and Training Amendments Act of 1960, recommended by the administration, preferable to the type of program proposed by H.R. 6906. In consequence, we have made no comment on the specific provisions of that proposal. The Bureau of the Budget advises that it perceives no objection to the submission of this report to your committee. Sincerely yours, ARTHUR S. FLEMMING, Secretary. EXECUTIVE OFFICE OF THE PRESIDENT, Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, MY DEAR MR. CHAIRMAN: This is in reply to your requests for the views of the Bureau of the Budget on H.R. 6906, H.R. 10255, and H.R. 11651. All of these bills are addressed to the subject of aid to medical and dental schools either in the forms of construction grants as H.R. 6906, or grants for scholarships as H.R. 10255 and H.R. 11651. Because the purposes of these bills are similar we are commenting on them collectively. This administration has been concerned about the need for a continued supply of competent, well-trained physicians and dentists. The President, in his messages transmitting both the 1958 and 1959 budgets to the Congress, recognized the need for expanding the existing program of grants for the construction of health research facilities to include medical and dental teaching facilities as well. The Secretary of Health, Education, and Welfare has again submitted to the Congress a legislative proposal designed to meet the objective of assuring an adequate reservoir of trained medical manpower by assisting these institutions in constructing teaching facilities. The administration is opposed to proposals to authorize scholarship aid as set forth in H.R. 10255 and H.R. 11651. Aid is now available to students in need, including those attending medical and dental schools, through the student loan program of the National Defense Education Act. In addition, the priority of need for the training of competent medical and dental personnel lies in the expansion of the capacity of schools to permit an increased enrollment in these important fields, and in the establishment of new schools. This priority has been recognized in the legislative proposal which has been submitted by the Secretary of Health, Education, and Welfare. Therefore the Bureau of the Budget recommends against the enactment of H.R. 6906, H.R. 10255, and H.R. 11651 but urges the committee to give favorable consideration to the proposal submitted by the Secretary of Health, Education, and Welfare. Sincerely yours, PHILLIP S. HUGHES, Assistant Director for Legislative Reference. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Washington, June 3, 1960. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, Washington, D.C. DEAR MR. CHAIRMAN: This is in response to your request of February 12, 1960, for a report on H.R. 10255, a bill "to amend the Public Health Service Act to provide Federal assistance to States which award scholarships to students of medicine and dentistry." The bill would authorize appropriation of $5 million for the fiscal year 1961, and $10 million for the fiscal year 1962 and each of the next 8 years, for grants to States having approved plans for scholarships for medical and dental students. Sums appropriated each year would be allotted among States having such scholarship plans on the basis of population aged 20 to 24. Federal payments to a State from its allotment would equal one-half the total of the scholarship payments made by the State under its approved plan, with a ceiling of $2,500 per student per academic year for the period normally required to obtain a medical or dental degree and in no case for more than 4 years. Participating States would establish or designate an existing agency to serve as a State commission on medical and dental scholarships. Among other things, the State plan would be required to provide that any State resident who had been accepted by an accredited medical or dental school would be eligible to compete for a scholarship, that awards would be made only to fulltime students and (except for the qualifying condition of previous acceptance by a school) would be based solely on merit and financial need, that continued payments would be conditioned on a satisfactory scholastic record, and that, insofar as possible, 75 percent of the grant funds would be used for medical scholarships and 25 percent for dental scholarships. To advise and consult with the Surgeon General of the Public Health Service on the administration of the proposed "Medical and Dental Student Scholarship Act," the bill would establish an "Advisory Committee on Medical and Dental Scholarships." The Surgeon General would serve as chairman ex officio of the Advisory Committee; the other nine members would be appointed by him with the approval of the Secretary of Health, Education, and Welfare three would be persons recognized as authorities in the field of professional education, three would be teachers or practitioners of medicine, osteopathy, or dentistry, and three would be public members. Impending shortages of physicians and other professional health workers have been a continuing concern to this Department. To both the 84th and the 85th Congresses we recommended enactment of legislation which would authorize grants to assist in the construction of needed teaching facilities at schools of medicine, osteopathy, dentistry and public health. The urgent need to expand our medical school capacity has recently been reemphasized by the report of a committee of medical school consultants appointed by the Surgeon General. We are also fully aware of-and this same report of the consultant group strongly urged upon our attention—the extremely heavy expenditures, both of time and money, which are required of the student and his family in order to complete his medical education. Aside from the equalization of educational opportunities in medicine and dentistry, additional student aids in this field would have, we believe, important advantages for increasing numbers of applicants and for raising the quality of students enrolling. Not only will economic barriers be removed from the path of the specially qualified college graduate, but the schools' opportunities for student selection will be enlarged. The ratio of applications to first-year student places has remained fairly constant for the last 30 years except for the years when educational assistance was available to the returning veteran, when it rose to a peak of three applicants for each place. If we are successful in increasing the capacity of our schools significantly an adequate student-aid program will become of even greater importance. Already some schools report that they are experiencing difficulty in obtaining full enrollment by well-qualified students. Nevertheless, the general picture is not yet one of vacant places in medical schools. Therefore, in our view, the problem of expanding training capacity in the health professions has a prior claim on our attention and upon available Federal tax funds. Moreover, the institution of a program of direct grants for student assistance in this one field of basic professional training would establish a new precedent for Federal policy on higher education. Although there are a number of Federal programs which provide student support in advanced and specialized fields, including medical and other health fields these have been predicated, for the most part, on an acute national need for particular kinds of personnel and are designed as supporting measures for achieving other major program objectives. The recently inaugurated program to stimulate and assist institutions of higher education in the establishment and enlargement of funds for low-interest student loans, which was authorized by the National Defense Education Act of 1958, is directly addressed to the purpose of assisting needy students to complete a program of higher education in the fields of their choices. These loans are available to medical students as well as to students in other fields of higher education. Thus, it would be a major departure from established policy to begin a categorical program of Federal financial participation in scholarship grants to students in selected fields of basic training and, although the fields of training in question may be vitally important, we believe this course should be considered only after other possibilities for reducing the burdens of time and expense have been fully explored. For example, State, institutional and other scholarship and loan programs are expanding and there is increasing experimentation with ways of cutting down the period of time required for completion of the medical school curriculum. An additional factor for consideration is that experience has shown that substantial student incentives for enrollment in any particular field tend to divert students from competing, and equally important, fields of study in which they may have a major interest and a high capacity. This proposal is itself responsive to the existence of significant student aids for advanced work in selected scientific fields, including fields of science related to medicine. While the proposed scholarship aid program would, as intended, operate to redress the balance of enrollment incentives for basic training in medicine and dentistry, pressures for its extension to include other selected fields could be expected. For the reasons outlined above we recommend against enactment of H.R. 10255. The Bureau of the Budget advises that it perceives no objection to the submission of this report to your committee. Sincerely yours, ARTHUR S. FLEMMING, Secretary. |