what funds would be allowed for the remainder of the year. wished not only to prevent the possibility of our fund being overexpended and therefore many bills to hospitals and physicians could not be paid. We certainly did not want that to develop.

I would like to compare it to the bankruptcy situation, where I am sure most persons would rather receive something than nothing. We also wish to give the legislature an opportunity to study this program.

In January there was an additional half million dollars of State funds transferred into the MAA program. It is under these funds that we are operating at the present time.

Mr. O'HARA. I believe your State and New York and Michigan have accounted for about 90 percent of the expenditures under the Kerr-Mills program in the last year. Is that correct?

Mr. SMITH. Yes, sir.

Mr. O'HARA. I know we are having problems in Michigan, in which I represent a congressional district. I hear more about the problems you would encounter. Our Governor recently testified that he felt the Kerr-Mills program created a number of very serious problems and that it was not performing as the officials of the State of Michigan, which was the first State to cooperate with the program as they had hoped it would.

Would that pretty much sum up your experience?

Mr. SMITH. That is certainly true. But I would like to make it clear, in returning to my first point, that a welfare department is not acclimated or trained or set up to administer a program of medical assistance of this proportion. That is one of the serious defects that we have found.

We do not have adequately staffed medical divisions.

We have a position that would pay $15,000 per year for a physician. We have been unable to fill that position. We must use consultants. Mrs. HANSEN. Would you venture to guess, of the type of administration desirable, what would be the cost to West Virginia?

Mr. SMITH. This is one of the problems when you are dealing through public assistance. While you receive sometimes 70-30 matching participation in your program cost, we, of course, must recognize that in actual experiences our administrative costs in public assistance will run about 60 percent State funds and 40 percent Federal, and MAA is the type of program which requires a great deal of administrative costs, because of the control and the high-paid personnel necessary to administer that type of program.

Chairman BAILEY. Would you say, Mr. Smith, that the inadequate appropriations, both from the Federal standpoint and that of the State, makes the Kerr-Mills bill unworkable?

Mr. SMITH. Let us face facts. If you have unlimited funds, you can make any type of program workable.

But let me say that in the State of West Virginia it would be extremely difficult to arrive at the amount of State money required to meet the adequate need of the number of people involved or potentially involved for such a program in the State of West Virginia.

For example, running a projection from our caseload, running up to November for next year, to run a program even similar to what we were running in November, would have required an expenditure of over $19 million.

As you know, about $5 million of that would have had to have been State funds. That was the projection as it grows. This is not shocking to anyone involved in public assistance or relief programs. This is always projected in this manner.

You will find that in any type of assistance program it will start very slowly and then will continue to grow as the information is projected through the community.

Chairman BAILEY. Would you say that the kind of a program that would adequately protect these people in this category of the aged and aging probably would have to have a more dependable base of financial support than has been available, depending on appropriations from Congress and the State legislature?

Mr. SMITH. We have always made our position clear on that, that this administration feels the social security approach is the soundest approach from a financial standpoint. There is another point we would like to make upon that, that at the present time of the needs test, the administrative cost involved in attempting to determine and to take out those persons who do not meet this needs qualification, we believe far outweighs the necessity for such a test.

Chairman BAILEY. There is a keen competition for State dollars, just like there are for Federal dollars, of course. Apparently your health situation is not to compete with Federal matching them 90 cents out of a hundred dollars on road appropriations.

Mr. SMITH. No.

Chairman BAILEY. The legislature are all roadbuilders and want to take advantage of that. A lot of your State funds are made available to match Federal appropriations for interstate highways and primary highways and secondary highways.

Then you have some competition from the schools and to a certain extent the question of health for the people of West Virginia, particularly in the category of the aged, has been somewhat neglected in West Virginia.

Mr. SMITH. This is another point I can bring out, Congressman Bailey, particularly from the southern part, in the most distressed areas of this State. We know in many instances had it not actually been for the MAA program or some type of State payment, many hospitals would not now be in existence in the southern part of the State.

In many instances, better than 50 percent of the income is from hospitals, and I am particularly referring to Logan County, were from payments from the department of welfare. They could not have kept their doors open and been able to serve the needier citizens of that community had it not been for some type of governmental program in that area.

I also have on file letters from physicians in those areas who also state they would have to move to other areas from which they could obtain income were it not for the payment from governmental sources.

Chairman BAILEY. I recall the instance of a hospital in the city of Bluefield that appeared before the Labor Committee under the Minimum Wage Act, asked to be excused on the ground they would have to close their doors if they had to pay the minimum wage.

Is that similar to other hospitals in the southern part of the State? Mr. SMITH. In the southern part of the State, with the exception of the United Mine Workers Hospital, most of them are on the complete borderline of closing up or operating.

For example, from many hospitals we will receive requests to hurry up the payments for MAA and our general medical programs so they can meet the payrolls for that given month. When we check it they are absolutely truthful. They are operating that close.

Chairman BAILEY. Then your recommendation would be that a more substantial finance base be established and you would suggest that the legislation would be based on participation in the social security system?

Mr. SMITH. We have always made our position clear on that.

Mr. ELLSWORTH. How many people are covered under the MAA program? You are paying out a million dollars a month, was it? Mr. SMITH. Yes.

Mr. ELLSWORTH. How many people are covered at that time?

Mr. SMITH. Very few more than are actually participating in services at the present time. We were treating in various months as high as 9,000 more than would receive some services.

I must explain this is the only way we will clarify it. When we have the figures of 32,000 eligible prior to December 1, this was when we were taking advance registration. If you were over 65 and met the qualification you could come in and register any time like you would in an insurance company, which I personally feel is the only way to operate a program of this type.

However, because of administrative time spent upon the program, we were forced to eliminate that. Now you apply for the services as you need them.

As I stated, prior to this time, at one time 51 percent of administrative work was done on this one program, which is a small program in the department of welfare.

Mr. ELLSWORTH. If my mathematics are right, you are spending more per month than your average payment on your public assistance program. Is that right? You are spending more per person on the MAA program for individuals than the average.

Mr. SMITH. The average, yes.

Mr. ELLSWORTH. You pay $31 on the average for old age and you are averaging over $40 for the other program. Is that correct? Mr. SMITH. No. Our average grants in old age assistance is $34.04 per month.

However, the old age assistance recipient is generally eligible for our medical program, not the MAA program.

In the general medical program our average cost per case at the present time is $7 per person. That has an interesting effect upon the expenses of the State of West Virginia. Since the initiation of the medical care for the aged program, the average cost per caseload on our general medical program has risen from $5 to better than $7, which is causing a tremendous increase from the expenditure of that fund.

Whether it is from the more knowledge of those services or whether it is of greater use, we cannot determine. But it has arisen alarmingly, I think, showing the need for increased services on these categories.

Mr. ELLSWORTH. So I can relate to this other testimony we have, what do you consider a case? How do vou define a case?

We get other figures per day and some per month.

Mr. SMITH. A case on MAA would be a treatment. If a person came in, went to receive treatment in a hospital or with a doctor, that would be a case within the terms I am referring to.

A case would be a person who spent a full 12 days in a hospital. It could also be one who spent 1 day.

Does that clarify it?

Mr. ELLSWORTH. For example, would it be a man with a chronic illness, which is what you will run into mostly?

Mr. SMITH. That is the point I tried to point out on my opening statement, that we do not cover, to the greatest extent. We have a very minute chronic program. Both the MAA program and the general medical program are limited exclusively to emergency

situations.

I may also point out in that relationship that many physicians and many hospitals tell me that it places them in an extremely difficult situation, that if a person comes into their office, over 65 years of age, and he says this is not an emergency situation, he knows full well we do not pay for that. In some cases, out of humanity, you must find out emergency situation.

Mr. ELLSWORTH. I missed that part of your opening situation. If a man comes in with a cold, a case is from the day let us say from an accident, and needs treatment, the case would be from the day he reports until he is released from that treatment?

Mr. SMITH. Yes.

Mrs. HANSEN. What do you do with a patient who needs long-term treatment, such as cancer or that type of illness?

Mr. SMITH. We have no program that would meet that need.

Mrs. HANSEN. What happens to him? Supposing a low-income person with no family is in this situation?

Mr. SMITH. The only thing that could be done is attempt to get on a private group or private aid, or some State hospital or Federal hospital. If the person could not get on one of those programs, there is a problem that should become and probably becomes a charity case of a physician or hospital.

Mrs. HANSEN. Are there any such private hospitals in West Virginia?

Mr. SMITH. No.

Mrs. HANSEN. How many veterans' hospitals are there?

Mr. SMITH. I know of at least two, but I am not sure of the number. Chairman BAILEY. We have, possibly, three. There is one in Huntington, one in Clarksburg, and the ambulatory at Martinsburg. Mr. SMITH. There is one at Beckley, also.

Chairman BAILEY. There are four of them.

We want to commend you for your informative statement, Mr. Smith. You make a good substitute for what we were expecting from Governor Barron.

Mr. SMITH. He sends his greetings from Japan.

Chairman BAILEY. I understood he was out of the country.

Mr. SMITH. Thank you. We have this statistical report for the record. I will supply it to you, if you desire.

Chairman BAILEY. Mr. Clerk, will you take it over and see that it is made available to the committee?

Mr. ELLSWORTH. Yes, sir.

1

Chairman BAILEY. Our next witness is Dr. Steger, president of the Ohio County Medical Association.

Doctor, come forward and be seated.

You might further identify yourself for the reporter and proceed with your statement.

STATEMENT OF DR. WILLIAM STEGER, PRESIDENT OF THE OHIO COUNTY MEDICAL SOCIETY

Dr. STEGER. My name is William Steger. I am the president of the Ohio County Medical Society.

Mr. Chairman, fellow members of your committee, and ladies and gentlemen, I have a prepared statement I would like to read. I might add that it is, in the opening paragraph, very similar to something that Dr. Kirkpatrick brought out, in that it is exceedingly difficult to separate these people into age groups. This is a factual report and, although we might be lost in a number of figures, if you will bear with me, I think they are important.

I think also they might answer some of the questions that have been asked.

The Ohio County Medical Society does not believe that the medical problems of the aged are unique to them but apply to all age groups. Surveys made available to the House Ways and Means Committee in 1961 indicate that the aged, as a group, are not in poor health. These people should not be arbitrarily segregated from the rest of the community at age 65 because the high quality of medical care in America not permits a majority of people reaching age 65 to anticipate a life expectancy of 15 more years.

In order to talk about the medical needs and medical care of our senior citizens, it is important to have an understanding of the medical care and the programs available to all age groups in the area, and indeed we are proud of our area.

In the Ohio County area, we have available for our citizenry prenatal clinics in the outpatient departments of both of our hospitals, Ohio Valley General and Wheeling Hospital, which are available to patients who are unable to pay. Subsequent hospitalization and delivery is provided without cost. In addition, facilities are available to patients who are unable to pay. Subsequent hospitalization and delivery is provided without cost. In addition, facilities are available for care of the unwed mother. Well-baby clinics are provided throughout various areas in the county which are controlled by our local city-county health department. Free inoculations are provided at these clinics and, in addition, facilities are provided in the local health department office in the city-county building for the inoculation and vaccination for the control of infectious diseases. This free service is provided to all individuals who are unable to pay. In addition, the health department provides a venereal disease clinic held weekly at one of our local hospitals.

Local public health nurses provide visits to the home for instruction and educational health purposes. Other community services are available such as the maintenance and use of an X-ray unit by the Ohio County Tuberculosis Association. Almost 3,000 chest X-rays were taken and were interpreted free of charge by several qualified