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made in commenting on S. 978 when it was pending before the Senate committee. As our report indicates, we do not condition our no-objection position on this bill on a basic change in financing the medical care program for seamen. This is what in my opinion the Budget Bureau's report amounts to.

As I understand the Budget Bureau's report, it amounts to a statement that they would not object to the extension of coverage of the law to self-employed fishermen, if at the same time user charges were imposed on all seamen or the tonnage tax were increased to cover the cost of the whole medical care program for all seamen.

We do not believe that this bill needs to be tied into the question of financing for the whole medical care for seamen program, and so we are not in agreement with the Budget Bureau that the consideration of this bill involves the other question.

Mr. ROGERS of Florida. You are not in agreement with the Bureau of the Budget?

Mr. ELLENBOGEN. On this question.

Mr. ROGERS of Florida. Yes. All right. Thank you, Mr. Chair

man.

Mr. ROBERTS. Anything further, gentlemen?

Mr. NELSEN. No questions.

Mr. ROBERTS. Then the subcommittee will be in recess, subject to the call of the Chair and we wish to thank you, Mr. Edelman, and your associates, for your attendance here today.

Mr. EDELMAN. Thank you, sir.

(The following information was submitted for the record:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
December 11, 1963.

Hon. KENNETH A. ROBERTS,
Chairman, Subcommittee on Health and Safety, Committee on Interstate and
Foreign Commerrce, House of Representatives, Washington, D.C.
DEAR MR. CHAIRMAN: Enclosed herewith is draft language for committee
amendments to S. 978 as requested at the recent hearing before your subcom-
mittee on that bill and certain House bills.

There are also enclosed herewith an explanation of the bill as thus amended and, in accordance with a request made at the hearing, estimates as to the cost of extending eligibility to owners and coowners of vessels. The figures are broken down as between owners of fishing boats and owners of other boats. Sincerely yours,

WILBUR J. COHEN, Assistant Secretary.

ENCLOSURE 1

PROPOSED COMMITTEE AMENDMENTS TO S. 978

On line 6, strike out "or self-employed" and insert in lieu thereof "(or, in the case of a commercial fishing vessel, self-employed)".

On line 11, strike out "'or self-employed'" and insert in lieu thereof “‘(or, in the case of a commercial fishing vessel, self-employed)'".

ENCLOSURE 2

EXPLANATION OF PROPOSED COMMITTEE AMENDMENTS TO S. 978

The proposed committee amendments would strike out the words "or selfemployed" in the first section and section 2 of the bill and insert in lieu thereof, in each section "(or, in the case of a commercial fishing vessel, self-employed)". The purpose of this bill, as modified by the proposed committee amendments, is to restore to owners and coowners of U.S.-flag commercial fishing vessels, who perform seamen's services on board, the eligibility for medical care in hospitals,

outpatient clinics, and other medical facilities of the Public Health Service which was provided to them, de facto, before a 1954 amendment to the regulations under the Public Health Service Act.

An opinion of the Office of the General Counsel of the Department of Health, Education, and Welfare, issued in 1951, had interpreted the term "employed” in section 2 (h) and section 322 (a) (1) of the Public Health Service Act as excluding persons who are self-employed. After the General Counsel's Office, upon request for reconsideration, had adhered to its earlier opinion, the regulations were amended in 1954 so as to exclude from the term "seamen" "the owner or joint owners of a vessel [and] the spouse of any such owner."

Under the proposed committee amendments, self-employed individuals engaged on board a commercial fishing vessel in the types of activity described in section 2(h) of the Public Health Service Act will be considered "seamen," whether or not they are owners or coowners of the vessel. At the same time, self-employed persons on pleasure boats and other vessels that are not commercial fishing vessels would be excluded from coverage, whether or not such vessels are owned or charted by such persons. Thus, self-employed persons on vessels used for sport fishery, even though the vessel be one owned by a person commercially engaged in chartering such vessels to sport fishermen or taking sport fishermen on fishing trips for pay, would be excluded. The phrase "commercial fishing vessel" is, on the other hand, intended to include vessels engaged in the gathering of any form of either fresh water or marine animal life for commercial purposes, and will thus include vessels engaged in the commercial catching or harvesting of shrimp, lobsters, oysters, etc., as well as fish, if, as required by section 322 (a) (1) of the Public Health Service Act, the vessel is a U.S.-flag vessel "registered, enrolled, and licensed under the maritime laws of the United States, other than canal boats engaged in the coasting trade." (The bill would not enlarge the coverage of section 322 (b) of the Public Health Service Act which authorizes medical, surgical, dental, and hospital services to seamen on foreignflag vessels on a user charge basis.)

U.S. Government memorandum.

To: Mr. Robert T. Hollinger, legislative legal liaison officer.
From: Acting Chief, Division of Hospitals.

OCTOBER 28, 1963.

Subject: Estimated cost of providing medical and dental care to self-employed

seamen..

In accordance with your request, attached is an analysis of the estimated additional patient load and cost of providing medical and dental care to selfemployed seamen of commercial fishing boats and self-employed seamen of other than commercial fishing boats.

Mr. Walter H. Stolting, of the Bureau of Commercial Fisheries, Department of the Interior, was contacted for an estimate of the number of self-employed: seamen of commercial fishing boats. The 10,000 self-employed seamen of com-/ mercial fishing boats estimated by Mr. Stolting differs from the 11,000 pre viously estimated in that the 11,000 included noncommercial fishing boats. Mr. Clem Freeman, of the Bureau of Customs, was contacted for an estimate of all other self-employed seamen. He indicated that it was impossible to make an estimate of the number of self-employed seamen. He stated that there are aprpoximately 54,000 documented American-flag vessels (including fishing boats). He agreed that a figure of 5,000 self-employed seamen of other than commercial fishing boats appeared to be reasonable. Based on the above, the estimated patient loads and costs should be looked upon as only very rough estimates.

C. DUDLEY MILLER, M.D., Medical Director.

1 Sec. 2(h) defines "seamen" as including "any person employed on board in the care, preservation, or navigation of any vessel, or in the service, on board, of those engaged in such care, preservation. or navigation." Sec. 322 (a) (1) provides that "Seamen employed on vessels of the United States registered, enrolled, and licensed under the maritime laws thereof, other than canal boats engaged in the coasting trade" shall in accordance with regulations be entitled to medical, surgical, and dental treatment and hospitalization from the Service.

ESTIMATED COST FOR THE MEDICAL AND DENTAL CARE OF SELF-EMPLOYED SEAMEN

SELF-EMPLOYED SEAMEN OF COMMERCIAL FISHING BOATS

It is estimated that there are 10,000 self-employed seamen of commercial fishing boats. If these 10,000 self-employed seamen are made eligible for medical and dental care in Public Health Service hospitals and outpatient facilities, the number of American seamen PHS beneficiary group would increase from 117,500 to 127,500. The additional cost for their care would amount to $1,824,200. The following table shows the estimated increased patient load and cost which would result from the additional 10,000 self-employed seamen of commercial fishing boats:

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SELF-EMPLOYED SEAMEN OF OTHER THAN FISHING BOATS There is no information available as to the number of owners of vessels documented as American-flag ships and, therefore, it is very difficult to estimate the number of self-employed seamen on vessels other than commercial fishing boats. Based on a discussion with a representative of the Bureau of Customs, it is believed that a figure of 5,000 would be reasonable. The table below shows the estimated increase in patient load and cost which would result from the additional 5,000 self-employed seamen of other than commercial fishing boats:

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(Whereupon, at 10:55 a.m., the subcommittee recessed subject to

the call of the Chair.)

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INTERSTATE AND FOREIGN COMMERCE HOUSE OF REPRESENTATIVES

EIGHTY-EIGHTH CONGRESS

FIRST SESSION

ON

H.R. 133

A BILL TO AMEND TITLE III OF THE PUBLIC HEALTH SERVICE
ACT TO ESTABLISH A NATIONAL ACCIDENT

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