Page images
PDF
EPUB

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
Washington, D.C., March 23, 1966.

Hon. HARLEY O. STAGGERS,

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This is in response to your request of February 4, 1966, for a report on H. R. 13196, the Allied Health Professions Personnel Training Act of 1966.

This bill embodies the provisions of a draft bill transmitted by us to the Congress in order to carry out the recommendations on assistance for training in the allied health professions contained in the President's message to the Congress on domestic health and education.

A more detailed justification for this legislative proposal will be presented in testimony before your committee.

We urge that your committee give favorable consideration to this bill and that it be enacted by the Congress.

Sincerely,

WILBUR J. COHEN, Under Secretary.

U.S. DEPARTMENT OF LABOR,

Hon. HARLEY O. STAGGERS,

OFFICE OF THE SECRETARY, Washington, D.C., March 24, 1966.

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This is in response to your request for the views of the Department of Labor on H.R. 13196, the "Allied Health Professions Personnel Training Act of 1966."

The Department of Labor strongly favors measures which would help in meeting the critical and growing shortage of medical services in our Nation. H.R. 13196 is designed to help meet this important need and is intended to carry out some of the recommendations made by President Johnson in his March 1, 1966, domestic health and education message to the Congress.

We note with approval that the bill appropriately protects the working standards of laborers and mechanics employed on projects authorized under its terms. The Bureau of the Budget advises that there is no objection from the standpoint of the administration's program to the submission of this report. Sincerely,

Hon. HARLEY O. STAGGERS,

W. WILLARD WIRTZ,
Secretary of Labor.

DEPARTMENT OF THE NAVY,
OFFICE OF LEGISLATIVE AFFAIRS,
Washington, D.C., March 28, 1966.

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D.C.

MY DEAR MR. CHAIRMAN: Your request for comment on H. R. 13196, a bill to amend the Public Health Service Act to increase the opportunities for training of medical technologists and personnel in other allied health professions, to improve the educational quality of the schools training such allied health professions personnel, and to strengthen and improve the existing student loan programs for medical, osteopathic, dental, podiatry, pharmacy, optometric, and nursing students, and for other purposes, has been assigned to this Department by the Secretary of Defense for the preparation of a report thereon expressing the views of the Department of Defense.

This bill would amend the Public Health Service Act to increase the opportunities for training of medical technologists and personnel in other allied health professions. It would provide for grants for new construction or rehabilitation or improvement of existing training centers, and improvement of the educational quality of the schools training such personnel. It would further improve the existing loan programs for students of medicine, osteopathy, dentistry, pharmacy, podiatry, optometry, and nursing.

The Department of the Navy, on behalf ot the Department of Defense, would have no objection to the enactment of H. R. 13196; however, we would defer to the

62-707-66-2

Department of Health, Education, and Welfare as the agency having primary interest in the bill.

This report has been coordinated within the Department of Defense in accordance with procedures prescribed by the Secretary of Defense.

The Bureau of the Budget advises that, from the standpoint of the administration's program, there is no objection to the presentation of this report for the consideration of the committee.

[blocks in formation]

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives.

DEAR MR. CHAIRMAN: This is in response to your request of March 7, 1966, for a report of our Office on H.R. 13196.

Al

The bill would provide assistance to colleges and universities with training programs in the allied health professions by authorizing grants for (1) construction of teaching facilities for allied health professions personnel, (2) basic and special improvements in the quality of training centers, (3) traineeships for advanced training of allied health professions personnel, and (4) development of new training methods. It also would amend portions of the Health Professions Educational Assistance Act of 1963, the Nurse Training Act of 1964, and the Higher Education Act of 1965 relating to educational loans to students pursuing a full-time course of study leading to a degree in medicine, dentistry, osteopathy, pharmacy, podiatry, or nursing, encourage the use of private capital for student loans, and establish revolving funds for the health professions and nursing student loan programs. Section 2 of the bill would amend title VII of the Public Health Service Act by adding a new part G which provides grants for construction (sec. 791) and for improvement of the quality of teaching and training facilities (sec. 792). though these sections authorize appropriations to carry out the legislation they do not specify the amount of funds authorized to be appropriated for each of the programs. Also, sections 793 and 794 of the bill, providing grants for advanced training of health professions personnel and development of new curriculums, respectively, do not specify the amount of funds to be appropriated. The above-cited sections of the bill do not contain a specific requirement for the maintenance of accounting records by grant recipients, except for section 792, and for access to such records for audit purposes. The committee may wish to amend the bill to establish the amounts to be authorized for each of the programs, and to include a provision for access to records and audits. On the latter point we suggest inclusion in the bill of language similar to that contained in section 304 of the Clean Air Act, approved December 17, 1963, Public Law 88-206, which requires maintenance of prescribed records and that access to such records be afforded to the Secretary of Health, Education, and Welfare and the Comptroller General, or their duly authorized representatives, for the purposes of audit and examination. See, also, section 909 of the Public Health Service Act, as added by Phblic Law 89-239.

Section 4 of the bill would amend titles VII and VIII of the Public Health Service Act to increase the annual loan cancellation percentage for physicians who choose to practice in rural areas and to make an additional 50 percent for a total of 100 percent of the loan eligible for cancellation. To encourage students to obtain new loans or to refinance existing student loans with loans from private lending institutions insured under the Higher Education Act, this section would further provide loan reimbursement payments. These reimbursement payments would be comparable to the loan cancellation privilege available under the Public Health Service health professions and nursing loan programs. According to information on the bill furnished to us by Public Health Service officials, the reason for encouraging the transfer and refinancing of student loans and the making of new loans under the insured program of the Higher Education Act is to substitute the use of private funds for direct Federal appropriations which would also result in additional funds being available in the student loan programs for the health professions and nursing loans.

Under the loan provisions of the Health Professions Educational Assistance Act (sec. 741(e)) and the Nurse Training Act (sec. 823 (b)(5)), the interest rate which may be charged the borrower is limited to 3 percent per annum or the going Federal rate (as defined in the acts) at the time the loan is made, whichever rate is the greater. Under the Higher Education Act (sec. 428 (a)(2)) the Federal Government pays the first 3 percent of the interest due on the borrower's loan. Therefore, the refinancing of existing loans and the making of new loans under the Higher Education Act will result in increased net interest costs to the Government. Also, increased administrative costs can be expected in connection with loan refinancing_transactions.

Sections 5, 6, and 7 of the bill would amend existing title VII and title VIII of the Public Health Service Act to encourage the use of private or other nonFederal funds to meet student loan needs by allowing the Secretary of Health, Education, and Welfare to (1) guarantee timely repayment of funds borrowed from private institutions, (2) reimburse the school for up to 90 percent of losses on loan defaults, and (3) make payments to the school for the difference between the interest payments received from student loans and the interest which the school or a student-assistance organization pays to borrow the funds. Moreover, the proposed legislation would authorize the Secretary, Health, Education, and Welfare with certain exceptions to guarantee and subsidize interest paid on a bank loan made to any student on the same terms as if made under one of the federally supported loan programs. Since the interest rates charged by private lenders probably would be higher than those provided for loans made from student loan funds, the Government may incur greater costs for the interest differential than would be incurred if appropriated funds were used for loan-making purposes.

The bill would provide no criteria by which consideration would be given to the financial ability of the student or his family in determining whether all or a portion of the interest differential should be subsidized. The committee may wish to consider criteria for inclusion in the bill similar to that stipulated as a condition for student loans under section 428(a)(1)(C) of the Higher Education Act.

The bill would create two revolving funds for the purpose of financing loans to students under titles VII and VIII, respectively, of the Public Health Service Act. These funds would be used to make deposits into student loan funds at those schools which are unable, for legal or other reasons, to take advantage of private capital with Federal assistance. The use of revolving funds to finance activities under the pertinent provisions of the bill would represent a departure from the regular annual review and affirmative action through the budgetary and appropriation processes and, accordingly, would result in a lessening of congressional control. Whether adequate justification exists for this departure we are not in a position to state, but suggest the matter be fully evaluated in the consideration of this bill.

We note the bill would provide no limitation on the total amount of deposits into student loan funds which could be outstanding at any one time. If the revolving fund provisions are retained in the bill, the committee may wish to consider the desirability of establishing such limitations.

Also, under the proposed legislation student notes would be assigned to the Secretary who could sell participations in obligations so acquired (through the Federal National Mortgage Association or otherwise) to secure capital funds from the private market for deposit in the revolving funds. In effect, the Secretary, Health, Education, and Welfare, would be authorized to borrow funds directly from the public to finance a portion of its student loan operations without showing such borrowings as part of the public debt. Also, since the bill provides that if at any time the Secretary determines that moneys in the funds exceed the requirements of the funds, such excess shall be transferred to the general fund of the Treasury, funds could become available for use for general Government purposes from borrowings not shown as part of the public debt.

The rate of interest which would be paid by the Secretary on the participation obligations would be dependent on market conditions at the time the loan obligations are offered for sale. Consequently, it is not determinable at this time to what extent, if any, the interest costs of financing through the issuance of participation obligations would exceed the interest cost of financing through congressional appropriations and the related public debt obligations. However, to the extent that the interest rates on the participation obligations may be larger than the interest rate on public debt issues having comparable maturity, there would be added cost to the Government.

In reports to the Congress on our audits of the Export-Import Bank of Washington for the fiscal years 1962, 1963, and 1964, we described sales by the ExportImport Bank of participation certificates to commercial banks. The interest rates on the participation certificates sold in fiscal years 1962 and 1964 were at least one-fourth of 1 percent higher than the interest rates on Treasury securities with comparable maturities issued at a comparable time. However, the interest rate on the participation certificates sold in fiscal year 1963 were about the same as the interest rates on Treasury securities with comparable maturities.

Section 3(a) of the bill proposes an amendment to section 725(c) of the Public Health Service Act. It appears the reference should be to section 725(d). The last line in section 7 of the bill cites section 428(c)(1)(A) of the Higher Education Act of 1965, but the reference should be section 428(b) (1) (A). We have no other comment or recommendation to offer.

Sincerely yours,

FRANK H. WEITZEL,

Assistant Comptroller General of the United States.

The CHAIRMAN. When you stop to think about it, optimum use of present day medical knowledge could cut the death rate in half. That is how important the bill is. In the face of medical capabilities today, poor health is the greatest disgrace to our vaunted American regard for the human welfare.

It has been said that disease causes more hospitalization of our fighting men in Vietnam than wounds. It has been said that the ratio is 4 to 1 on the casualty lists.

I am glad to see that our Secretary of Health, Education, and Welfare and our Surgeon General are both back from Saigon safely. We welcome you back. We are glad to have you at the hearings. They must have decided, Dr. Stewart, that they did not need doctors so badly or they would not have let you come home.

Our first witness this morning will be the Secretary of Health, Education, and Welfare, Hon. John W. Gardner.

STATEMENT OF HON. JOHN W. GARDNER, SECRETARY OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. WILLIAM STEWART, THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE; DR. PHILIP LEE, ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS; AND JAMES KELLY, COMPTROLLER Secretary GARDNER. Mr. Chairman, members of the committee, I am happy to appear here today to express the Department's strong and enthusiastic support for H.R. 13196, the proposed "Allied Health Professions Personnel Training Act of 1966," introduced by the distinguished chairman of this committee, Mr. Staggers.

Mr. Chairman, in the past 3 years the Congress has enacted a number of major pieces of health legislation that will contribute significantly to improvement in the quantity and quality of our health

manpower resources.

Most of this legislation came from this committee. You have written into law the Health Professions Assistance Act of 1963 and the 1965 amendments; the Nurse Training Act of 1964; the Heart, Cancer, and Stroke Amendments of 1965, and other important

measures.

Under the Health Professions Educational Assistance Act of 1963, and the 1965 amendments, and under the Nurse Training Act of 1964, steps are being taken to narrow the gap between the supply and demand for physicians, dentists, nurses, optometrists, podiatrists, and

pharmacists. Grants under these programs to date will result in the addition of 885 new first year places in medical schools, 372 new places in dental schools, and 1,125 new places in nursing schools.

Every one of these new health laws was a major step forward, and a necessary one-necessary because as a nation we are committed to nothing less than providing the very best in health care to every American.

The extent and complexity of that commitment requires that we utilize all of our health resources as efficiently and effectively as possible.

H.R. 13196 is one step toward that end. It is one part of our overall approach to the complex and changing health care picture. It would carry out one of three major health proposals made by the President in his March 1 message on domestic health and education. Those recommendations related to modernizing obsolete health care facilities; revitalizing State and local public health services, and training highly qualified people in the allied health professions.

It is, of course, toward this last objective that H.R. 13196 is directed. The goal would be to meet a growing need for supervisors of subprofessional workers, for teachers in the allied health professions, for highly skilled technical specialists and for new types of allied health professionals.

The

The proposed legislation would authorize a 3-year program to provide Federal assistance to schools and students for the expansion and improvement of baccalaureate and advanced degree training. bill also extends additional loan forgiveness to doctors practicing in poor rural areas.

And it provides for conversion of the health professions and nurses student loan programs to a more flexible approach allowing both Federal subsidy and guarantee of privately financed loans as well as direct Federal loans.

Mr. Chairman, the demand for health care in this country is growing, and will continue to grow, and here are some indicators.

The annual expenditure on health and medical services in this country increased from $13 billion in 1950 and $27 billion in 1960 to approximately $40 billion last year. Private spending for personal health care in this country in 1965 was more than $26 billion-about 6.1 percent of personal consumption expenditures.

Many factors are at work to enlarge the demand: rising incomes, better education, urbanization, population growth, the changing age structure of the population, and new mechanisms of payment for services, including private insurance coverage and public programs. Although physicians, dentists, and nurses form the nucleus of the health manpower team, we rely for services on an increasing number and variety of other health workers. There is a need for allied health professionals to extend the reach of services, both in terms of quantity and quality that can be provided by physicians and dentists. There is a need for a virtual army of health workers at the subprofessional level who will require training and supervision to provide needed services.

Within the past 3 years, public or private agencies in many States have published studies pointing to shortages of health manpower, and the need for new and expanded training facilities.

« PreviousContinue »