MEDICAL CARE FOR THE AGED MONDAY, NOVEMBER 18, 1963 HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, Washington, D.C. The committee met at 10 a.m., pursuant to notice in the committee hearing room in the Longworth Building, Hon. Wilbur D. Mills (chairman of the committee) presiding. The CHAIRMAN. The committee will please be in order. The committee today begins 9 days of public hearings for the purpose of receiving testimony on the subject of medical care for the aged. As was stated in the press release which was issued announcing the hearings, the testimony will cover: (1) The adequacy of medical programs under existing law; (2) the extent and adequacy of coverage under private or nongovernmental health insurance programs; (3) the President's hospital insurance proposal, which is contained in H.R. 3920, which was introduced by the Honorable Cecil R. King of California, and (4) proposed alternatives. I wish to express appreciation to those witnesses who coordinated their testimony pursuant to our request contained in the press release. Without objection there will be included at this point in the hearings the press release of October 29 last, along with a copy of H.R. 3920, the administration proposal, and also a print of a brief comparison of major types of health insurance proposals pending before the committee and the Kerr-Mills Act dated November 14, 1963, with the understanding that other proposals if desired will be included in the record at the point to which they are referred. (The press release, bill, and comparison referred to follow :) CHAIRMAN WILBUR D. MILLS, DEMOCRAT, OF ARKANSAS, COMMITTEE ON WAYS AND MEANS, HOUSE OF REPRESENTATIVES, ANNOUNCES PUBLIC HEARINGS TO BEGIN OF THE SUBJECT OF MEDICAL CARE FOR THE AGED ON NOVEMBER 18, 1963 The Honorable Wilbur D. Mills, Democrat, of Arkansas, chairman, Committee on Ways and Means, U.S. House of Representatives, today announced that the Committee on Ways and Means has scheduled public hearings to begin on Monday, November 18, 1963, for the purpose of receiving testimony on the subject of medical care for the aged. The chairman stated that the hearings would include testimony on (1) the adequacy of medical programs under existing law (Kerr-Mills Act); (2) the extent and adequacy of coverage under private or nongovernmental health insurance programs; (3) the President's hospital insurance proposal, which is contained in H.R. 3920, which was introduced by the Honorable Cecil R. King of California; and (4) proposed alternatives. Chairman Mills stated that officials of the administration will be leadoff witnesses at the beginning of the hearings, to be followed by public witnesses. The hearings will be concluded no later than November 27, 1963. 27-166-64-pt. 1- -3 1 Chairman Mills emphasized that the committee was interested in receiving, in addition to whatever general views individuals and organizations may have, specific factual information, statistics, etc., which would be of assistance to the committee in evaulating the various aspects of existing programs, the President's proposal, private programs, and other alternatives which have been or may be suggested. In view of the very heavy schedule of the Committee on Ways and Means, it is essential that these hearings be expedited. To that end, the chairman urged that all persons and organizations with a similar interest consolidate their testimony and designate one spokesman so as to prevent needless and time-consuming repetition. This is required in order to enable the committee to make more adequate time allocation to witnesses who may want to express differing points of views. In the past it has been the experience of the committee that there have been numerous requests to be heard by many persons and groups representing the same interests wherein it appears that there would have been an undue amount of needlessly repetitious testimony since, in general, the position of many of these groups is the same on a particular subject-either supporting or opposing the legislation. Interested groups have cooperated with the committee in the past in avoiding time-consuming, needless repetition which does not add to the knowledge or understanding of the committee or the interested public. is again urged that groups interested in this legislation cooperate with the committee. It In the cases where there are differences within an organization or group, this fact should be pointed out in the request to be heard and the committee will undertake to schedule spokesmen representing the different points of view. It is emphasized that all persons who desire to do so will be permitted to file written statements in lieu of a personal appearance for the careful consideration of the committee. Such written statements of substance will be included in the printed record of the hearings. Three copies of such written statements should be submitted. Persons desiring to appear and testify before the committee should submit their request to Leo H. Irwin, Chief Counsel, Committee on Ways and Means, Room 1102, Longworth House Office Building, Washington, D.C., not later than the close of business November 13, 1963. To properly schedule witnesses and to allocate time if this has to be done, it will be necessary for the request to be heard to specify IMPORTANT (1) The name, address, and capacity in which the witness will appear and the group or persons he represents; (2) The amount of time the witness desires in which to present his direct oral testimony; and (3) Whether the witness, in general, supports or oppose the administration proposal. A witness cannot be properly scheduled unless the above information is submitted as a part of the request to be heard. Witnesses who are scheduled to appear will be notified as soon as possible after the termination date for receipt of requests to be heard-November 13, 1963. Witnesses who are scheduled to appear in person before the committee should, where possible, submit a minimum of 60 copies of their statement for the use of the committee members and staff at least 24 hours in advance of their scheduled appearance. If a witness also desires that his statement be made available to the press and the interested public, it is suggested that at least 60 additional copies be submitted for this purpose to the staff office, room 1102, Longworth House Office Building, on the witness' date of appearance. Persons submitting statements in lieu of an appearance may submit the number noted immediately above, if they desire the same distribution. These statements should be received by the committee by not later than the close of business November 27, 1963. It will be most helpful to the members and staff if the written statements contain subject headings on the subjects and points covered and a summary of comments and recommendations. [H.R. 3920, 88th Cong., 1st sess.] A BILL To provide under the social security program for payment for hospital and related services to aged beneficiaries Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Hospital Insurance Act of 1963". TABLE OF CONTENTS Sec. 2. Findings and declaration of purpose. Sec. 101. Benefits. TITLE I-HOSPITAL INSURANCE BENEFITS FOR THE AGED TITLE XVII-HOSPITAL INSURANCE BENEFITS FOR THE AGED Sec. 1703. Description of services. (a) Inpatient hospital services. (b) Skilled nursing facility services. (c) Home health services. (d) Outpatient hospital diagnostic services. (e) Drugs and biologicals. (f) Arrangements for certain services. Sec. 1704. Deductible; duration of services. (a) Deductible. (b) Duration of services. (c) Election as to duration of inpatient hospital services and deductible. (d) Benefit period. Sec. 1705. Entitlement to benefits. Sec. 1706. Definitions of providers of services. (a) Hospital. (b) Skilled nursing facility. (c) Home health agency. (d) Physician. (e) Utilization review. (f) Provider of services. (g) Skilled nursing facilities affiliated or under common con trol with hospitals. (h) States and United States. (1) Additional skilled nursing facilities. Sec. 1707. Use of State agencies and other organizations to develop conditions of participation for providers of services. Sec. 1708. Use of State agencies and other organizations to determine compliance by providers of services with conditions of participation. Sec. 1709. Conditions of and limitations on payment for services. Sec. 1710. (a) Requirement of requests and certifications. (b) Determination of costs of services. (c) Amount of payment for more expensive services. (d) Amount of payment where less expensive services furnished. (e) No payments to Federal providers of services. (f) Payment for emergency inpatient hospital services. (g) Payment for services prior to notification of noneligibility. Agreements with providers of services. Sec. 1711. Payment to providers of services. Sec. 1712. Health insurance benefits advisory council. Sec. 1713. Review of determinations. Sec. 1714. Overpayments to individuals. Sec. 1715. Use of private organizations to facilitate payment to providers of Sec. 1716. Option to individuals to obtain private health insurance protection. Sec. 1718. Applications of certain provisions of title II. Sec. 1719. Designation of organization or publication by name. Sec. 102. Federal Hospital Insurance Trust Fund. Sec. 103. Transitional provision for eligibility for presently uninsured individuals. (a) Definition of wages. (b) Definition of self-employment income. (c) Definitions of quarter and quarter of coverage. (d) Table for determining primary insurance amount. Sec. 105. Technical amendments. (a) Suspension in case of aliens. (b) Persons convicted of subversive activities. (c) Advisory Council on Social Security Financing. TITLE II-AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1954 Sec. 201. Changes in tax schedules. (a) Self-employment income tax. (c) Tax on employers. (d) Effective dates. Sec. 202. Increase in tax base. (a) Definition of self-employment income. (b) Definition of wages. (c) Federal service. (d) Returns in the case of governmental employees in Guam and American Samoa. (e) Special refunds of employment taxes. (f) Effective date. Sec. 203. Technical amendment. TITLE III-RAILROAD RETIREMENT AMENDMENTS Sec. 301. Hospital insurance benefits for the aged under the Railroad Retirement Act. (a) Hospital insurance benefits for the aged. (b) Amendment preserving relation between railroad retirement and oldage, survivors, disability, and health insurance systems. (c) Financial interchange between Railroad Retirement Account and Federal Hospital Insurance Trust Fund. TITLE IV-MISCELLANEOUS PROVISIONS Sec. 401. Studies and recommendations. FINDINGS AND DECLARATION OF PURPOSE SEC. 2. (a) The Congress hereby finds that (1) the heavy costs of hospital care and related health care are a grave threat to the security of aged individuals, (2) most of them are not able to qualify for and to afford private insurance adequately protecting them against such costs, (3) many of them are accordingly forced to apply for private or public aid, accentuating the financial difficulties of hospitals and private or public welfare agencies and the burdens on the general revenues, and (4) it is in the interest of the general welfare for financial burdens resulting from hospital services and related services required by these individuals to be met primarily through social insurance. (b) The purposes of this Act are (1) to provide aged individuals entitled to benefits under the old-age, survivors, and disability insurance system or the railroad retirement system with basic protection against the costs of inpatient hospital services, and to provide, in addition, as an alternative to inpatient hospital care, protection against the costs of certain skilled nursing facility services, home health services, and outpatient hospital diagnostic services; to utilize social insurance for financing the protection so provided; to encourage, and make it possible for, such individuals to purchase protection against other health costs by providing in such basic social insurance protection a set of benefits which can easily be supplemented by a State, private insurance, or other methods; to assure adequate and prompt payment on behalf of these individuals to the providers of these services; and to do these things in a manner consistent with the dignity and self-respect of each individual, without interfering in any way with the free choice of physicians or other health personnel or facilities by the individual, and without the exercise of any Federal supervision or control over the practice of medicine by any doctor or over the manner in which medical services are provided by any hospital; and (2) to provide such basic protection, financed from general revenues, to those persons who are now age 65 or over or who will reach age 65 within the next several years and who are not eligible for benefits under the oldage, survivors, and disability insurance or railroad retirement systems. (c) It is hereby declared to be the policy of the Congress that skilled nursing facility services for which payment may be made under this Act shall be utilized in lieu of inpatient hospital services where skilled nursing facility services would suffice in meeting the medical needs of the patient, and that home health services for which payment may be made under this Act shall be utilized in lieu of inpatient hospital or skilled nursing facility services where home health services would suffice. (d) It is further declared to be the policy of the Congress that no individual who receives aid or assistance (including medical or any other type of remedial care) under a State plan approved under title I, IV, X, XIV, or XVI of the Social Security Act shall receive less benefits or be otherwise disadvantaged by reason of the enactment of this Act. |