"(6) Payments to an individual under public or private retirement, annuity, endowment, or similar plans or programs equal to his contributions thereto;

"(7) Amounts equal to amounts paid by a widow or child of a deceased veteran for

“(A) his just debts,

66

(B) the expenses of his last illness, and

"(C) the expenses of his burial to the extent such expenses are not reimbursed under chapter 23 of this title;

"(8) Proceeds of fire insurance policies" (38 U.S.C. 503).

Veterans' hospital or domiciliary care and medical treatment

"(a) The Administrator, within the limits of the Veterans' Administration facilities, may furnish hospital care which he determines is needed to-* (1) (B) a veterans of any war for a non-service-connected disability if he is unable to defray the expenses of necessary hospital care" (38 U.S.C. 610(a)). NOTE. The determination of inability "to defray the expenses of necessary hospital care" is made under administrative regulations.

PART II. OTHER PROGRAMS FOR THE NEEDY

While these programs do not contain a means test as such, they are intended to help only the needy.

Indian health

"Hereafter the Secretary of the Interior is authorized, in his discretion and under such rules and regulations as he may prescribe, to make advances to old, disabled, or indigent Indian allottees, for their support, to remain a charge and lien against their land until paid; such advances for fiscal years after 1939 to be made from appropriations specifically available for such purposes" (25 U.S.C. 306(a)).

Surplus food programs

To prevent waste of commodities in private stocks or acquired through pricesupport operations by the Commodity Credit Corporation before they can be disposed of in normal domestic channels without impairment of the price-support program or sold abroad at competitive world prices, the law provides that:

"*** the Commodity Credit Corporation is authorized, on such terms and under such regulations as the Secretary of Agriculture may deem in the public interest: *** (3) in the case of food commodities to donate such commodities to the Bureau of Indian Affairs and to such State, Federal, or private agency or agencies as may be designated by the proper State or Federal authority and approved by the Secretary, for use in the United States in nonprofit school lunch programs, in nonprofit summer camps for children, in the assistance of needy persons, and in charitable institutions, including hospitals, to the extent that needy persons are served; * * *” (7 U.S.C. 1431). [Emphasis added.]

Under the food stamp program, the law provides for the distribution of surplus food commodities to needy persons in the United States. Food stamps are issued by the Secretary of Agriculture to welfare departments of States or political subdivisions requesting the distribution of surplus foods. The stamps are issued by the welfare department to needy persons who may redeem them for food at local distribution points.

A "needy person" is defined as follows:

"(f) For the purposes of this section, a needy person is anyone receiving welfare assistance (financial or otherwise) from the welfare department or equivalent agency of any State or political subdivision thereof, or who is, in the opinion of such agency or agencies, in need of welfare assistance but is ineligible to receive it because of State or local law" (7 U.S.C. 1695 (f)).

Maternal and child health services

The law authorizes appropriations "for the purpose of enabling each State to extend and improve, as far as practicable under the conditions in such State, services for promoting the health of mothers and children, especially in rural areas and in areas suffering from severe economic distress *" (42 U.S.C.

701).

This program, while not setting forth a means test, does require the State plan to "(7) provide for the development of demonstration services in needy areas and among groups in special need" (42 U.S.C. 703 (a) (7)).

Services for crippled children

While this program does not specifically require a means test, it may be assumed that priority is given to needy crippled children because of limitation of available funds.

The law authorizes appropriations "for the purpose of enabling each State to extend and improve (especially in rural areas and in areas suffering from severe economic distress), as far as practicable under the conditions in such State, services for locating crippled children, and for providing medical, surgical, corrective, and other services and care, and facilities for diagnosis, hospitalizaton, and aftercare, for chldren who are crippled or who are suffering from conditions which lead to crippling, * **" (42 U.S.C. 711).

Child welfare services

The law authorizes appropriations for the provision of child welfare services. "*** the term 'child welfare services' means public social services which supplement, or substitute for, parental care and supervision for the purpose of (1) preventing or remedying, or assisting in the solution of problems which may result in, the neglect, abuse, exploitation, or delinquency of children, (2) protecting and caring for homeless, dependent, or neglected children, (3) protecting and promoting the welfare of children of working mothers, and (4) otherwise protecting and promoting the welfare of children, including the strengthening of their own homes where possible or, where needed, the provision of adequate care of children away from their homes in foster family homes or day-care or other child-care facilities" (42 U.S.C. 728).

National Defense Education Act loan program

This program authorizes Federal grants to universities and colleges for the purpose of making loans to students: "(1) such a loan shall be made only to a student who (A) is in need of the amount of the loan to pursue a course of study at such institution, ***" (20 U.S.C. 425 (b) (1)).

Treatment of narcotic addicts

In providing treatment to narcotic addicts:

(b) *** Any such addict may be required to pay for his subsistence, care, and treatment at rates fixed by the Surgeon General and amounts so paid shall be covered into the Treasury of the United States to the credit of the appropriation from which the expenditure for his subsistence, care, and treatment was made. Appropriations available for the care and treatment of addicts admitted to a hospital of the Service under this section shall be available, subject to regulations, for paying the cost of transportation to any place within the continental United States, including subsistence allowance while traveling, for any indigent addict who is discharged as cured" (42 U.S.C. 260(b)).

PHS treatment of lepers

"The Service shall, in accordance with regulations, receive into any hospital of the Service suitable for his accommodation any person afflicted with leprosy who presents himself for care, detention, or treatment, or who may be apprehended under section 256 or 264 of this title, and any person afflicted with leprosy duly consigned to the care of the Service by the proper health authority of any State * When the transportation of any such person is undertaken for the protection of the public health the expense of such removal shall be met from funds available for the maintenance of hospitals of the Service. Such funds shall also be available, subject to regulations, for transportation of recovered indigent leper patients to their homes, including subsistence allowance while traveling * * *" (42 U.S.C. 255).

Dr. HALL. Again parenthetically in this connection, I also call your attention to an evaluation of one of these means test programs by HEW Secretary Celebrezze, aid to dependent children. The January issue of Parents' Magazine published an article by the Secretary in which he described this program in these words:

To millions of persons, over the years since AFDC began, the monthly check and the visits to a welfare worker have been a sign that the community did, indeed, care about them, and this knowledge has helped many a family retain self-respect and independence.

If the aid-to-dependent children program with its inherent means test has such noble virtues as these, why is the Kerr-Mills program, with much more generous eligibility requirements, considered undignified and degrading?

Further, I hold in my hand, evidence bordering on tampering on the part of HEW with hospital payments for care of the aging under Missouri's new Kerr-Mills Act and its prior program and its implementation.

Examples are given herein and I will be glad to make any one of them available to the committee.

Suffice it to say that both the director of welfare of Missouri and Missouri Hospital Association and individual hospitals are opposed to the new directive which precludes collecting or seeking to collect beyond the per diem allowance for the days authorized. This is done by regulation.

Finally, point 4, Mr. Chairman: I want to say that after my election to Congress I asked a group of doctors in the Seventh District of Missouri to assist me in the event that I received mail from any constituent which indicated that the constituent was unable to receive medical care because he could not afford it. I have not yet had to refer a single letter. I furthermore have made the same offer that I heard Mr. Curtis make here this morning. I have not yet had to refer a single letter, as I said.

Gentlemen, a Democratic colleague of mine, whom I hold in high esteem, from the great State of Tennessee, has had a very similar experience. I would like to conclude my remarks with this news article from the Memphis Press-Scimitar reporting on Congressman Everett's own medical referral plan.

EVERETT'S OWN MEDICARE PLAN-KERR-MILLS, PLUS REFERRAL SYSTEM WASHINGTON, June 21.-Representative Robert A. (Fats) Everett, of Union City, Tenn., has organized his own medical referral plan for indigent sick persons in his district.

Everett is opposed to the administration's pending King-Anderson plan to finance medical care for needy oldsters under social security.

He contends the existing Kerr-Mills program of grants to States to administer their own programs is preferable and should be given a fair trial.

"I met last fall," he recalled, "with doctors from northwest Tennessee and told them I didn't know how I was going to vote on the King-Anderson bill.

"I told them I'd had a number of complaints from constituents who said they needed treatment but couldn't afford it. The doctors, of course, opposed KingAnderson.

"So, at my insistence, they formed a committee in each of the district's nine counties, with the understanding that any time I had a complaint from a needy constituent I could refer him to the appropriate doctors' committee.

"Since that time I've had three or four complaints and have referred them to the physicians. These people have all been cared for. One man wrote me bragging about the fine service he got from the doctor to whom he had been referred. "If physicians would do something like this all over the State and the Nation, there wouldn't be any problem."

Everett said his mail indicates majority opposition to King-Anderson and approval of a fair trial for Kerr-Mills. Tennessee, he noted, is planning to liberalize its coverage under the Kerr-Mills program.

This ends the quotation from the Memphis paper.

I would say his experience has been very similar to my own.

I am pleased to have met with the committee today. I am glad to have added these four points.

I thank you for the opportunity and the attention, Mr. Chairman and colleagues.

The CHAIRMAN. Without objection, the material referred to by Dr. Hall on the next to the last page of his statement, the "Federal Programs Requiring Means Tests," will be included in the record at the point at which he referred to it.

What is that other information you had? Is that correspondence? Dr. HALL. This is personal correspondence from the executive director of the Missouri State Hospital Association, from members and executive directors of hospitals in my hometown. Telephone calls to the Department of HEW, statements by the director of welfare in the State of Missouri, concerning this new administrative memorandum that affects the noncollection of fees over and above the per diem allowed by the hospitals which is costing them much more than the 15 or 20 percent that hospitals usually expect to assume in caring for the per diem cases, Mr. Chairman. I would say the total amounts to

less than 12 pages.

The CHAIRMAN. Do you think anyone who has an opportunity to read the record and hear the statement which you made orally to the committee would be helped by this further information?

Dr. HALL. I think so. I will be glad to make it available.

The CHAIRMAN. Then you think it ought to be in the record, I assume?

Dr. HALL. I would so recommend.

Mr. KEOGH. Before that request is put, I think that I have difficulty following how it is pertinent to the pending bill. What is this, the matter of administration of the Kerr-Mills program?

The CHAIRMAN. Apparently it has to do with the OAA program as well.

Dr. HALL. That is correct. Both the OAA and MAA.

measure.

Mr. KEOGH. The OAA program is not before us in this pending I have grave doubts as to whether MAA is before us. The CHAIRMAN. The hearing before the committee, I might state to my friend from New York, is not on just the King-Anderson proposal by any means. As pointed out in the press release, that has been issued, it is on the subject matter of medical care of elderly citizens. If anyone has information that a department of Government is not performing as it should with respect to even the medical care of the OAA recipients, I would think we would want to know about that.

Mr. KEOGH. I think fairness would impel the committee to permit the department mentioned to respond to it.

The CHAIRMAN. We certainly want that. They will not be foreclosed.

But the open statement made by Dr. Hall, I think, from his own point of view and from the point of view of the facts of the situation, should be amplified by whatever evidence he has in hand.

Mr. KEOGH. I have not seen the letters. Therefore, I do not know whether they are talking of their personal knowledge or whether they are reporting that which some other people have told them.

Dr. HALL. Mr. Chairman, if I might be of some assistance; No. 1, let me say that the Department of Health, Education, and Welfare, by

my direct contacts, has been helpful in trying to straighten this difficult situation out.

No. 2, the exchange of correspondence does include their directives and their letters answering the situation and explaining the difficulty of bringing about an equitable and a just and a fair method of the participating hospitals collecting under the current situation as against the old situation.

Mr. KEOGH. Collecting for what?

Dr. HALL. Collecting for patient service care in hospitals.
Mr. KEOGH. Under what program?

Dr. HALL. Both the OAA and the MAA programs.

Mrs. GRIFFITHS. I want to ask a question.

The CHAIRMAN. Mrs. Griffiths is recognized.

Mr. CURTIS. I have an inquiry on the point of this going into the record.

I wish to make a parliamentary inquiry. The point I want to make is that the point of order relates to the pertinency of this material.

Mr. KEOGH. By suggesting you wished to propound the parliamentary inquiry, you took the lady from Michigan off her feet. That is what you wanted to do and you did it.

The CHAIRMAN. If the gentleman does not have a parliamentary inquiry, the Chair has recognized the lady from Michigan. Mr. CURTIS. I have a parliamentary inquiry.

Mr. KEOGH. I will make a point of order to it.

Mr. CURTIS. The parliamentary inquiry is the question of putting material in the record. There has been discussion on that parliamentary point. I want to discuss that parliamentary point.

I feel that did come under the parliamentary inquiry. Mrs. Griffiths indicated that she wanted to ask a question of the witness. Mr. KEOGH. The gentleman has not stated a parliamentary inquiry. The CHAIRMAN. Just a moment.

Mrs. Griffiths, do you have some questions?

Mrs. GRIFFITHS. I want to ask the witness some questions.

The CHAIRMAN. Let us dispose of this first. Is there objection to the inclusion in the record all the material which Dr. Hall suggests will be supplementary to his oral statement?

Mr. CURTIS. Reserving the right to object, Mr. Chairman, the point I would make on this in answer to the question whether it should be included. One of the very pertinent points of the legislation before us, as was brought out in the interrogation between Congressman Ullman and the witness from the American Hospital Association, is the question of how you work out the mechanics of payment and the difficulties that the hospital association people experience in these administrative problems.

This evidence relates in fact, Dr. Hall used the word "tampering"-to this problem, and, therefore, is evidence that I think this committee is most anxious to get and anything that bears in this general area.

The CHAIRMAN. Is there objection?

All right, submit the material to us if you will, and let us look it

over.

(The material referred to follows:)