The enclosed statement on methods of arriving at policy decisions will presumably appear in the record at the point after Mr. Curtis' question rather than with my statement on H.R. 3920. Sincerely yours, IRVIN P. SCHLOSS, Legislative Analyst, Washington Office. PROCEDURE FOR DEVELOPING SOCIAL POLICY POSITIONS The American Foundation for the Blind is the national voluntary research and consultant agency in the field of services to blind persons. On its staff are specialists in various areas of these services who are called upon by State and local, public and voluntary, agencies for the blind for specialized consultative services in the development of programs. Also, the foundation's regional representatives routinely contact a substantial number each year of the more than 500 agencies for the blind throughout the country. In addition, the Foundation's research staff stimulates and itself conducts various types of studies designed to develop authoritative information about the characteristics of the blind population of the United States, their special needs, and ways of meeting these needs. As a result of collective staff experience and observation in localities throughout the country, demographic studies stimulated or conducted by our research staff, and special institutes and seminars conducted by or participated in by various staff members, consensus positions as to the needs of blind persons and the most effective ways of meeting these needs are developed. Inasmuch as some of these needs can best be met through national public programs rather than voluntary effort, this same procedure is applicable to questions involving public social policy in meeting human needs. As a result of many years of collective staff experience in studying the needs of the elderly blind and severely visually impaired population of the country, the American Foundation for the Blind came to the inescapable conclusion that a uniform national program utilizing the Federal social insurance system would be the most effective way of assisting these individuals to meet the high cost of adequate health care. Therefore, the foundation urged favorable action by the Congress on H.R. 3920. COUNCIL OF JEWISH FEDERATIONS AND WELFARE FUNDS, INC., Mr. LEON H. IRWIN, Chief Counsel, Ways and Means Committee, House of Representatives, (Attention of Mrs. Kagan.) DEAR MR. IRWIN: At the request of Congressman Thomas B. Curtis, I submit the following information regarding the statement presented by Elizabeth Wickenden in behalf of several national welfare organizations, including our own, during her appearance before the hearings of the House Ways and Means Committee on the subject of medical care for the aged on November 20, 1963. The Council of Jewish Federations and Welfare Funds is the national association of 218 central Jewish community organizations responsible for financing and planning virtually all types of health and welfare services. These include general and specialized hospitals; homes for the aged; family service agencies, a large part of whose caseload are the aged; vocational service agencies, a number of which provide rehabilitative and retraining assistance to the aged. Our position on meeting the costs for the medical care of the aged was adopted by the delegates to our annual general assembly meeting on November 18, 1962, and reaffirmed by the general assembly meeting on November 10, 1963. The general assembly is the governing body of our organization, consisting of delegates chosen by our member community organizations. The action by our assembly followed the consideration and recommendation by our board of directors. public welfare committee, and health services committee. Over 1,000 leaders of Jewish federations and their affiliated agencies participate in the assembly. The position, as you know, supports the principle of Federal legislation to meet the costs of "medical care for the aged through the mechanism of the old age and survivors insurance program, while making adequate provision for those persons not so covered." Sincerely yours, PHILIP BERNSTEIN, Executive Director. YOUNG WOMEN'S CHRISTIAN ASSOCIATION OF THE U.S.A., Hon. WILBUR MILLS, Chairman, Ways and Means Committee, Washington, D.C.: YWCA, NATIONAL BOARD OF THE New York, N.Y., February 11, 1963.. In connection with Representative Curtis' request of Miss Wickenden on November 20 when she testified on health care for the aged, I am summarizing briefly the way in which the national YWCA adopts its policy and acts on public affairs matters: The national convention of the YWCA votes policies and guiding principles which provide the framework and directive for national board action. The national board has a mandate to implement convention action. Local associations are autonomous and take such action as their study and conviction lead them to. Sincerely yours, ETHLYN CHRISTENSEN, Executive Secretary, National Public Affairs Committee. NATIONAL CONFERENCE OF CATHOLIC CHARITIES, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. MILLS: I have been informed that a member of the House Ways and Means Committee, Congressman Curtis, has asked for a statement on the manner in which organizations arrive at policy positions, with special reference to proposals concerning medical care for the aging. In the case of the National Conference of Catholic Charities, suggestions may emerge from any of its constituent groups or from individual members. By constituent groups I refer to the conference of religious, made up of the Sisters who administer most of our institutions. The second constituent group is the priest directors of Catholic charities, comprised of professionally trained clergymen who administer the social agencies which make up Catholic charities. These groups, working through their own executive committees, can present recommendations to the board of directors of the National Conference of Catholic Charities, which meets semiannually. Individual members have this same opportunity either via the mail or during the course of the annual business meeting of the National Conference of Catholic Charities in the fall of each year. Material thus submitted is considered by the board of directors of the National Conference of Catholic Charities which is comprised of 31 members of the laity, clergy, and religious who make up the national conference. If material thus submitted needs additional study, it is referred to a committee. If it is feasible to do so, the board may act without such additional consultation. In the matter of meeting the medical needs of the aging, a member of the board of directors proposed that a position should be taken with regard to this problem. The board, in formal session, considered it at length and voted to endorse the contributory method of financing medical needs, by payroll deduction, after the social security method. Following the action of the board, its motion was endorsed by the separate constituent groups so that it, in truth, represents the position of the entire membership of the National Conference of Catholic Charities. We appreciate the sincerity which prompted Mr. Curtis to seek this information. It is only by methods such as this that we can come to an appreciation of the full meaning of statements that are made before him. With kindest regards, I remain, Sincerely yours, Rt. Rev. Msgr. RAYMOND J. GALLAGHER, Secretary. NATIONAL FEDERATION OF SETTLEMENTS & NEIGHBORHOOD CENTERS, Hon. WILBUR D. MILLS, Chairman, Ways and Means Committee, House of Representatives, Washington, D.C. MY DEAR CONGRESSMAN: In response to the question put to Elizabeth Wickenden by Congressman Curtis on November 20 at a hearing before your committee, we submit the following information: The National Federation of Settlements & Neighborhood Centers is composed of 264 affiliates, operating 356 neighborhood centers in 88 cities and 31 States and the District of Columbia. The National Federation of Settlements & Neighborhood Centers supports H.R. 3920, Hospital Insurance Act of 1963, on the basis of the resolution adopted at its delegates' annual business meeting in Boston, June 1960, as follows: "The National Federation of Settlements & Neighborhood Centers believes that communities must assure to all their citizens full access to the best possible preventive treatment, and rehabilitative services known to modern health sciences. It therefore supports a comprehensive program of health insurance through the social security system with supplementary programs for nonparticipants in the social security system with no means test." If you wish further information on this subject, please let us know. GLADYS DUPPSTADT, Secretary for Social Education and Action. The committee will have to momentarily recess. We will be back as soon as we respond to the call for a record vote. Our first witness will be Mr. Adams. Mr. Adams, will you remain in the room? We will be back in just a few minutes. (Short recess.) Mr. GREEN (presiding). Mr. Adams, you may proceed. STATEMENT OF ARLIN M. ADAMS, SECRETARY OF PUBLIC Mr. ADAMS. My name is Arlin M. Adams. I am secretary of Public Welfare for the Commonwealth of Pennsylvania. It is a great pleasure to appear before you to tell you about our program of medical assistance to the aged. In Pennsylvania we have responsible and deep concern for the health and human services needs of all of our citizens. This is particularly true for our older people. Public Law 86-778, the Kerr-Mills law, made it possible for us to fulfill our responsibility more adequately. While we recognize that our program under the law is not complete, we extended it in 1963 and hope to improve it even further. Our MAA program began January 1, 1962. In September of 1963 we broadened the scope of the program, revising the eligibility requirements to the extent that we believe they are now the most liberal in the Nation. WHO IS ELIGIBLE IN PENNSYLVANIA? The following income and assets may be held without affecting the eligibility or the amount of the MAA payments: A single individual or one not living with spouse may have: Gross annual income up to $2,400; home, household furnishings, and car; insurance, cash surrender value up to $500; and other property, net value up to $2,400. A married individual living with his or her spouse may have: A combined gross annual income up to $3,840; home, household furnishings, and car; insurance, cash surrender value up to $500 each, and husband's and wife's other property combined, net value up to $3,840. If the income or property exceed the above limits, one-half the excess income and all the excess other property are to be used by the individual to pay for the MAA care received. You can see that the figures I have read do not constitute absolute limits. The individual is not restricted by law or regulation with respect to his use of income and property within the above limits, including the payment for physician's services. Our 1963 legislation further liberalized the MAA program by deleting from the Pennsylvania support law all reference to recovery from the individual's property for any of the services for which payment was correctly made. Of singular importance in determining eligibility for MAA is that part of our State's support law which spells out the extent to which spouses, living apart from the applicant, and sons and daughters have a responsibility for helping the individual meet his medical care costs if the relative is financially able. Effective September 24, 1963, the Department decreased the amount required from the relatives and it is currently studying the effects of this liberalization in this regard-and complete elimination of the relatives' responsibility provisions. Another improvement in our MAA legislation authorized the Department to determine eligibility at the time of application, without regard to the applicant's health condition at the time. Current regulations provide for issuance of a certificate of application to an eligible applicant which is valid for 12 months. It is our judgment that identifying the individual as a potential recipient of MAA on presentation of an identification card will facilitate giving more prompt service. It will provide more effective coordination between the vendors and the Department. Since September 24 through October this change has resulted in 1,469 applications prior to the onset of illness. The assembly also added posthospital nursing home care to the benefits under MAA. WHAT BENEFITS ARE PROVIDED? Pennsylvania's current MAA program pays for the following medi care: Inpatient hospital care for up to 60 days during a benefit period. This period of hospitalization is continuous or intermittent. A new benefit period starts after 60 uninterrupted days of nonhospitalization. Thus an individual could be eligible to receive 180 days of hospitalization during a 12-month period. The daily rate of payment is based upon the average per patient per diem operating costs, but not to exceed $25. Posthospital care in a private nursing home for up to 60 days during a 12-month period, provided the individual entered a nursing home within 5 days after he was discharged from inpatient hospital care as an MAA beneficiary. The daily rate of payment is based on the rates established for public assistance recipients, and depends on the type of care the particular nursing home is equipped to provide. Visiting nurse service in the home as prescribed by the individual's physician. For the first 4 weeks of this type of care, the program provides for as many visits as the person's condition requires. After the first 4 weeks of care, payment is limited to a monthly maximum of 12 visits. The rate of payment per visit is the minimum charge not to exceed $4, plus mileage under specified circumstances. Posthospital care furnished in the individual's home by a hospital, under an organized home medical care program. This consists of medical care in the home by a hospital team of physician, nurse, therapist, and social worker. The program includes nursing service, medications, sickroom equipment, laboratory service, physician's supervision, physical therapy, etc. The posthospital care the individual had been receiving in the home must be an uninterrupted continuation of the inpatient hospital care the individual had been receiving. Need for medical care under this program must be reviewed at least every 3 months. We pay the actual daily cost up to $5 for the service for every day the patient is in the program. Public nursing home care in county institutions. Nursing home care must be prescribed by a physician. Full cost is paid. Pennsylvania's MAA program does not pay for services by physicians, dentists, chiropodists, for outpatient hospital services, drugs, or applicances. HOW MANY PEOPLE HAVE BEEN SERVED AND HOW MUCH HAS IT COST? The MAA program has been in effect in Pennsylvania for 22 full months. During this period approximately 79,000 persons applied for care. Of the 79,000 applications, 66,000 were for inpatient hospital care and 8,000 for public nursing home care. Approximately 56,000 applications were approved for payment, including 45,000 for inpatient hospital care. MAA expenditures of Federal and State funds in these 22 months totaled $26,389,435; for inpatient hospital care $16,091,755; for public nursing home care $10,070,169; and the remaining $227,511 for nursing care in the home and home-hospital care. The payment for inpatient hospital care is the cost for the care provided approximately 36,000 patients. The difference between this 36,000 and the 45,000 approved for payment reflects the lag between applications approved and payments. In addition, the fact that an application is approved does not mean that a payment will be made. Pennsylvania's partnership with the Federal Government under Kerr-Mills has made it possible to provide hospital and certain other health care to older persons who are least equipped financially to pay. Our aged population is becoming increasingly aware of the objectives of the MAA program and are learning to use it. The hospitals and the medical profession are helping by cooperating in educational campaigns. We believe that the liberalization in the Department's support regulations and the deletion of recovery from property will lead to an increase in the number of persons who make use of the program. In fact, it has been estimated that with the 1963 changes in |