tions for these two additional programs for maternal and child health services and crippled children's services should likewise be increased from the present $25 million to $50 million by 1971. Dr. Martha Eliot, who is vice chairman of the American Parents Committee and is professor of maternal and child health emerita of the School of Public Health of Harvard University and the former Chief of the U.S. Children's Bureau, has drafted an amendment to this effect.

(2) Dr. Eliot has also proposed another amendment which the APC also endorses. This other amendment is to provide a new program of grants to the States to enable the States to assist large cities (100,000 population and over) to extend and improve their maternal and child health and crippled children's services. The authorization for appropriations for each purpose is to start with $10 million in the fiscal year 1963 and increase to $20 million in 1971. Dr. Eliot has prepared the exact text of an amendment embodying these two recommendations and copies have been set to Mr. Mills, the chairman of this committee. The American Parents Committee urges that this amendment be either added to H.R. 10032 or, perhaps more appropriately, to H.R. 9299. I have copies of the amendments that Dr. Eliot has proposed. Copies of these proposed amendments have been sent to Mr. Mills, and a covering memorandum explaining them in further detail here, and these are endorsed by the American Parents Committee, and if you wish I will place them in the record at this point.

The CHAIRMAN. We would like to have them in the record, Mr. Hecht, at the conclusion of your statement. Without objection, they will be included.

Mr. HECHT. (3) The bill, in paragraph C5 on page 8, provides that the State public assistance agencies may contract with nonprofit private agencies for necessary services for public assistance clients. The bill goes on to state that the State agencies can purchase this service only if in their judgment the necessary services cannot be as economically and effectively provided by the staff of the State or local public

agency.

The American Parents Committee believes that, in order to preserve both good public and good private agencies, we need to prevent the development of large quasi-public agencies administered under private auspices. If this has to be done, we would advocate some limitation on the amount of service that can be purchased from a given private agency. Perhaps this could be done through some required matching plan-for example, that the private agency must contribute a matching $1 of private funds for every $1 of public funds received, or $1 to $2, or $1 to $3 of matching. The ratio, it seems to us, is not as important as the principle.

The American Parents Committee is vitally concerned with preserving both strong private welfare agencies and also good public welfare agencies. Although it believes that services to families can be improved in certain instances through the purchase by public agencies of certain welfare services to be rendered by private agencies, the present wording of the bill may not prevent an imbalance from developing. We believe that, for example, sources of private philanthropy might be dried up if there are not some restrictions on the amount of public money paid to any one private agency. We would suggest, therefore, that any given private agency so dealt with must

We

have a sizable portion of its funds coming from private sources. should not want to see this bill promote the development of large quasi-public agencies which, though private in name, obtain almost all of their financing from public sources.

(4) In connection with the ADC program, we wish to express this word of caution: There are many ADC families in which it is not desirable to get the mothers to work; but rather that the public policy should be that mothers of very young children should stay home with their children.

We received copies of bill H.R. 10032 only on Monday of this week (February 5, 1962) and neither I nor other officers and directors of our committee have been able to give the bill the detailed study that such an important bill deserves. But we hope that you will give careful consideration to the recommendations that we have made. We believe them to be in the public interest particularly for families with children.

Thank you.

(The statement referred to follows:)

HARVARD UNIVERSITY, SCHOOL OF PUBLIC HEALTH, DEPARTMENT OF MATERNAL AND CHILD HEALTH, BOSTON, MASS., February 5, 1962. Memorandum re proposed amendments to title V of the Social Security Act. From: Martha M. Eliot, M.D., professor of maternal and child health emerita. The attached draft amendments to title V, parts 1 and 2 of the Social Security Act which I am proposing are intended to strength the program of maternal and child health services (pt. 1) and services for crippled children (pt. 2). I have submitted them to Congressman Mills, the author of H.R. 9299, with the suggestion that they be made title II of that bill. I enclose also a copy of H.R. 9299.1

The attached draft amendments provide

(1) Increase in the authorized ceilings under which appropriations are now made for grants to the States for maternal and child health services (pt. 1) and services for crippled children (pt. 2) from the present $25 million each to $50 million each in 1971. The increases in authorization would occur every 2 years in the amount of $5 million for each program, thus allowing forward planning for a decade.

(2) A new program of grants to the States under both parts 1 and 2 to enable the States to assist large cities (100,000 population and over) to extend and improve their maternal and child health and crippled children's services. The amendments (see underlined parts of sections 501 (b), 502 (c) and (d), 503 (a), 511(b), 512(c) and (d), and 513(a)) provide for separate authorizations for appropriation, separate allotments, and separate provisions in the State plans for the programs in the large cities. The authorizations for appropriation start with $10 million in the fiscal year 1963 and increase to $20 million in 1971.

The existing programs (for which increases are proposed by the amendments described in (1) above) would retain their original and continuing purpose of enabling the States to extend and improve maternal and child health services and services for crippled children, especially in rural areas and areas of severe economic distress. This is important because there are still many unsolved problems in rural areas and health and medical services that we know how to provide for mothers and children are not yet available in many such areas of

1 H.R. 9299 amends title V of the Social Security Act by adding pt. 4. It authorizes the Secretary of Health, Education, and Welfare (presumably through the Children's Bureau) to make grants, contracts, and jointly financed cooperative arrangements for research relating to maternal and child health services and crippled children's services. H.R. 9299 was introduced on Sept. 19, 1961, by Mr. Wilbur Mills, chairman of the House Committee on Ways and Means, and is now pending before that committee. A companion bill S. 2273 was introduced by Senator Kerr and Senator Hill on July 18, 1961.

the country. The existing program must be extended and improved to meet the needs of the rural areas and smaller cities.

The new programs to assist cities of 100,000 population and over would encourage new and improved services for mothers and children in these large cities. Many of these are the central cities of rapidly growing great metropolitan areas. They have grave problems in their maternity care, child health and medical care programs which involve families in the lower economic groups, families which are disadvantaegd socially, and families which have recently migrated from rural areas to these central cities replacing those of higher income who have moved to the suburbs. Federal grants would stimulate new efforts and new ways to meet these problems.

Letters concerning these proposed amendments to parts 1 and 2 of title V should go to Congressman Wilbur Mills, chairman, House Committee on Ways and Means, Washington, D.C. (See list also for other members.)

If you wish to support the principles involved in these proposed amendments and are also in support of H.R. 9299, it is suggested that reference be made to H.R. 9299 in your letter and to the addition of the proposed amendments as title II of this bill.

It is hoped that Senator Kerr will also incorporate these amendments as part of S. 2273.

In his message to the Congress on February 1, 1962, President Kennedy recommended amendments to part 3 of title V-Child Welfare Services-which would increase this authorization from the present $25 million to $50 million, by 1969. starting with an increase in 1963 to $30 million. He has also recommended earmarking up to $5 million in 1963 for grants for day-care services and up to $10 million thereafter for this purpose.

In my view this proposal should be strongly supported by persons concerned with all aspects of child-life for it embodies further help to the States in their efforts to provide high quality protective and other social services for children in their own homes and in foster care. It is the program under which States may also provide adoption programs, day care and homemaker services, and help meet other child welfare needs.

PROPOSED AMENDMENT TO H.R. 92991

(H.R.9299 was introduced by Mr. Mills on September 19, 1961, and is now pending before the House Committee on Ways and Means)

PURPOSE OF AMENDMENT

To amend title V, parts 1 and 2, of the Social Security Act (1) to increase the amounts authorized for maternal and child health services and crippled children's services, especially in rural areas and areas of severe economic distress, and (2) to provide for grants to the States to enable them to assist their large cities in extending and improv ing their services for promoting the health of mothers and children and for medical and oher services for children who are crippled or suffering from conditions which lead to crippling

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That parts 1 and 2 of title V of the Social Security Act are amended to read as follows:

"PART 1-MATERNAL AND CHILD HEALTH SERVICES

"SEC. 501. For the purpose (a) 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, and (b) of enabling each State to determine its urban trends and problems in respect to the health of mothers and children, and enabling each State having one or more cities of 100,000 population or more (hereinafter referred to as large cities) to make grants to such cities proportional to the number of live births in such cities and to their financial and other need for assistance in providing services for promoting the health of mothers and children, there is hereby authorized to be appropriated pursuant to section 501(a) for the fiscal years ending June 30, 1963 and 1964, the sum of $30,000,000, for the fiscal years ending June 30, 1965 and 1966, the sum of $35,000,000, for

1 Proposed by Dr. Martha M. Eliot.

the fiscal years ending June 30, 1967 and 1968, the sum of $40,000,000, for the fiscal years ending June 30, 1969 and 1970, the sum of $45,000,000, and for the fiscal year ending June 30, 1971, and for each fiscal year thereafter the sum of $50,000,000; and there is hereby authorized to be appropriated pursuant to section 501(b) for the fiscal years ending June 30, 1963 and 1964, the sum of $10,000,000, for the fiscal years ending June 30, 1965 and 1966, the sum of $12,500,000, for the fiscal years ending June 30, 1967 and 1968, the sum of $15,000,000, for the fiscal years ending June 30, 1699 and 1970, the sum of $17,500,000, and for the fiscal years ending June 30, 1971, and for each year thereafter the sum of $20,000,000. The sums made available under this section shall be used for making payments to States which have submitted and had approved by the Secretary of Health, Education, and Welfare State plans for such services, including specific plans for such services in large cities as provided in section 501 (b).

SEC. 502. (a) Out of the sums appropriated pursuant to section 501 (a) for each fiscal year beginning after June 20, 1962, the Secretary shall allot one-half as follows: He shall allot to each State $70,000, and shall allot to each State such part of the remainder of this one-half as he finds that the number of live births in such State bore to the total number of live births in the United States in the latest calendar year for which the Secretary has available statistics.

(b) Out of the sum appropriated pursuant to section 501 (a) the Secretary shall allot to the States (in addition to the allotments made under subsection 502(a)) for each fiscal year beginning after June 30, 1962, one-half as follows: Such sums shall be allotted from time to time according to the financial need of each State for assistance in carrying out its State plan, as determined by the Secretary after taking into consideration the number of live births in such State; except that not more than 25 per centum of such sums shall be available for grants to State health agencies (administering or supervising the administration of a State plan approved under section 503), and to public or other nonprofit institutions of higher learning (situated in any State), for special projects of regional or national significance which may contribute to the advancement of maternal and child health.

(c) Out of the sums appropriated pursuant to section 501(b) for each fiscal year beginning after June 30, 1962, the Secretary shall allot one-half as follows: He shall allot to each State $25,000 and shall allot each State having one or more large cities such part of the remainder of this one-half as he finds that the number of live births in the large cities in such State bore to the total number of live births in such cities in the United States in the latest calendar year for which the Secretary has available statistics.

(d) Out of the sums appropriated pursuant to section 501(b) the Secretary shall allot to the States (in addition to the allotments made under subsection 502 (c)) for each fiscal year beginning after June 30, 1962, one-half as follows: Such sums shall be allotted from time to time according to the need of the large cities for assistance in carrying out their part of the State plan, as determined by the Secretary after taking into consideration the number of live births in such cities; except that not more than 25 per centum of such sums shall be available for grants to State health agencies or to the health agencies of large cities, and to public or other nonprofit institutions of higher learning (situated in any State), for special projects of regional or national significance which may contribute specifically to the advancement of the health of mothers and children living in such cities.

Subsection (c) to become subsection (e).

"APPROVAL OF STATE PLANS

"SEC. 503. (a) A State plan for maternal and child-health services, including special plans for services in large cities, must (1) provide for financial participation by the State in respect to the purpose of section 501(a) and for participation by the large cities in respect to the purpose of section 501(b): Etc. (continue as at present).

"PAYMENT TO STATES

"SEC. 504. (a) From the sums appropriated therefor and the allotments available under subsections 502(a) and 502 (c), the Secretary of the Treasury shall pay to each State which has an approved plan for maternal and child health services, for each quarter, beginning with the quarter commencing July 1, 1962, amounts, which shall be used exclusively for carrying out the State plan, includ

ing plans for large cities, equal to one-half of the total sums, expended from allotments available under subsections 502(a) and 502(c) during such quarter for carrying out such plan." Etc. (continue with appropriate minor amendments).

(Unchanged.)

OPERATIONS OF STATE PLANS

"PART 2-SERVICES FOR CRIPPLED CHILDREN

"APPROPRIATIONS

"SEC. 511. For the purpose (a) 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, hospitalization, and aftercare, for children who are crippled or who are suffering from conditions which lead to crippling, and (b) of enabling each State to determine its urban trends and problems in respect to such services and care of crippled and handicapped children, and enabling each State having one or more large cities to make grants to such cities proportional to the number of children in such cities and to their financial and other need for assistance in providing such services and care, there is hereby authorized to be appropriated pursuant to section 511(a) for the fiscal years ending June 30, 1963 and 1964, the sum of $30,000,000, for the fiscal years ending June 30, 1965 and 1966, the sum of $35,000,000, for the fiscal years ending June 30, 1967 and 1968, the sum of $40,000,000, for the fiscal years ending June 30, 1969 and 1970, the sum of $45,000,000, and for the fiscal year ending June 30, 1971, and for each year thereafter the sum of $50,000,000; and there is hereby authorized to be appropriated pursuant to section 511(b) for the fiscal years 1963 and 1964, the sum of $10,000,000 for the fiscal years ending June 30, 1965 and 1966, the sum of $12,500,000, for the fiscal years ending June 30, 1967 and 1968, the sum of $15,000,000, for the fiscal years ending June 30, 1969 and 1970, the sum of $17,500,000, and for the fiscal years ending June 30, 1971 and for each fiscal year thereafter the sum of $20,000,000. The sums made available under this section shall be used for making payments to States which have submitted and had approved by the Secretary of Health, Education, and Welfare State plans for such services, including specific plans for such services in large cities as provided in section 511(b).

SEC. 512. (a) Out of the sums appropriated pursuant to section 511(a) for each fiscal year beginning after June 30, 1962, the Secretary shall allot one-half as follows: He shall allot to each State $70,000, and shall allot the remainder of this one-half to the States according to the need of each State as determined by him after taking into consideration the number of crippled children in such State in need of the services referred to in section 511(a) and the cost of furnishing such services to them.

(b) Out of the sum appropriated pursuant to section 511(a) the Secretary shall allot to the States (in addition to the allotments made under subsection (a)) for each fiscal year beginning after June 30, 1962, one-half as follows: Such sums (continue to end of subsection as at present).

"(c) Out of the sums appropriated pursuant to section 511(b) for each fiscal year beginning after June 30, 1962, the Secretary shall allot one-half as follows: He shall allot to each State $25,000, and shall allot the remainder of this one-half to the States having one or more large cities according to the need of such cities in each State as determined by him after taking into consideration the number of crippled children in such cities in need of the services referred to in section 511(a) and the cost of furnishing such services to them.

(d) Out of the sums appropriated pursuant to section 511(b) the Secretary shall allot to the States (in addition to the allotments made under subsection 512(c)) for each fiscal year beginning after June 30, 1962, one-half as follows: Such sums shall be allotted from time to time according to the financial need of the large cities in each State for assistance in carrying out their part of the State plan, as determined by the Secretary after taking into consideration the number of crippled children in such cities in need of the services referred to in section 511 (a) and the cost of furnishing such services to them; except that not more than 25 per centum of such sums shall be available for grants to State agencies or large cities and to public or other nonprofit institutions of higher