Hon. WILBUR D. MILLS, COMMONWEALTH OF PUERTO RICO, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C. (Attention: Mr. Leo H. Irwin). DEPARTMENT OF HEALTH, DEAR MR. MILLS: As a social worker, identified with the welfare needs of our population in Puerto Rico, I strongly endorse the provisions contained in H.R. 10032, the Public Welfare Amendments of 1962, and specially those contained in section 151 of the bill related to the removal of the limitation on the total public assistance payments to Puerto Rico, the Virgin Islands, and Guam. I am confident that the approval of this bill will provide a great opportunity for the Commonwealth of Puerto Rico to improve its public assistance program and incorporate into it the needed services and administrative procedures that will strengthen the rehabilitative and preventive aspects of this program. Prior to the extention of the public assistance titles of the Social Security Act in 1950, Puerto Rico had developed, within the limitations of its fiscal resources, a public assistance program for its needy aged, blind, dependent children, and other disabled individuals. With the extension of Federal aid, the Commonwealth was able to improve this program which progressed from a flatgrant program to one of individualized assistance to the needy. From a $3 million annual program financed totally from Commonwealth funds, the public assistance program has come to be a $20 million annual program, to which the Government of the United States is contributing $9 million annually at present. Although the original provisions in the Social Security Act provided that the Federal Government would match 50 percent of the costs of the program in Puerto Rico, the overall limit on the total cost of public assistance payments, also included in the law, has not made possible the 50 percent matching formula. As new social problems have arisen, it seems desirable to review the policy that inspired provisions of the Social Security Act of 1950 for Puerto Rico and other jurisdictions. The development of the Commonwealth public assistance program shows a great disposition on the part of the Commonwealth government to assume responsibility for its needy as pointed out by the fact that in spite of its still low per capita income it has been providing 53.8 percent of the total cost of its public assistance program. The State governments, in general, were financing only 35.9 percent of the cost of their programs. In only three States-Washington, Illinois and Connecticut-as well as the Virgin Islands, the State government was financing more than 53 percent of the cost of their public assistance programs. Additional efforts made by the Commonwealth government to improve the general living standard of its people and the relatively high proportion of its budget being devoted to health, education, and welfare (approximately 53 percent) point to the government's positive attitude to find solutions to its basic problems. The ceiling limitation established by the present provisions of the Social Security Act does not respond to the growing and urgent demands for an improved welfare program in Puerto Rico at this time or to the continuously expanding efforts which are being put forth by the Commonwealth government in this direction. Despite the tremendous fiscal effort being made at present by the Commonwealth government and the financial help provided by the Federal Government, the level of assistance is very low in Puerto Rico. As of November 1961, Puerto Rico was making a monthly average payment of $11.49 to all needy categorical groups. This meant average monthly payments of $8.32 for the aged, $14.78 and $3.78 per family and per child respectively in aid to dependent children, $8.23 for the blind and $8.64 for the disabled. National average 1 Office of the Governor, Bureau of the Budget-proposed budget for 1963. U.S. Department of Health, Education, and Welfare Social Security Administration, Bureau of Family Services, Division of Program Statistics and Analysis, Source of Funds Expended for Public Assistance, fiscal year ended June 30, 1961. monthly payments for the Continental United States were reported at $68.78 for the aged, $121.29 and $31.26 per family and per recipient respectively in aid to dependent children, $73.88 in aid to the blind and $70.32 in aid to the permanently and totally disabled. With the level of assistance, in which real basic needs are not being met, it is very hard to achieve the rehabilitative and prevention goals at which the public assistance program aim. An adequate level of assistance to meet the realistic minimum financial needs of families is a prerequisite for the rehabilitation of these families and the prevention of dependency. Although no substantial increases in the monthly benefits to needy families could be provided if the ceiling provision is eliminated, this could enable us to introduce service components in the program, reduce caseloads to allow for more individualized services and stimulate further action by the Commonwealth government to reorient its public assistance program to real rehabilitative ends. I am confident that future legislative efforts will allow for an improvement in the matching formula for Puerto Rico, that would result in an adequate level of assistance to the needy. The provision of a more favorable matching formula for the public assistance program in Puerto Rico would respond more positively to the present social policy of the U.S. Government in its progressive leadership role to help other countries improve the living conditions of their people and bring an end to extreme poverty, disease and ignorance. Respectfully yours, AIDA G. PAGAN, Director. MANATI, P.R., February 15, 1962. Mr. WILBUR MILLS, House of Representatives, Washington, D.C.: Endorsing the provision contained in H.R. 10032, Public Welfare Amendments of 1962, provision contained in section 151 of the bill related to the removal of the limitation of the public assistance payment to Puerto Rico. NORBERTO SANTARA, President, Public Assistance Workers Association of Puerto Rico. Hon. WILBUR D. MILLS, SAN JUAN, P.R., February 15, 1962. Chairman, Committee on Ways and Means, Respectfully request approval section 151, H.R. 10032 and extension national matching formula to Puerto Rico. DR. SEBASTIAN CABRER, President, Puerto Rico Institute of Family Relations. Hon. WILBUR D. MILLS, SAN JUAN, P.R., February 13, 1962. Chairman, Committee on Ways and Means, Urge approval section 151 of House bill 10032 and extension national matching formula to Puerto Rico. CARMELINA FREIRE, President Young Women's Christian Association. 3 U.S. Department of Health, Education, and Welfare Social Security Administration, Bureau of Family Services, Division of Program Statistics and Analysis, Advance Release of Statistics on Public Assistance, November 1961. Hon. WILBUR D. MILLS, COLLEGE OF SOCIAL WORKERS OF PUERTO RICO, Chairman, Committee on Ways and Means, House of Representatives, House (Attention: Mr. Leo H. Irwin, Chief Counsel, Ways and Means.) DEAR MR. MILLS: The Puerto Rico College of Social Workers, the professional association which represents all Puerto Rican social workers, respectfully submits the following statement related to section 151 of House bill H.R. 10032 on the removal of limitations on total public assistance payments to Puerto Rico, Guam, and the Virgin Islands. We are quite worried because Puerto Rico will not be able to participate in the benefits of the new approach to public assistance programs due to the restrictions imposed by the above-mentioned special matching formula. The special formula weighs heavily upon our programs and its adverse effects are reflected in the following average monthly payments corresponding to November 1961. 1 U.S. Department of Health, Education, and Welfare Social Security Administration, Bureau of Family Services, Division of Program Statistics and Analysis, advance release of statistics on public assistance, November 1961. Jan. 12, 1962, table 3. The average assistance payment for all categories in Puerto Rico was $11.49 in November 1961. Monthly payments barely cover 45 percent of the unmet family needs in the case of adults and 33 percent in the case of dependent children. The minimum family budget was established in 1950 and has not been adjusted in accordance with changes in the cost of living. Thus, the purchasing power provided by our present assistance grants amounts really to 33 percent of the unmet family needs in the case of adult recipients and 25 percent in the case of children. Insufficient payments and heavy caseloads make rehabilitation almost impossible. The Commonwealth of Puerto Rico is making strong efforts to improve the conditions of the needy. We have been able to raise appropriations for public assistance from $3 million in 1943 to about $11 million at present. Puerto Rico is contributing proportionately with a higher State share than the majority of the States, although we have a lower per capita income than the poorest State. Nevertheless, as the Federal sharing is limited to $9 million, the intention of Congress of equal sharing of responsibilities is defeated. But the mere removal of the statutory limit is not enough to fulfill the requirements of social justice. The improvement of our public assistance programs will only be possible if the removal of the ceiling is accompanied with a substantial improvement of the matching formula. If Puerto Rico were able to receive equal treatment as other States-a matching formula of 4 to 1 instead of the prevailing formula of 1 to 1-our current average monthly payment could be raised from $11.49 to almost $30 per case. The improved average payment will still be less than half of the national average. Our present public assistance program is unrealistic, inadequate, and essentially inhuman. It is unrealistic to determine the minimum financial needs of a family and then provide that family with about one-third of its unmet needs. It is inhuman to deprive 200,000 children of the opportunities to become healthy, educated, and useful citizens, and to deny to thousands of handicapped and senior citizens decent living conditions and opportunities for rehabilitation. It is poor economy to administer an inadequate program that tends to perpetuate the social ills attributable to poverty. Puerto Rico is contributing to the general welfare as a promoter of good will toward American traditions, ways of life, and democratic ideals. The Commonwealth has contributed also as a living example of the economic progress that can be attained through democratic leadership. But, certainly, its public assistance programs are not models of human solidarity and social justice. Undoubtedly, the extension of the national matching formula to Puerto Rico would enhance its achievements in the prevention and amelioration of human suffering. Respectfully yours, ELISA DÍAZ GONZÁLEZ, President, College of Social Workers. Hon. WILBUR D. MILLS, AMERICAN MEDICAL ASSOCIATION, Chairman, Committee on Ways and Means, New House Office Building, Washington, D.C. Chicago, Ill., February 9, 1962. DEAR CONGRESSMAN MILLS: The following statement is submitted on behalf of the American Medical Association with respect to certain provisions of H.R. 10032, 87th Congress, the Public Welfare Amendments of 1962, which is now before your committee for consideration. The proposed addition of a new title XVI to the Social Security Act would permit States to formulate single unified plans combining public assistance programs for the aged, blind, and disabled and medical assistance for the aged. This proposal is wholeheartedly endorsed by the American Medical Association as being consistent with the policy of this association that there are no reasonable grounds for arbitrarily dividing the needy into categories. At the most recent meeting of the American Medical Association, which was held in Denver during November of last year, our house of delegates adopted a recommendation that all "categories" in Federal-State programs of assistance to the needy should be eliminated. The house of delegates further stated that: "Eligibility should be based on a comparison of the individual's or family's resources and a reasonable estimate of the amount necessary for adequate maintenance of the necessities of life, including necessary medical care, with due regard to enabling the individual family to regain self-supporting status, so far as possible. Assistance should be based on need, rather than attained age or physical disabilities." It would appear that the proposed addition of title XVI to the Social Security Act would be in furtherance of this policy. The American Medical Association has no established position with respect to the other provisions of H.R. 10032, 87th Congress, with the exception of that portion of section 1602 (a) (12) which authorizes the determination of blindness of an individual by an optometrist. It has long been the position of the medical profession that the appropriate responsibility of the optometrist is in the measurement of ocular refractive errors and their correction by glasses. The science which deals with the structure, function, and diseases of the eye and of the visual system is ophthalmology, a branch of medicine. The ophthalmologist is a physician. He has acquired general medical knowledge and has special education and training in the diagnosis and treatment of ocular diseases, in the application of physiological and optical principles to the prescription of glasses and the correction of aberrations of ocular function, and in the surgery of the eye and its related structures. The determination of blindness is a diagnostic procedure. Diagnosis, as much as medical therapy, requires medical training. Medical training is not necessary to qualify one to perform refractive tests, nor is it always necessary to qualify one to prescribe satisfactory glasses. However, complete medical training is required to qualify one to determine the need for medical treatment, to diagnose. and to assume the responsibility for detecting or determining the presence of or absence of diseases. That portion of section 1602(a) (12) of H.R. 10032, 87th Congress, which would authorize an optometrist to determine whether or not an individual is blind, is not, in our opinion, in the public interest in that it grants medical responsibilities to nonphysicians, and implies that one other than a physician is competent to discharge them. The effect of this provision is to establish a double standard for the practice of medicine which is neither in the interest of the public nor the recipients of public assistance. We thank you for giving us the opportunity to express the views of the physicians of America on this important legislation. We respectfully request that this statement by the American Medical Association be included in the record of the hearings on H.R. 11032, 87th Congress. Sincerely yours, F. J. L. BLASINGAME, M.D. MISSISSIPPI STATE MEDICAL ASSOCIATION, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. CHAIRMAN: This letter is a formal empression of the views of the Mississippi State Medical Association with respect to a portion of H.R. 10032 which we understand is before your committee for formal hearings. It is respectfully requested that this statement be considered by your committee and included in the printed record of the hearings. In presenting this statement, our association-a State organization of approximately 1,400 physicians expresses its deep and continuing concern for the well-being of the recipients of care under the several titles of the law now being considered for amendment. Our position in this respect was determined after careful study and evaluation of experience as physicians in the various category care programs. Our association is especially concerned over prescribed manner for determination of blindness within the meaning of title X: Grants to States for aid to the blind, section 1002 (a) (10), of present law and section 1602 (a) (12) of H.R. 10032. We believe that it is not in the best interest of the applicant to have such a determination made by an optometrist, who, by reason of not being a physician skilled in diseases of the eye, i.e., an ophthalmologist or oculist, is untrained in detection and diagnosis of pathology. This particular inability could seriously impede rehabilitative and restorative procedures which, if promptly undertaken, might offer opportunity for improvement of vision. We further believe that the permissive clause in title X allowing choice by the applicant between a doctor of medicine and an optometrist for examination for determination of blindness appears contrary to the spirit of the proposed legislation which recognizes values inherent in rehabilitation and restorative procedures. In reaffirming our belief in this connection, we urge that your committee amend section 1602(a) (12) of H.R. 10032 to read “(12) provide that, in determining whether an individual is blind, there shall be an examination by a physician skilled in diseases of the eye," deleting the words, "or by an optometrist, whichever the individual may select." On behalf of our association, permit me to express our appreciation for your consideration of this statement and for the significant service and exercise of leadership by you and your colleagues of the committee. We shall hold ourselves in readiness to supply any additional information which we may be able to furnish your committee if desired. Sincerely, LAWRENCE W. LONG, M.D., President. Hon. WILBUR D. MILLS. Chairman, Ways and Means Committee, NEW YORK, N.Y., February 23, 1962. House of Representatives, Washington, D.C.: Consistent with the National Society for the Prevention of Blindness stand since 1950 with testimony given to the Ways and Means Committee at that time and with efforts made in subsequent years, it is respectfully requested that the committee in passing on H.R. 10032 amend proposed section 1602 (a) (12) of the 80118-62-44 |