MAJOR FEDERAL LEGISLATIVE AND EXECUTIVE ACTIONS AFFECTING SENIOR CITIZENS 1965 I. INTRODUCTION This report summarizes actions on aging taken between January 1, 1965, and October 23, 1965 (the date on which the 1st session of the 89th Congress adjourned). It does not list bills on aging which were not reported from committees. Such bills are listed in "Listing of Bills Relating to Programs Under the Social Security Administration,' published by the Division of Program Evaluation and Planning of the Social Security Administration and "Digest of Public General Bills," published by the Legislative Reference Service of the Library of Congress. (See index headings "Aged and Aging," "Old Age," "Pensions," "Retirement," "Senior Citizens," and "Social Security.") Copies of hearings, reports, and other publications of the Special Committee on Aging to which reference is made in this report can be obtained free of charge, while the supply lasts, by requests addressed to: Senate Special Committee on Aging, Room G-233, New Senate Office Building, 1 II. HEALTH A. "MEDICARE" A new program of health care for the elderly (medicare) was enacted as part of the Social Security Amendments of 1965 (Public Law 89-97). This comprehensive health costs financing mechanism is summarized in the appendix, beginning on page 25. A summary of its history during 1965 follows: January 1: The Advisory Council on Social Security, in its report on the "Status of the Social Security Program and Recommendations for Its Improvement" recommended amending the Social Security Act to provide inpatient hospital benefits, outpatient diagnostic services, extended-care facilities and home-nursing services for social security and railroad retirement beneficiaries, and others 65 and over. January 4: President Johnson's State of the Union Message listed as an item of high priority "help for the elderly, by providing hospital care under social security and by raising benefit payments to those struggling to maintain the dignity of their later years." January 4: Representative King of California introduced H.R. 1 to provide hospital insurance under the social security program and an increase in cash benefits. Senator Anderson of New Mexico introduced S. 1, the Senate companion bill. The bills embodied the administration's hospital insurance proposal and contained many of the same provisions which had been extensively considered by the Congress in 1964. January 7: The President's message on "Advancing the Nation's Health" assigned top priority to the President's recommendation for a hospital insurance program for the aged, financed through the social security system. February 4: Representative Byrnes of Wisconsin introduced. H.R. 4351 to provide a voluntary health insurance program for persons over 65 with monthly contributions by the Federal Government based on participants' income, with individual contributions ranging from $5 to $11.50 monthly. March 23: The House Ways and Means Committee, after 6 weeks' consideration of H.R. 1, approved by a 17-to-8 vote a bill to modify the administration's proposal with a package of health benefits and social security improvements. This was the first time that this committee had acted favorably on a medical insurance bill for all senior citizens. March 24: Chairman Wilbur D. Mills, of the Ways and Means Committee, introduced H. R. 6675, as the proposed Social Security Amendments of 1965. The bill proposed two coordinated health insurance programs under the Social Security Act for people 65 and over: (1) A basic plan of hospital insurance and related care, with financing through a separate payroll tax and trust fund; and (2) A voluntary supplementary plan providing for doctors' fees and other medical and health services, financed by $3 a month premium payments by each participant matched by an equal amount from Federal general revenues. March 29: H.R. 6675 was reported from the Ways and Means Committee. April 8: After 2 days of debate, H.R. 6675 passed the House, without amendment, by a vote of 313 to 115. April 29: The Senate Finance Committee began public hearings on H.R. 6675, calling Secretary Celebrezze as the first witness. June 30: The Senate Finance Committee, after adopting 75 amendments, reported H.R. 6675 favorably by a vote of 12 to 5. July 9: After action upon numerous proposed floor amendments, the Senate passed the bill by a vote of 68 to 21. July 14: The conference committee to resolve differences between the Senate and House versions convened its first session. July 21: The conference committee reached agreement upon a compromise bill which conformed in all basic respects to the administration's specifications for a comprehensive medicare program. July 27: The House ratified the conference agreement on the bill by a vote of 307 to 116. July 28: The Senate ratified the conference agreement by a vote of 70 to 24, sending the bill to the President. July 30: President Johnson signed the bill in Independence, Mo., and it thereupon became law (Public Law 89-97). B. PUBLIC ASSISTANCE HEALTH CARE The Social Security Amendments of 1965 (Public Law 89-97), in establishing a new title XIX in the act, provided for a more effective Kerr-Mills medical assistance for the aged program and extended its more liberal provisions to the elderly on old-age assistance. Among the new medical assistance provisions are: 1. Increased Federal participation in public assistance medical care. 2. Limitation of the family responsibility test to the spouse of the applicant. 3. Requiring the States to relate their income tests for determination of eligibility to the expenses incurred by the applicant. Many States had employed "in or out" income tests which had the effect of denying eligibility to many needy elderly. 4. Authorizing the Federal Government to match vendor payments to providers of health services in behalf of recipients of old-age assistance without limit on the amount to be matched. Previously, the Federal Government would match only up to $15 monthly for the elderly on OAA, while no maximum was applicable to those older persons covered under Kerr-Mills medical assistance for the aged (MAA). The new law also specifies that the States may not provide less in health benefits for those on old-age assistance than they provide those on Kerr-Mills medical assistance for the aged (MAA). 5. Requiring the States after July 1, 1967, to include in their vendor payment programs the cost of the deductible under the basic hospital program, as well as inpatient and outpatient 55-475-65- -2 hospital services, other laboratory and X-ray services, skilled nursing home care, and physicians' services. The prohibition on Federal sharing in assistance payments for the elderly in tuberculosis and mental hospitals was also removed. These changes in the public assistance titles require, in almost all cases, action by each State to meet the conditions established by the Congress in order to assure that increased Federal payments will not simply be used by the States to reduce their present expenditures. Title 19 may be employed by the States effective January 1, 1966. The new title is mandatory for States effective January 1, 1970, if they are to continue to receive Federal matching funds for vendor medical payments. C. MENTAL HEALTH The Community Mental Health Centers Act (Public Law 88-164) provided Federal grants toward the costs of construction of comprehensive community mental health centers. The 1965 amendment of the act (Public Law 89-105, approved Aug. 4, 1965) authorizes Federal matching payments toward the costs of staffing the centers during their first 51 months of operation. D. HEART DISEASE, CANCER, AND STROKE The Regional Medical Centers Act (Public Law 89-239, approved Oct. 6, 1965) authorizes $340 million over a period of 3 years for the establishment of programs in certain medical centers for prevention, detection, and treatment of heart disease, cancer, stroke, and related diseases. For the first year of the program, $50 million has been appropriated. The original bill included provision for some 400 community units that would have concentrated on the same problems and served as "feeders" for the regional centers. This provision was not included in the final version of the measure. E. MAJOR ACTIVITIES OF PUBLIC HEALTH SERVICE 1. A new Division of Medical Care Administration was created within the Public Health Service in August 1965. It was assigned the Public Health Service responsibility for the health insurance for the aged program. The Office of Care Services and the Nursing Homes and Related Facilities Branch of the Division of Chronic Diseases were transferred from that Division to the newly created Division of Medical Care Administration. 2. The Gerontology Branch, PHS, launched a cooperative program with the Social Security Administration to provide health-counseling services to applicants for social security benefits. Two pilot projects were begun in July and November, respectively, to demonstrate the effectiveness of providing such services. 3. Curriculum in applied gerontology. One of the high priority areas of the Gerontology Branch is professional education and training in applied gerontology. A curriculum in applied gerontology was completed by the Gerontology Branch in June 1965. This is a comprehensive body of gerontological knowledge assembled for use by organizations which carry on educational activities in geronotology. |