2. Continuation of group insurance on workers who retire and their dependents.

3. Continuation on an individual policy basis of coverage originally provided by group insurance, this being accomplished by conversion of the group coverage on termination of employment or membership in the insured group.

4. New issuance of group insurance on such groups of older people as associations of retired persons or employees, retired teachers and civil servants and golden age clubs.

5. Continuation into later years of individual insurance purchased at the younger ages.

6. New issuance of individual insurance at advanced ages. Many of these forms do not require evidence of uninsurability and after a nominal waiting period cover loss due to preexisting conditions.

7. Issuance of insurance that becomes paid up at age 65, thus enabling the policyholders to pay for his protection during his productive years.1

Through these and other methods, notably those of the service plan type insurers, the percentage of the aged population having some voluntary health insurance has grown at a remarkable rate. According to the Health Insurance Institute of America, 60 percent of our senior citizens who need and want health insurance will have protection by the end of next year. And, the institute says, that percentage will increase until three-quarters will be covered in 1965 and 90 percent in 1970.2

What happens if you arrive at age 65 and have no coverage? This can easily happen when you consider that many group policies automatically cut off their members from any kind of coverage after retirement. The problem is compounded by the fact that people over 65 are most likely to need medical care. This means that coverage must either be quite skimpy or else quite expensive. And in most cases the applicants for this kind of insurance must show that they are in good health.

INSURANCE AVAILABLE IN WEST VIRGINIA

Here are some examples of so-called senior hospitalization and surgical policies available to older people in West Virginia: American Casualty Co. of Reading, Pa., offers a senior hospital expense policy for persons over age 60 who are in good health. It pays various amounts per day for hospital room and board, depending upon the benefits selected, which vary with premium size.

For example, the policy would pay up to $10 a day for 90 days on any one disability, plus up to $100 miscellaneous hospital expense plus up to $200 surgical expense at an annual cost of $86.66 for either men or women. The policy is not guaranteed renewable, and applicants must fill out a questionnaire about their health.

New York Life writes a policy for people aged 60 to 75 that is guaranteed renewable for life. Applicants, of course, must fill out a medical questionnaire. At the $10-a-day hospital rate with up to $100 miscellaneous hospital expense and up to $250 surgical expense, the annual cost would be as follows:

As noted above, most hospitalization and surgical policies require the filling out of an application. If answers indicate a physical condition the company thinks is uninsurable, the company may refuse to issue the policy. If the answers indicate questionable conditions, the company may request the applicant to submit to a physical examination. In some cases an applicant who has had certain serious diseases or physical impairments but who has recovered can obtain insurance at a somewhat higher rate. Such policies are called substandard or qualified-risk policies. Often they require a waiting period during which a particular specified condition is not covered.

1 Proceedings, joint council to improve the health care of the aged.

2 The medical profession's program on aging-a community responsibility.

Continental Casualty Co. of Chicago has pioneered in this kind of policy, as well as policies designed for older people. In 1957, for example, Continental offered in Iowa an experimental hospitalization and surgical policy for older people called 65 Plus. This program was reopened in Iowa last fall and extended to Illinois, Indiana, and Wisconsin. This policy is not now available anywhere, but the company expects to extend it further in a few weeks, based on the experience in these States to date. During enrollment campaigns, any person 65 or over can buy coverage and there is only one limitation in the matter of the applicant's health. This is a provision that for the first 6 months of coverage no benefits will be paid for any disability resulting from conditions that previously have been treated or known. Benefits are up to $10 per day for hospital room and board for a maximum of 31 days; up to $100 miscellaneous hospital expense; and up to $200 surgical expense. Premium is $6.50 per month. At present, Continental is offering a group policy for people over 65 that requires neither medical examination nor questionnaire and contains this limitation on preexisting conditions. During the first year of coverage, no payment will be made for any condition for which the insured was hospitalized during the preceding 12 months. This group policy is available to all members of the American Association of Retired Persons, 310 East Grand Avenue, Ojai, Calif. Membership in this association is open to anyone age 65 or over.

The policy does not pay too much in benefits-up to $10 a day for 31 days for each hospital confinement, up to $200 surgical benefits and 50 percent of miscellaneous hospital expenses up to a maximum of $125 (50 percent of $250). Nevertheless, this is probably the first time that a hospital and surgical plan of any kind has been available to people over 65 without wide limitation on preexisting conditions. Membership in the American Association of Retired Persons is $2 a year. For this, the member receives a subscription to a bimonthly magazine and may buy the group insurance on himself (or herself) for $6 a month. For another $6 a month the insurance may be extended to cover husband or wife.

Recognizing certain pitfalls and shortcomings in the protection provided by voluntary health coverage plans, some recommendations stand out clearly: 1. Continued intensified study by voluntary insurers and Blue Cross-Blue Shield plans to amplify existing programs in all directions for the benefit of the insured.

2. Extension of the right to continue coverage by individuals when they leave employment or when they retire.

3. General incorporation into existing policies of the right to convert upon leaving a group by retirement, without medical examination or any evidence of insurability, into a guaranteed renewable lifetime major medical expense policy covering himself and those of his dependents who were covered under the group plan.

4. Development of a public education program to stimulate awareness and understanding of those reaching age 60 or 65 of their rights and responsibilities with reference to their present insurance policy so that coverage will not lapse or be forfeited.

5. Emphasize the importance of providing noncancelable insurance while insurable.

Senator RANDOLPH. Dr. Sheppard of our staff kept me informed about the progress of the preparation for today's hearing. He said Mr. Charles Lively-and I speak to the older of the two, but it applies I am sure to both-has given the utmost cooperation in connection with his request for testimony, such as presented here this afternoon. We are helped by the attention which you men have given to this problem. I liked especially the idea expressed by Dr. Hoffman that you recognize perhaps you have not gone as far as you should have gone. This is not in criticism of what you have already done, but that you feel there is a real challenge in extending medical programs to the aged and the aging of our country.

I do think this is the attitude which is stimulating-not that we are attempting to talk about the levels of Government or the participa

Changing Times, the Kiplinger magazine (January 1959).

tion of agencies-but that we all recognize our responsibility in this category.

Dr. Hoffman, I am very glad that you said what you did because I think it indicates the idea that you have expressed as to the purpose of the practicing physicians and surgeons of the medical profession of this State.

Mr. HOFFMAN. Thank you.

Senator RANDOLPH. Now, just this one thought that perhaps I should not bring into the subject, but we have had endorsement today of the so-called Forand bill, pending in the Congress. It would not be to your desire perhaps to go into details about the legislation. However, if you care to take just a moment to speak about your feeling as men of medicine in reference to that legislation which is proposed, we would be very glad to have it.

In other words, I would not want the record to indicate that we had heard only one side of the question.

Dr. HOFFMAN. I am personally against the Forand bill, I think for several reasons, for many reasons.

First, as a physician, I can recognize the terrific abuse which would be obvious. I think the cost would be tremendous. It is estimated it would cost probably $2 billion this first year. It would mean a marked increase in social security to cover that. I think it would be definitely a move toward the road of total nationalization of our country which I don't think we want in any way, shape, or form. I think that the waste of money could be tremendous. And I think those are my first thoughts on the subject.

I think it would be a move in a direction of total socialization. I think when we are giving money for social security it is a different thing, but when it comes to services then I think we are moving into a territory which is tremendously dangerous.

Those are my thoughts.

Senator RANDOLPH. Is there any comment, Dr. Gage, you would like to add?

Dr. GAGE. I agree with Dr. Hoffman, and there are two other comments I would make.

First, it seems to me that it would not affect many of our indigent people whom we see now who are not in any way covered by social security, and, second, I believe it would make for poor medicine. I have lived in foreign countries where it has been tried, and my experience and my discussion with people has convinced me that the patient, himself, would eventually get not better but poorer care.

Senator RANDOLPH. Thank you, gentlemen, for having testified. Mrs. Holt and Dr. Dickerson, Dr. Lilly, if you will come, please, to the table.

Mrs. Helen Holt, representing the public institutions programs; Mrs. Holt, will you begin.

Give your title, if you will.

STATEMENT OF MRS. HELEN HOLT, ASSISTANT COMMISSIONER, WEST VIRGINIA PUBLIC INSTITUTIONS

Mrs. HOLT. I am assistant commissioner of institutions, I do not have a prepared statement because I did not expect to speak for our department. First I would like to tell you that Mr. Neely is very

sorry that he cannot be here. We have had another very important meeting in our department today. We feel that we have accomplished something for our public institutions, made a great stride, I might say toward something we have been wanting for some time. A chaplains' advisory committee for our State institutions has been organized. The Governor has appointed the commission, which represents all faiths. Most of the members are also members of the West Virginia Crime and Delinquency Council. This committee, of course, affects our elderly citizens as well as the younger ones.

My duty here this afternoon is merely to tell you what State institutions there are for the older citizens. You have received a mimeographed sheet which tells you about our two homes, the colored Huntington Home for the Aged, and the Andrew S. Rowan Memorial Home in Sweet Springs, Monroe County, W. Va.

I will not go into detail to tell you about the facilities in these two homes. Both of them are very nice. I hope you will have an opportunity to visit them sometime. Our purpose is to take care of the senior citizens after they come to our institutions, and we certainly try to do the best that we can for them to make them comfortable, and to keep them as happy as possible. We hope that from these hearings today we will receive suggestions which will enable us to do a better job in our care of the persons in our institutions.

I should mention that in addition to these two homes primarily for the aged we have Denmar State Hospital for the Chronically Ïll at Beard, W. Va. Of course there we have all ages, but as you can understand a great many of those persons are past 65. In both of our homes the guests must be over 65, and ambulatory. Denmar Hospital has all bed patients.

If there are many questions you would like to ask me I will be glad to tell you more. Otherwise, I do not want to take more of your time at this late hour.

Thank you.

Senator RANDOLPH. Mrs. Holt, you speak with clarity and you are helpful in your testimony in this informal, yet very direct statement. Is there a statement which you will file for Mr. Neely with the committee? We would be delighted to receive it, even later by mail so it might be inserted at this point.

Mrs. HOLT. I have filed a brief description of the two homes for the aged.

Senator RANDOLPH. That will take care of the presentation and it will be made a part of the record at this point.

(The prepared statement of Mrs. Holt follows:)

PREPARED STATEMENT OF MRS. HELEN HOLT ON FACILITIES FOR CARING FOR THE AGING OFFERED BY THE OFFICE OF COMMISSIONER OF PUBLIC INSTITUTIONS

WEST VIRGINIA HOME FOR AGED AND INFIRM (COLORED MEN AND WOMEN) The West Virginia Home for the Aged and Infirm (colored men and women) is 6 miles east of Huntington, W. Va., on a 150-acre tract of land. In addition to the two buildings for housing the patients and staff, the institution has two large barns, three chickenhouses, two garages, and a residence for the superintendent. The farm supplies part of the table commodities.

The 80-guest home is staffed by 18 full time employees, which include a doctor, supervisor, nurse aids, matrons, cooks, attendants, and a farmer. There are at present 60 guests-28 men and 32 women.

To be eligible for admission one must have been a resident of the State of West Virginia for at least 1 year immediately preceding the application, and must have attained the age of 65. It is necessary that all guests making application be ambulatory upon entrance. Guests are admited through the department of public assistance or are voluntary pay.

ANDREW S. ROWAN MEMORIAL HOME (AGED MEN AND WOMEN)

The Andrew S. Rowan Memorial Home at Sweet Springs, Monroe County, is located in the heart of the bluegrass section-midway between Union and White Sulphur Springs. The oldest and largest building, which was completed in 1833, was designed by Thomas Jefferson and so named in his honor. The grounds consist of 690 acres, 225 of which are suitable for farming and pasture.

The institution is staffed by 87 full time employees, which include a doctor, 4 nurses, supervisors, social workers, dietitian, 3 chaplains, attendants, and 2 farmers.

Guests in the 360-bed home are admitted in the same way as those in the West Virginia Home For The Aged And Infirm. One hundred and twenty male and 130 female guests are housed in the home at present.

The office of the commissioner of public institutions is entrusted with the administration of the two named institutions now serving our senior citizens of West Vrginia. In addition to the supervision of all administrative functions, the department processes all applications for admission to these institutions.

It is the responsibility of the office of the commissioner of public institutions to transfer guests of these two institutions to other State institutions where specified medical and surgical needs are required. All such transfers are made through the commissioner's office at the request of the superintendents of the two institutions.

The department is continually striving to improve the facilities, as well as programs of rehabilitation, in order to give maximum comfort to all guests of the institutions.

Senator RANDOLPH. Thank you very much.

It has been my privilege to visit Sweet Springs, and I found that it is a splendid institution.

Dr. Lilly or Dr. Dickerson, as you wish.

STATEMENT OF DR. LEON A. DICKERSON, STATE HEALTH

DEPARTMENT

Dr. DICKERSON. I am Dr. Leon Dickerson, director of disease control for the West Virginia State Health Department.

A statement concerning health problems of the aging and programs of the West Virginia Department of Health has already been submitted by Dr. N. H. Dver, State director of health. I wish to comment further on two items contained in his statement.

When limited funds became available to the State health department for new chronic disease activities in 1958, being aware of the growing number of older persons in our State, and the frequency with which chronic illness attends the aging process, we instituted two projects, a survey of the 54 nursing homes licensed in the State at this time, and a small scale demonstration home-care project in Charleston in conjunction with the local health department for selected chronically ill older patients who were either receiving public assistance, or considered medically indigent.

In the nursing home survey, the diagnoses reported were senility, 21.6 percent; stroke, 18.4 percent; and other cardiovascular diseases, 9 percent. Thirty-five and three-tenths percent of the patients were considered to require extensive nursing care, while 44.1 percent needed