(2) Any funds which are allotted to, but not received by, any State for any fiscal year shall be reallotted among the several States for the succeeding fiscal year in the same manner as that provided by paragraph (1).

(b) (1) From each State's allotment under this section for any fiscal year the Secretary shall pay to such State an amount equal to the Federal share of the cost, during such fiscal year, of initiating and operating projects under and in accordance with its State plan approved under section 402.

(2) For the purposes of this subsection the "Federal share" of the cost involved shall be, in the case of any State, 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of the continental United States (excluding Alaska), except that (A) the Federal share shall in no case be more than 66% per centum or less than 33% per centum, and (B) the Federal share for Hawaii and Alaska shall be 50 per centum, and for Puerto Rico and the Virgin Islands shall be 66% per centum.

(3) The "Federal shares" of the several States shall be promulgated by the Secretary between July 1 and September 30 of each odd-numbered year, on the basis of the average of the per capita incomes of the States and of the continental United States for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation.

TITLE V-GRANTS TO INSTITUTIONS AND ORGANIZATIONS

AUTHORIZATION AND USE OF APPROPRIATION

SEC. 501. (a) For the purpose of assisting public and other nonprofit institutions and organizations in carrying out research and training programs which, in the judgment of the Secretary, hold promise of making a substantial contribution to the policies set forth in section 101 of this Act, there is hereby authorized to be appropriated the sum of $2,000,000, to remain available until expended.

(b) The sum appropriated pursuant to this section shall be used for making payment to public and other nonprofit institutions and organizations under standards which shall be prescribed by the Secretary.

TITLE VI-GENERAL PROVISIONS

ADMINISTRATION

SEC. 601. (a) In administering this Act, the Secretary shall cooperate with and render technical assistance to States and organizations in matters relating to needs of older persons, provide short-term training and instruction in technical matters relating to services, and otherwise promote the development and improvement of programs for services on their behalf.

(b) The Secretary is authorized to make rules and regulations for carrying out the provisions of this Act.

(c) There is hereby authorized to be included in the appropriations for the Department of Health, Education, and Welfare for each fiscal year such sums as are necessary to administer this Act.

ADVISORY COMMITTEES

SEC. 602. The Secretary is authorized to establish an Advisory Committee on the Aged and Aging composed of professional and public members, and, as necessary, to establish technical advisory committees, to advise and assist him in the administration of this Act. Appointed members of such committees, while attending conferences or meetings of their committees (or while traveling to or from the same) or otherwise serving at the request of the Secretary, shall be entitled to receive compensation at a rate to be fixed by the Secretary, and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by law (5 U.S.C. 73b-2) for persons in the Government service employed intermittently.

PAYMENTS

SEC. 603. (a) The method of computing payments under title IV of this Act shall be as follows:

(1) The Secretary shall, prior to the beginning of each calendar quarter or other period prescribed by him, estimate the amount to be paid to each State for such period, such estimate to be based on such records of the State and information furnished by it, and such other investigation, as the Secretary may find necessary.

(2) The Secretary shall pay to the State, from the allotment available therefor, the amount so estimated by him for any period, reduced or increased, as the case may be, by any sum (not previously adjusted under this paragraph) by which he finds that his estimate of the amount to be paid the State for any prior period under such title was greater or less than the amount which should have been paid to the State for such prior period under such title.

(b) Payments under title V shall be made in advance or by way of reimbursement for services performed and purchases made, as may be determined by the Secretary, and shall be made on such conditions as the Secretary finds necessary to carry out the purposes of such title.

(c) Payments of grants made under this Act shall be made through the disbursing facilities of the Treasury Department, in such installments as the Secretary may determine.

(d) Any funds paid under this Act to a State or to a public or other nonprofit institution or organization which are not expended for the purpose for which paid shall be repaid to the Treasury of the United States.

WITHHOLDING OF PAYMENTS AND JUDICIAL REVIEW

SEC. 604. (a) Whenever the Secretary

(1) after reasonable notice and opportunity for hearing to the State officer or agency designated in accordance with section 302(1), finds that the State officer or agency is not complying substantially with a provision required by section 302 to be contained in its application for funds under title III, or

(2) after reasonable notice and opportunity for hearing to the State officer or agency administering or supervising the administration of a State plan finds (A) that the State plan or a specified portion of the State plan submitted and approved under section 402 has been so changed that it no longer complies with a provision required by section 402 to be included in the plan, or (B) that in the administration of the plan or a specified portion of the plan there is a failure to comply substantially with such a provision, the Secretary shall notify the State officer or agency that no further payments will be made to the State under section 303 or section 403, as the case may be (or in his discretion that further payments will not be made to the State for portions of the State application or State plans affected by such failure), until he is satisfied that there will no longer be such failure. Until he is so satisfied, the Secretary shall make no further payments to such State under section 303 or section 403 (or shall limit payments to portions of the State plan in which there is no such failure).

(b) If any State is dissatisfied with the Secretary's action under subsection (a), such State may appeal to the United States court of appeals for the circuit in which such State is located. The summons and notice of appeal may be served at any place in the United States. The findings of fact by the Secretary, unless substantially contrary to the weight of the evidence, shall be conclusive; but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may thereupon make new or modified findings of fact and may modify his previous action. Such new or modified findings of fact shall likewise be conclusive unless substantially contrary to the weight of the evidence. The court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part. The judgment of the court shall be subject to review by the Supreme Court of the United States upon certiorari or certification as provided in title 28, United States Code, section 1254.

INTERDEPARTMENTAL COMMITTEE ON PROBLEMS OF AGING

SEC. 605. (a) There is hereby established an Interdepartmental Committee on Problems of Aging to be composed of the Secretary of Health, Education, and Welfare (who shall be chairman, the Secretary of Labor, the Secretary of

Commerce, the Secretary of the Treasury, the Secretary of Agriculture, the Administrator of the Housing and Home Finance Agency, the Administrator of Veterans Affairs, and the Chairman of the United States Civil Service Commission. (b) The Committee shall have the following functions—

(1) to strengthen and coordinate existing programs in all departments and agencies of the Government to meet the needs of the older population; (2) to advise the President with respect to recommendations for additional executive and legislative measures with respect to problems of aging; and (3) to facilitate Federal-State-local relationships in the field of aging on an integrated, across departmental lines, basis.

(c) The Assistant Secretary of Health, Education, and Welfare for the United States Office of Aging shall serve as the Executive Director of the Committee, and he shall utilize the services of the United States Office of Aging for staff purposes in carrying on the work of the Committee.

CUMULATIVE REPORT TO CONGRESS

SEC. 606. Not later than January 1, 1962, the Secretary shall transmit to the President for transmission to the Congress (1) a report of the experience of Federal, State, and local agencies in the administration of titles III, IV, V, and VI of this Act, together with such recommendations as he deems advisable.

CHAPTER II

THE HEALTH STATUS OF THE AGED AND THE FINANCING OF ADEQUATE HEALTH SERVICES

One outstanding fact commands the attention of the subcommittee: Between 1948 and 1959 premiums for health insurance have increased 600 percent for persons of all ages-but in the same period of time, the incomes of aged family heads and of aged unrelated individuals have grown by only 48 and 44 percent, respectively.

In dealing with the current question of the most appropriate method of financing the costs of medical care for the aged, consideration should be given to (1) their health conditions, (2) the role of current insurance programs in meeting costs, (3) the role of the public assistance approach, (4) the elements of a positive health services program for older Americans, and (5) their income status, discussed in chapter III.

HEALTH STATUS OF THE AGED

Despite various attempts to obscure the basic facts, we are still impressed by the demonstrated data concerning the health problems of the aged. Our basic source of information on this subject is the careful series of studies conducted by the U.S. national health survey of the Public Health Service.

The National Health Survey, it should be emphasized, is the Nation's most reliable source of knowledge concerning the health status of all age groups. It consists of interviews in households selected on the basis of the most sophisticated scientific techniques of sampling and interviewing. For example, in a 24-month period ending in June 1959, the Survey covered about 235,000 individuals from 73,000 households. The research design allows for a continuous measurement of a wide number of health characteristics. The total nonresponse rate is only 5 percent, with 1 percent being refusals to be interviewed. The sampling errors are minimal.

The survey tends to understate much of the dimensions of the health problems of the aged, as regards hospital experience, for instance. To quote from the NHS' report on health characteristics of older

persons:

Since the mortality rate as well as the rate of hospitalization is high among older persons in the population, it is known that the hospital data collected by the survey considerably understate the total hospital experience for persons 45 years and older.

Another reason for the survey's understating of the health problem stems from its exclusion of the institutionalized population, which includes at least 4 percent of the total aged population. Other than these two qualifications (exclusion of decedents and the institutional

"Health Statistics: Older Persons, Selected Health Characteristics," Public Health Service, September 1960 (series C-No. 4), p. 3. Some of the titles from this study are reprinted in the appendix.

ized), the survey represents all segments of the country's population. Every segment, in terms of region, urban-rural residence, income, race, etc., is properly represented.

We have included this brief description of the national health survey because we feel strongly that its vital role in clarifying the current controversy over the financing of adequate medical care for the aged of the United States has too often been overlooked and neglected by the public and, indeed, by certain parts of the health profession itself. Reliable knowledge is indispensable to good legislation. Other more limited studies, with small samples often selected poorly and excluding various population segments, and otherwise faulty (wording, thoroughness, period of time covered, etc.), have only confused and misled many individuals and groups in the country. On the other hand, the national health survey was created by Congress to provide accurate and reliable knowledge on the health conditions and related characteristics of the American people. Its methodology and techniques are of the highest quality known to the field of survey sampling science.

Through its carefully detailed research, we have come to know the following, for example:

1. The rate of chronic illness (such as heart disease, cancer, diabetes, arthritis, etc.) among the aged is more than double that for those under 45 years of age-77 percent versus 34 percent.

2. Although they constitute less than 9 percent of the total population, the aged make up more than 55 percent of all persons with limitations due to chronic illness.

3. The average number of physician visits among the aged is 36 percent greater than for the general population.

4. The aged spend approximately twice as many days per year (15) in general hospitals as does the rest of the population.

5. The proportion of aged hospitalized in general hospitals for more than 1 month per year is nearly 60 percent greater than the proportion prevailing in the rest of the population, 38.8 percent as against 24.6 percent.

DATA FROM U.S. NATIONAL HEALTH SURVEY, JULY 1957-JUNE 1959 Number and percent of persons 45 years and older with one or more chronic conditions by sex and age: United States, July 1957-June 1959