Mr. ROGERS. Thank you very much. We appreciate your interest in being here.

Mr. Preyer.

Mr. PREYER. I thank you, too, and I think you have given us an eloquent statement of bottoms-up planning which will be very help

ful.

Mr. ROGERS. Thank you so much.

The next witness is another distinguished colleague of ours, the Honorable Gary Meyers from the State of Pennsylvania.

We welcome you to the committee and will be pleased to have your statement. It will be made a part of the record at this point and you may proceed.

STATEMENT OF HON. GARY A. MYERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. MYERS. Thank you, Mr. Chairman.

I appreciate the opportunity to appear here today and share briefly with the subcommittee some of my views on the health planning process. I will deviate from my prepared remarks and compliment you for honoring the commitment you have made on the floor of the House and to a number of us that you would provide the opportunity for input such as this.

We have had an active HSA in southwestern Pennsylvania and a great deal of public participation in a sometimes volatile health planning process. The views I will express are based on my observations of and participation in that process.

I realize the subcommittee has before it both subcommittee and administration bills proposing far-reaching changes in HSA structure and process, as well as recently altered HEW national health planning guidelines. While I may wish to comment on specific provisions of those bills or those guidelines in the future, I want to take this opportunity to share with you several overall principles which I believe should guide the subcommittee as it considers the important issues facing it.

The first principle that should guide health planning policy, in my opinion, is to keep decisionmaking as close as possible to the people. I know I am not telling the subcommittee something it has not heard before when I say that citizens in communities across the Nation are the individuals who build and who maintain community hospitals. Federal and State assistance has helped, but by and large it local citizens who have raised the funds, issued the bonds and attracted the doctors. And, with all due regard to the need for regional health planning, it is these local citizens who should have the greatest say in decisions about providing health services.

This principle of local control is worth repeating as the subcommittee considers whether the locus of power in the planning process should be at the HSA, State or Federal level. I believe it should be underscored and it must be remembered as the subcommittee considers HSA composition issues.

Transferring power too far from the hands of local citizens or creating nonrepresentative boards can alienate citizens and com

munities from the health planning process. Even now, many citizens in western Pennsylvania tend to view our HSA not as a local agency -as it is seen from Washington-but as a long arm of the Federal Government. And transferring decisionmaking power from localities can unfortunately destroy one of our Nation's most vital health resources: local interest in and support of community health facilities. While this local interest and support is not conventionally listed among "health resources," I submit that it far exceeds in importance very CAT scanner in the Nation. Once again, I urge the subcommittee to keep health planning as close as possible to the people.

A second principle that should guide Federal health planning decisions, in my estimation, is maximum flexibility both at the HSA level and at the sub-HSA level. There may be a time in the future when health planning techniques are sufficiently sophisticated and assured of bringing results so as to argue for rigid guidelines. Now, though, when health planning is still in its infancy, excessively rigid health system plans, certificate of need, or appropriateness review procedures serve only to alienate citizens and to achieve a nonproductive "leveling" effect.

I believe, at this state of health planning sophistication, that community medical facilities should be given considerable flexibility, and should be encouraged to comply with regional health plans rather than being forbidden to deviate from a prescribed system. Medical facilities not complying with HSA plans could be penalized through the medicare reimbursement system, for example, so that they lose that part of the reimbursement amount attributable to noncompliance facilities or services.

But there should be no absolute ban on providing services for which a local community is willing to pay a premium out of its own pockets. There should not be, in my estimation, federally supported groups telling local communities they absolutely cannot try harder and provide services above a mandated level.

Finally, Mr. Chairman, I would suggest as a third principle guiding the health planning process noninvolvement by HSA's in social or moral issues peripheral to the health planning process. This is an area, Mr. Chairman, where I respectfully suggest the subcommittee may wish to provide guidance to HSA's.

I do not believe, for example, that the issue of appropriateness of abortion should affect HSA health planning policies. Normally, I would not have even considered raising the abortion controversy in the context of health planning. However, the issue has already been raised in western Pennsylvania-and, I understand, in other areas of the Nation-since the HSA of southwestern Pennsylvania board passed a resolution supporting medicaid-funded abortions.

I am not interested in limiting the free speech of citizens serving on HSA boards. But the resolution to which I refer has caused considerable_concern among pro-life groups in my district-justifiable concern, I believe that the HSA board's personal views on controversial social and moral issues will color the health planning process. Regardless of whether one feels formal health planning will work or not, I believe there is a consensus that planning should be attempted on a rational, nonemotional basis. Interjecting controversial

topics like abortion rights into the debate can only further complicate the planning process. Once again, I urge the subcommittee to offer guidance to HEW to guard against permitting HSA involve

ment in social and moral issues.

Thank you again for the opportunity to appear here today, Mr. Chairman. I appreciate the subcommittee's consideration of my remarks.

I would also like to just briefly underscore what Congressman Stangeland pointed out. He had examples of local hospitals whose costs ran significantly below the national average. We had a community in our area where the hospital administrators could prove that the HSA was attempting to phase out a facility that was providing hospital care at a cost substantially below that at the facility to which the citizens would be diverted. It is not true that formal planning is correct in all cases. That is why I think flexibility should be made in all areas that it can be provided.

Mr. ROGERS. Thank you. Your suggestions are helpful to the committee and will be carefully examined.

Mr. PREYER. I share your views about the noninvolvement of HSA's in social and moral issues. I think that will handicap the planning process. I wonder what kind of guidance we can give on that without interfering with their local autonomy and perhaps constitutional freedom of speech issue?

Mr. MYERS. As I understand it, there are lobbying prohibitions currently in law that address the use of Federal funds. I think we should look at whatever way we can broaden that where the activities concern HSA's. I think the HSA board members have the right as individuals to take positions on social and moral issues. But as a body to pass a resolution which then may affect their decision to close one hospital which might have a service which perhaps might not be consistent with their moral values would, I think, cause a very difficult situation in the community and actually erode the confidence that health planning had been done on a basis absent of that particular bias.

I think the committee can in fact include strong language which would specifically point out the intent of Congress that we don't expect the bodies to embroil themselves in these social issues unless they are relevant to the mandate of planning that has been given to them and I think, within that mandate, there should be sufficient flexibility for them to express their personal opinions.

Mr. PREYER. Thank you, Mr. Chairman.

Mr. ROGERS. Mr. Carter.

Mr. CARTER. Thank you, Mr. Chairman.

I would like to congratulate the gentleman from Pennsylvania. You have a broad spectrum of citizens from every level of society in your HSA.

Mr. MYERS. I guess it would depend on who you ask. If you ask the HSA membership, they probably think they have a broad spectrum. If you ask the individual citizens affected by the HSA decisions, there is currently a feeling that there is not a representative level of communities and, quite frankly, I think the process by

which individuals are elected to HSA boards is so well hidden that the average participant in the community really does not know how to prepare himself to become a member. I am not speaking of immediately becoming a member, but to prepare himself in his plans to become a member sometime in the future.

I think there is not, from my observation, a cross-section, sufficient cross section represented in the agency.

Mr. CARTER. At the present time approximately 15 percent of the membership throughout the country is composed of elected officials, I believe. Do you think that is sufficient or should there be more, or less? Should they be classified as providers or consumers?

Mr. MYERS. That is a difficult question because I think there could be attempts by elected officials to utilize their membership on an HSA board to enhance their other political aspirations. I think that is a risk that should not be ignored.

I don't think that we can accept the theory that simply because somebody has been elected as a Member of Congress or a member of the legislature of a State or as a city councilman that he is best qualified to serve on a health planning board.

I am not sure that that is all that is necessary. I think whatever the board's makeup is, that certainly one of their responsibilities is to consider the opinions of people who have been elected in the communities. This can be done through the hearing process by permitting an adequate interface between the two bodies.

Mr. CARTER. I want to thank the distinguished gentleman for his excellent statement.

Mr. MYERS. Thank you, Dr. Carter. I appreciate your interest and the subcommittee's interest.

Mr. ROGERS. Thank you for your help.

Without objection, the Chair wishes to place in the record, as though read, the statements of Congressman Stewart B. McKinney of Connecticut and Hon. Baltasar Corrada, Resident Commissioner, Puerto Rico.

[Statements of Congressman Stewart B. McKinney and Hon. Baltasar Corrada, Resident Commissioner, Puerto Rico, follow:]

STATEMENT OF HON. STEWART B. MCKINNEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CONNECTICUT

Mr. MCKINNEY. Mr. Chairman and committee members: I value this opportunity to offer the committee some first-hand insight into the failure of HEW to properly administer the regional health systems program. I must also urge the committee to review and clarify certain existing provisions under Public Law 93-641 and Public Law 95-215, before further granting the regional HSA's the power to decertify certain medical facilities. I have personally witnessed, Mr. Chairman, the controversy, anger and harm that can result from misinterpretations of existing law. HEW has interpreted its power to grant an extension of temporary designation for a Health Systems Agency [HSA] one way, the public has interpreted its right to a meaningful public comment period in another way. Hence,

before the national program for the establishment of regional health plans proceeds much further, this committee must clarify the Agency's power, the public's right to involvement and HEW's responsibility to respond to public concern.

I recently became involved in a matter regarding the proposed health systems plan [HSP] for Fairfield County, Conn. As a result of the overwhelming public concern in Fairfield County regarding the future possibility of decertifying certain hospital units, the lack of available information regarding the HSP's regional, economic impact, and the insufficient opportunity for full public comment, I solicited the assistance of both the HEW regional office in Boston and Secretary Joseph Califano. In both instances I requested that the fast-approaching deadline for submission of the Southwestern Connecticut Health Systems Agency's application for permanent designation be delayed for just 90 days in order to allow the public's overwhelming concern every opportunity to be fully expressed. It was not until I received the Secretary's official response to my request for extension, that I realized how harmful HEW's misinterpretation of existing law could be to the future of all H.S.A. programs in the country. It was also as a result of this response that I realized the importance of this committee's task in clarifying existing provisions to correct H.E.W.'s misinterpretation, and thereby mollify the public's legitimate concern that future plans will be arbitrarily forced upon them. Let me explain in more detail.

As a result of the controversy and inordinate public interest by Fairfield County resident's concerning the content of the proposed HSP. I sent Secretary Califano a letter outlining those concerns. [insert No. 1, see p. 913].

Unfortunately, Mr. Chairman, the Secretary's response not only lacked cognizance of the dilemma facing Fairfield County (as outlined in my letter), it also demonstrated an insensitivity to the public concern and an astonishing lack of knowledge of the language of the enabling legislation. Insert No. 2 [sec p. 916] is the response bearing the secretary's signature.

Clearly the Secretary's response was inaccurate. The exact wording of Pub. L. 92-215 states:

The Secretary may upon application of a conditionally designated entity, extend for an additional period of not to exceed 12 months the period of such entity's conditional designation if the Secretary determines that (A) unusual circumstances exist.

The conference report accompanying Pub. L. 95-215 (House Report 95-828), to which the Secretary refers in his letter, states:

Such circumstances which might cause the Secretary to make such a determination include but are by no means limited to (emphasis added) the following: -Agencies serving areas that in whole or in large part have had to devote a greater portion of their effort and resources in the first 2 years to organizational development, community involvement

There is a clear contradiction between the Secretary's interpretation of the criterian needed to extend a programs' conditional designation and the conference reports interpretations of those same criteria. The Secretary's letter refers to a "rather specific list" of