(The following letter was later received from Mr. Brindle:) INTERNATIONAL UNION, UNITED AUTOMOBILE, AIRCRAFT, AND Hon. CHARLES A. WOLVERTON, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington 25, D. C. DEAR MR. WOLVERTON: This letter is in response to your recent request for additional information about the prepaid hospital-medical-surgical care plans which cover members of the international union, UAW-CIO. The UAW-CIO does not itself operate comprehensive prepaid health programs for its members and their families. Our members utilize the program available to the community in which they work and live. Consequently, the range of protection varies in accordance to what is offered in different areas throughout the country. I. DESCRIPTION OF UAW-CIO HEALTH SECURITY PROGRAMS The typical UAW-CIO health program (a) Hospitalization.-The typical UAW-CIO health security program provides hospitalization benefits on a service basis for periods ranging from 70 to 120 days. The worker and his dependents are entitled to full care in semiprivate accommodations, covering room and board, general nursing, use of operating room, drugs, laboratory services, basal metabolism test, anesthesia, oxygen, etc. There are no age limits on enrollment and children are covered from birth. If the worker should leave his group he is entitled to convert to an individual (or direct pay) contract. These hospitalization benefits are provided through local Blue Cross plans or by commercial group insurance carriers. (b) Surgical care.-Benefits are paid in accordance with fee schedules; maximum benefits payable for a specified procedure range from $175 to $225. In some communities the health plans obtain agreement from those physicians who agree to participate to accept these fees as full payment for surgical services for persons whose incomes fall below specified ceilings. For example, in Michigan there are two "income ceiling" plans: One assures full payment for persons with total annual family incomes of $2,500 or less; the other, with a higher fee schedule and higher premiums, has an income ceiling of $5,000. Most communities, however, do not have full payment provisions based on income ceilings or the income ceilings are so low as to fall below typical industrial workers' earnings, and surgical insurance is simply a cash indemnity feefor-service plan. (c) Medical care.-This insurance is confined to cash indemnity payments to the physician for nonsurgical care rendered a patient in the hospital. The period of benefit duration usually equals the period provided under hospitalization insurance, 70 to 120 days. The benefit allowance typically is $3 or $4 a day; in Michigan, Blue Shield pays $10 for the first day, $4 from the second to the fourth days, and $3 for the remaining 116 days. The most comprehensive UAW-CIO health plans To qualify as comprehensive a plan must provide full care-preventive, diagnostic, therapeutic-for the worker and his family both in and out of the hospital. At present we have members covered by two such programs: The Kaiser Health Foundation in California, and the Health Insurance Plan of Greater New York (HIP). We are enclosing a brochure which describes the benefits offered under the Kaiser Health Foundation to a group of Ford Motor Co. workers. From the material which you have sent us we are sure that your committee has full information on the benefits offered under HIP. Our members in New York must carry separate prepaid hospital coverage in addition, since HIP by itself does not provide hospital coverage. Blue Cross in New York City provides fairly comprehensive hospital services but only for a period of 21 days; it provides 50 percent benefits for another 180 days, which means that the patient has no assurance of full payment in a serious or long-term illness. The least comprehensive health plans Health benefits provided to workers' vary between areas and also vary due to different collective bargaining situations. Since there are practically no prepaid comprehensive medical care plans available in most areas where our membership is heavy, we use completeness of hospital protection as the main criterion. Substandard hospitalization programs provide benefits on a cash indemnity basis, with low room and board allowances, limited cash payments for ancillary services (drugs, X-rays, anesthesia, and other hospital services), and coverage for a stay of low duration in the hospital. Many of these plans do not provide coverage for dependents, or if they do, do not cover infants from birth but impose a waiting period ranging from 14 days to 3 months during what is medically a most critical period for the infant. Maternity benefits are too low or they are not provided at all. Age limits make impossible in many of these cases for workers over 60 or 65 to participate in a health-insurance plan. Preexisting conditions are excluded from any coverage; and there are also moral exclusions for cases due to alcoholism, venereal diseases. Should the worker leave his group, in most cases his coverage will cease immediately and he will not be able to convert to an individual contract. II. THE HEALTH INSTITUTE OF THE UAW-CIO Since 1943 the UAW-CIO has operated a diagnostic clinic in Detroit: the health institute. Its program calls for the extension of preventive medicine and of methods for the elimination of industrial diseases and accidents. Any member of UAW-CIO local unions in the Detroit area affiliated with the health institute is eligible for medical diagnostic services. The membership of the UAW-CIO in the Detroit area was approximately 390,000 in 1953. Union members' dependents are not covered. UAW and other unions not affiliated with the health institute may secure payment for their members by payment of an examination fee. The diagnostic examination includes laboratory work, complete medical history, physical examination, and any additional laboratory procedures, diagnostic X-rays or consultations with specialists which the examining physician considers necessary. The clinic is supported by per capita payments of the affiliated local unions and an international union subsidy. The mental hygiene clinic offers diagnostic and therapeutic psychiatric services to union members and other adults 18 years old or over in the metropolitan Detroit area. There is also an eye department which provides optometric examinations and refractions and purchases glasses at wholesale prices for union members and their dependents. III. NUMBERS ELIGIBLE FOR HEALTH PROTECTION Virtually all the 1.4 million UAW-CIO members and their approximately 22 million dependents are eligible for coverage under collectively bargained hospitalsurgical prepayment plans. Slightly over 1 million members have some medical protection (payment for nonsurgical care in the hospital and in some cases the home or at the doctor's office), and the dependents of approximately 40 percent of these workers are also entitled to some medical care protection. IV. COMMENTS ON H. R. 7700 As indicated in my testimony before your committee some weeks ago, we in the UAW-CIO favor stronger governmental measures than loan insurance to accomplish our goal of comprehensive health protection for the American people. However, we understand that the leaders of the nonprofit group practice prepayment health service programs in the United States today believe that H. R. 7700 would be extremely helpful in expanding their programs. And of course, the UAW-CIO would favor such an effect. We hope this information will be of use to you. JAMES BRINDLE, Acting Director, Social Security Department. Mr. EDELMAN. Mr. Chairman, could I just observe as sort of a postscript to what we have discussed here this afternoon about plans like Permanente in several large California communities, and HIP in New York, to which my union subscribes very enthusiastically. But could I point out, sir, that in both of those places the services which are now already available to the ordinary citizens are much better than they are in the average small community or scattered area throughout the United States. As Dr. Brand pointed out here, you even go to a place like Allentown, Pa., which is still a crowded industrial area, and there you run up against the absolute granite opposition of the American Medical Association against the establishment of Permenente type plan. You go into your District, Congressman Hale, and you can go into 20 places in which my union has had experience in the South, and you come across absolute granite opposition to any type of experimentation with any kind of group insurance plan. You cannot even get an official conversation between a union and a local medical association in respect to what the worker shall get for what he pays under any group plan. I simply wish to point out, Mr. Chairman, that the area which is still to be covered by some rudimentary improvement on present services is very vast and that these quite thrilling and important experiments are significant, but still very, very minor in the extent of benefit which they have achieved. Mr. PEELY. You say the opposition of the American Medical Association. You mean local societies. Mr. EDELMAN. Local societies. Mr. HALE (presiding). Are there any further questions, gentlemen? If not, we thank you very much, Mr. Brindle, and the committee will stand adjourned until tomorrow morning, at 10 o'clock. (Thereupon, at 4: 20 p. m., the committee was recessed, to reconvene at 10 a. m., Wednesday, January 20, 1954). X |