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Appendix 1.—Prepaired statements:

Item 1. Prepared statement of Arthur F. Hanley, president, Rhode

Island Blue Cross and Blue Shield..
Item 2. Prepared statement of Dr. Richard J. Kraemer, chairman,

Committee on Aging, Rhode Island Medical Society ----
Item 3. Prepared statement of Edwin C. Brown, secretary-treasurer,

Rhode Island AFL-CIO..
Item 4. Prepared statement of Eleanor F. Slater, coordinator, Divi-

sion on Aging--
Item 5. Prepared statement of Dr. Mary Mulvey, vice-president, Na-

tional Council of Senior Citizens.--
Item 6. Prepared statement of Wade Johnson, executive director,

Hospital Association of Rhode Island..
Item 7. Summary of prepared statement of Dr. P. Joseph Pesare,

Medical Care program director, Rhode Island medical assistance

program--

Item 8. Prepared statement of Dr. P. Joseph Pesare -
Appendix 2.-Additional information requested from witnesses by Senator
Pell:
Item 1. Supplementary, materials in response to specific questions

raised by Senator Pell: submitted by Dr. P. Joseph Pesare.--
Item 2. Letter from Wade C. Johnson, executive director, Hospital

Association of Rhode Island, in response to specific questions.

raised by Senator Pell.-Item 3. Letter from Albert V. Lees, president, Rhode Island Associa

tion of facilities for the Aged, in response to specific questions raised

by Senator Pell. Item 4. Letter from Richard J. Kraemer, M.D., vice-president,

Rhode Island Medical Society, in response to specific questions

raised by Senator Pell.. Item 5. Letter from Gustin Buonaiuto, president, Rhode Island

State Nursing Home Association, Inc., in response to specific ques

tions raised by Senator Pell.--Item 6. Reply from Arthur F. Hanley, chief executive officer, Rhode

Island Blue Cross and Blue Shield, in response to specific questions
raised by Senator Pell.--
Item 7. Letter from Shirley A. Whitcomb, R.N., director, Cranston

District Nursing Association, in response to specific questions
raised by Senator Pell---
Item 8. Letter from Alex M. Burgess, Jr., M.D., chief, Division of
Planning

and Standards, in response to specific questions raised by
Senator Pell..
Appendix 3.- Additional material submitted by witnesses:

Item 1. Letter to Senator Pell from Veronica Murray, Providence, R.I.

Item 2. Letter to Senator Pell from Mildren A. Dean, Providence, R.I.
Appendix 4.-Letters from individuals and organizations:

Item 1. Letter to Senator Pell from Doris Ē. Johnson, Providence, R.I.
Item 2. Letter from Aristide B. Morsilli, Johnstown, R.I.
Item 3. Letter to Senator Pell from Anthony J. Agostinelli, executive

director, The Urban Coalition of Rhode Island. Appendix 5.-Statements submitted by the hearing audience:

Heltzen, Ms. Louise, Providence, R.I.
Terrier, Eugene, Woonsocket, R.I..
McCullough, Daniel J., Providence, R.I.
Davis, William E., Providence, R.I..
Cullen, Miss Ellen, Providence, R.I.--
Goode, James A., Providence, R.I.
Hood, Marshall L., Providence, R.I.
Coffey, Paul, Providence, R.I.

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CUTBACKS IN MEDICARE AND MEDICAID COVERAGE

MONDAY, SEPTEMBER 20, 1971

U.S. SENATE,
SUBCOMMITTEE ON HEALTH OF THE ELDERLY,
SPECIAL COMMITTEE ON AGING,

Providence, R.I. The subcommittee met at 10 a.m., pursuant to call, in the Diocesan Auditorium, Saints Peter and Paul Cathedral, Cathedral Square, Providence, R.I., Senator Claiborne Pell, presiding.

Present: Senator Pell. Also present: Keven McKenna, legislative aide to Senator Pell; Kenneth Dameron, Jr., professional staff member; Carol Ann De Vaudreuil, secretary; and Janet Neigh, assistant chief clerk.

OPENING STATEMENT OF SENATOR CLAIBORNE PELL, PRESIDING

Senator PELL. This hearing of the Subcommittee of the Special Committee on Aging of the U.Š. Senate will come to order.

I am very pleased to say I am grateful to the Catholic Diocese for the use of this auditorium. I thought we would start punctually because we have quite a long list of witnesses. Nearly 7 years ago the Congress acted to pass a law to care for the

7 health needs of our senior citizens. Today we are here to review the operation of the Medicare and the Medicaid programs over the past years in Rhode Island. The Senate is presently considering a bill, H.R. 1, to change the scope of the Medicare and Medicaid programs. Today we are here to examine the ramifications of that bill on the senior citizens of Rhode Island. Today we are also here to take a comprehensive overview of the Medicare and Medicaid programs in Rhode Island.

Following our discussion of the problems of access to health care, we will hear senior citizen consumer representatives as to the adequacy of the Medicare and Medicaid programs in Rhode Island. Following our discussion of consumer viewpoints, we will hear directly from those persons who have the responsibility for providing health care services to senior citizens, the doctors, the hospitals, the nursing homes, and the visiting nurses.

The Department of Health, Education, and Welfare recently predicted, in a cost study required by an amendment of mine enacted into law last year, that health costs will rise by 50 percent in the next 2 years. One question I plan to pose for the providers of health care services in Rhode Island is how they plan to control this expected 50 percent rise in health costs. If this rise cannot be controlled, the senior citizens will unfortunately have to pay the bill.

Following up on our panel discussion we will look at a new means of health delivery which offers much hope for senior citizens in the future. Ed Brown of the Rhode Island AFL-CIO will discuss with us at that time the program of the Rhode Island Group Health Association.

One of the purposes of our hearing is to hear directly from the senior citizens. At the close of our panel discussion, there will be a town meeting in which members of the audience will be invited to offer their comments for the hearing record.

In this regard, I am informed, one group feels they have been muffled and not been able to make their viewpoint known. If there is any group that feels muffled, please let me know and we will be more than glad to hear from them.

The only pressures are those of time, and I would urge all witnesses to be as brief as they can in their presentation.

Now, I am particularly honored that we are up here also under the auspices of the city of Providence; and its chief executive, my old and good friend, Joseph Doorley, is here to help open our proceedings and grace them. Mayor Doorley. [Applause.]

STATEMENT OF JOSEPH DOORLEY, MAYOR, PROVIDENCE, R.I. Mayor DOORLEY. I think it would be somewhat presumptuous of me to welcome Senator Pell to Providence, R.I., for as long as I have been mayor, whenever I have had a problem I have never hesitated to call upon him. He has always been accessible and he has always been of great assistance to me.

But in his capacity as a member of the Committee on Aging, and particularly in his capacity representing the U.S. Senate, I would like to formally welcome this panel discussion and this hearing, because I think it is fair to say that to the best of my knowledge no other group in this Nation has been as severely affected by inflation as our senior citizens.

Their incomes are limited in 95 percent of the cases. And one of the gravest concerns, and I speak now from personal experience, of our senior citizens is the dreaded fear of becoming ill. What is going to happen to them when they become ill? When they become sick, what is going to happen to whatever limited resources they have?

We ought to be concerned about medicare and medicaid. I have had the personal experience of a man 67 years old, the father of a close friend of mine, with a rare blood disease, and without medicare his personal medical expenses in 2 months would have been over $26,000.

2 Now, without the programs that have been promulgated through the help of men like Senator Pell, that man would be without a home today, without an automobile, and without any resources.

Another problem area that has been directly brought to my attention are those people in what I would call the twilight zone. They are in their early sixties and they are not 65, and they have some resources, and the cost of medical care is drastically affecting them, the outright cost, and what will happen after the Medicare has been used up. What do they do then?

And this is an area which I think merits your concern. Another factor that I am personally aware of is the cost of pharmaceuticals, pharmaceutical supplies and drugs, which is greatly needed by our aging. I think, Senator, we are going to have to find some way of providing a pharmaceutical center where our people, particularly our senior citizens, know they are getting a fair deal on their pharmaceutical supplies.

Now, I know, for example, from the personal experience we have had with the operation of the Rhode Island Group Health Association facility, that the savings for pharmaceutical supplies runs any. where from 30 to 70 percent. And I am hopeful there is some way we are going to be able to provide these drugs and pharmaceutical materials at a discounted price for our senior citizens.

And finally, one last word, Senator, we can provide a tremendous amount of services, health carewise, recreationwise, and educationwise, when we have our senior citizens where they can gather together or where they are naturally gathered together. I think of the facility such as Bradford House. There is not a week that goes by that I do not receive at least 10 letters requesting some type of assistance in having people admitted there.

I think if we can assure a better share of housing for the elderly and we have these people in these facilities, we can provide the health care using the home or the facility, of course, as the center. And I do hope, Senator, that the Congress of the United States will look very, very carefully at what the administration requests in this particular area and, naturally, increase it.

With that, I thank you for the opportunity of making a brief presentation.

Senator PELL. Thank you very much, Mayor Doorley. I would add that we from the northeastern part of the country are very conscious of these problems of the elderly and the importance of rearranging some of our priorities and the importance, Mayor Doorley, of having more units for the elderly. Actually, our own Congressman, Congressman St Germain, in his district has gotten more units than any other Congressman in the country, but we need far more because the pile of citizens is 6 years, and he has more pressure in his area than any other area, I think, in our State in this regard.

I would also like to mention that this hearing is not just a unique occurrence, but is one of a series. The first hearing in the series was held in May, in Los Angeles, and we had one in Woonsocket, R.I., in June. Next week there is going to be one in St. Louis, and then one in Florida and in Maine.

These hearings of this subcommittee, which is chaired by Senator Muskie of Maine, have been called at his request and we hope to do a fairly good job covering the whole United States so as to find out how H.R. 1 can be improved, what are the needs of the elderly, and to try and marshal public opinion behind a reordering of the priorities, so you don't have a situation that presently exists where better than 95 percent of the moneys that are authorized for defense and space are spent, while an average of 50 percent of the funds that are authorized for the human sector of the economy, health and education, housing for the elderly, things of that sort, are spent.

And one of the purposes of these hearings is to marshal public opinion to try to rearrange these priorities. Now we come to our first panel, which is the Panel on Access to Health Care. And I would hope that the first panel, which is Mrs. Ann Hill, director of the St.

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Martin de Porres Center for Senior Citizens; and Miss Hannah Marshall, can come up and sit with us here. And Miss Ruth Lamoreux with Mrs. Sadie Gildea, Mrs. Connie Carter, field aide for Project SECAP, which is senior citizens action program. Mrs. Eleanor Slater, an old friend and coordinator of the Rhode Island State Division of Aging. And most important of all, our Col. Walter McQueeny, chief of the Providence Police Department, who has done such a fine job in opening communications in our city here.

If they would all come up and sit in the panel on the left, I'd be very grateful. Maybe I started so promptly, which is unusual for a politician, we haven't got all of our panel here. I think I still want to keep on schedule, so we will start with the witnesses that we have and just move ahead.

Medicare could provide all the health benefits possible and still be meaningless to our older citizens if those health benefits were not accessible to our senior citizens. Actually, census figures today indicate that Providence is becoming increasingly a city of citizens of grayhairs, longhairs, and Afros; that is to say, middle-class, middle-aged citizens have moved out of the city and left it to their elderly mothers and fathers and the youth and the poor of the city.

Our first panel will discuss the relationship of our poverty, youth, and our elderly citizens in our city of Providence and see how this relationship is sometimes rooted in brutal crime. Our first panel will discuss how terror has immobilized our senior citizens and inhibited them from obtaining the health care they need. And I see our panel is increasing in size. Colonel McQueeny has many, many responsibilities; he may be a little bit late.

So I think we will open up, if I may, with Mrs. Ann Hill and Miss Hannah Marshall. And I would ask Mrs. Hill, director of the St. Martin de Porres Center for Senior Citizens, sponsored by the Catholic Church, to begin. She is a member of the Rhode Island Crime Commission and the Rhode Island Drug Commission. And Miss Marshall, who is with her, 76 years of age, has been robbed twice and can speak specifically.

Mrs. Hill is at the far end. Mrs. Hill, would you start out?

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STATEMENT OF ANN HILL, DIRECTOR OF THE ST. MARTIN

de PORRES CENTER FOR SENIOR CITIZENS

Mrs. HILL. Thank you, Senator Pell. I think that a part of this discussion in transportation and crime are very interrelated with many other problems that go along with it. Miss Marshall, at my right, is one of our senior citizens who has had the personal experience of being robbed, purse snatching in the street.

LACK OF IMMEDIATE FACILITIES CONTRIBUTE TO CRIME We could very easily attribute these things to many circumstances. It is my opinion that the lack of transportation and immediate facilities in certain neighborhoods contribute a great deal to crime. For example, in our own West End neighborhood, we do not have a super

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