Expansion of Federal aid to higher education has been rapid and dramatic-in the programs of the Office of Education, from $164 million appropriated in 1964 to over $1.2 billion requested in the 1967 President's budget. It is because of this recent and tremendous growth that we are not requesting in 1967 the relatively small amount in annual funds authorized and specifically earmarked for the land-grant colleges. They will, of course, continue to participate in our other higher education programs. The Higher Education Facilities Act provides assistance for the construction of college and university libraries; the 1965 Higher Education Act authorizes aid for purchasing library books and materials, training professional librarians, and conducting research and demonstration projects to improve library services. We are requesting a 1966 suplemental to initiate these library programs, and the 1967 budget calls for greatly increased support, providing for about 2,700 grants for library resources, 800 traineeships, and 70 research and demonstration projects. We are requesting substantial increases in 1967 for two other programs under the Higher Education Act. The first of these is the new program of grants to States for strengthening community service programs of institutions of higher education in order to assist in the solution of community problems-in much the same way as land-grant institutions have demonstrated their ability to deal with the problems of the farm. In 1967, we plan to involve 250 higher educational institutions in this program. The second program is one which authorizes grants for cooperative projects to upgrade faculty and academic quality of developing colleges. In 1966, the first year of the program, we expect to support 110 projects; the 1967 budget would provide support for 6 times that many. OTHER SUPPORT FOR EDUCATION In addition to the programs already mentioned, the Elementary and Secondary Education Act provided authority for a greatly expanded educational research program. In passing the act, the Congress recognized that improvement in educational quality will depend on educational research and the early success of efforts to disseminate its results. In 1965, about $16 million was appropriated for the educational research program; in 1967, we are requesting five times that amount. In addition to research projects, the request will support educational research training, research centers concentrating on specific problem areas in education, and regional education laboratories. The regional laboratories will involve State educational departments and local school personnel in conducting research and bringing innovations quickly into practice. By 1967, we plan to support 12 of these regional laboratories and 11 research centers. Legislation enacted last year also expanded the research and demonstration program in education of the handicapped, as well as the program to train professional personnel in fields related to education of handicapped children. Under our 1967 budget request, more than 9,100 persons would receive training, an 80-percent increase over the number trained in 1965. Up-to-date vocational training is an essential element in our overall education program. In our 1967 budget, we would continue basic sup port for vocational education at the 1966 level, more than six times the amount appropriated in 1964. In addition, we are requesting the remaining amount authorized for area vocational schools under the Appalachian Regional Development Act. The total appropriation requested for vocational education in 1967 is slightly below the 1966 amount because a portion of the vocational education work-study program will be shifted to the Office of Economic Opportunity. One of the most successful programs of the Office of Education, support for library services and construction provides expanded opportunities for individual self-development. Since its inception, new or improved public library services have been made available to 65 million persons. With construction grants, assistance was made available in 1965 to support the construction and renovation of 363 libraries serving an estimated 23 million persons; an additional 400 projects will be supported each year in 1966 and in 1967. HEALTH Improvement of the Nation's health is a central aspect of our investment in human resources. The last 3 years have seen major legislative gains in all aspects of our national health programs, culminating in the Social Security Amendments of 1965. SOCIAL SECURITY AMENDMENTS OF 1965 The Social Security Amendments of 1965 provide for comprehensive health care programs for the aged and for major changes and expansions of child health and other welfare programs. Of greatest significance are the medicare sections of the amendments which provide a basic program of hospital insurance, extended care, and home health services for the aged, financed through social security; a voluntary supplemental program covering doctors' fees and some other health services; and an expanded program of Kerr-Mills medical assistance for the needy aged, dependent children, the blind, and the disabled. The Social Security Administration has sent information on the medicare program to over 17 million of the 19 million who will be eligible for benefits in July, and another 1 million of those receiving old age assistance will be reached through local welfare agencies. To reach the remaining persons, special projects are being undertaken in cooperation with the Office of Economic Opportunity, the Department of Agriculture, and with senior citizens groups. We are particularly concerned that all eligible persons be given an opportunity to sign up for supplementary medical insurance by the March 31 deadline. In the new medical assistance programs under public assistance, we estimate that increased 1967 requirements will be devoted particularly to health care for dependent children. The 1965 amendments also provided major expansion in support for maternal and child health services and crippled children's services, and they established a new program of project grants to provide comprehensive health care and services for needy children of school and preschool age. In 1967, we are requesting the full authorization for these programs. COMMUNITY HEALTH PROGRAMS The new health programs may be expected to have a tremendous impact on the provision of health care in the community. It is in anticipation of this impact that we have established in the Public Health Service a program to deal with medical care administration. The purpose of this new program is to improve the quality and expand the availability of medical care, especially to older persons, in all settings, the hospital, the clinic, the physician's office, the home, and in extended care facilities. To make home health services more readily available, a new grant program is administered by the Public Health Service to offer assistance to States in the development of home health services under the health insurance program. This new program also includes standard setting, coordination of the health insurance activities with other State and local medical care activities, and other activities related to the providers of medical services. Under new legislation in the 1967 budget, we propose to reorient support of health activities to provide effective coordination between Federal health programs and those of State and local groups. The purpose is to achieve more effective utilization of scarce manpower and other resources through cooperative arrangements among the Federal Government, the States, local government, and nonprofit agencies. Grants would be available for comprehensive State and local area planning for services, facilities, and manpower. Several of the existing categorical grant programs would be converted to provide a more effective base for support and stimulation of comprehensive health services. Under new legislation we would also propose to support new programs aimed at improving the quality and efficiency of medical services by developing new ways of providing them. HEALTH FACILITIES AND MANPOWER If we are to fulfill the promise of recently enacted legislation for expanded health services we must insure that the facilities and trained manpower are available to make this possible. The Hospital and Medical Facilities Amendments of 1964 expanded the hospital construction program and authorized a far-reaching new grant program for modernization or replacement of existing facilities, particularly in urban areas where the greatest need exists. The first of these modernization grants was awarded recently. In 1967, we are requesting the maximum authorization for all parts of the facilities construction and modernization program. One of the most pressing needs we face in the provision of health care is for substantial growth in the number of trained medical and paramedical personnel. It was to meet this need that the Health Professions Educational Assistance Act was enacted 3 years ago and expanded last year. It is our goal under this act to provide partial support for the creation of 20 to 25 new medical schools over the next decade. We hope to increase the number of physicians each year from the present 8,800 to 12,700 by 1971. In 1967, we are requesting a very substantial increase for construction of health educational facilities for medical, dental public health, nursing, and other health personnel. The response to this program far exceeds the amounts available; we have already approved grants to aid in the construction of facilities for eight new medical schools. In the health research facilities program of the National Institutes of Health we will give first priority to those facilities required by new and expanding medical schools. The largest increase in operational support for health education requested in 1967 is in the grants for improvement of educational quality. Health professions scholarships were newly authorized in the 1965 Health Professions Amendments, and we are requesting a program expansion in 1967. Under proposed legislation, we would begin an education and training program to overcome existing critical shortages of medical technoligists and other allied health profes sionals. Also under new legislation, we proposed to convert the existing student loan programs to guaranteed loan programs utilizing private capital, retaining all the special features of the present programs. PUBLIC HEALTH SERVICE HOSPITALS Turning to our own medical services programs, our long-term goal is to convert the Public Health Service Hospitals into centers of excellence. Our 1967 budget request will enable us to move in this direction by providing additional funds to plan for modernizing the facilities, to improve staff patient ratios, to expand the training capability of the hospitals, and to develop their operational and clinical research capability. Mr. Chairman, I would now like to touch briefly upon some of our health programs aimed at specific problem areas. HEALTH OF MIGRATORY WORKERS Migratory workers represent a group with inadequate access to health care services. For this reason, the Congress established the migratory workers health service program in 1962. This program was extended last year and expanded to include for the first time necessary short-term hospital care. Our 1967 budget includes a substantial increase for this program. MENTAL RETARDATION I have already mentioned our program in education of the handicapped including the mentally retarded. We have also included in the 1967 budget funds to continue the program of grants to States to assist in the development of comprehensive community programs to combat the problems of mental retardation. We have already made the initial awards for construction of mental retardation service facilities, and this program is expected to enter the full-scale construction phase within the next few months. We have also received a large number of requests for assistance in the construction of university-affiliated mental retardation facilities; with the 1967 budget request, a total of 16 such centers would be supported by the end of 1967. The complementary professional training program administered by the Children's Bureau will be initiated in 1967. MENTAL HEALTH In the field of mental health, we have awarded the first community mental health center construction grant; we are requesting in 1967 a continuation at the same level of support as in 1966. By the end of 1967, construction assistance will have been provided for 230 community centers. The 1967 budget also includes a sizable increase in support for staffing these centers, as well as for staffing new services in existing mental health centers. REGIONAL MEDICAL PROGRAMS The Heart Disease, Cancer, and Stroke Amendments of 1965 authorized a new program of project grants to assist universities, medical schools, and research institutions to develop and disseminate new tech niques for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases. This program will emphasize regional planning and coordination of medical resources, continuing education for doctors and other medical personnel, and the rapid distribution of new knowledge and techniques. We are beginning to implement this program with a 1966 supplemental appropriation; in 1967 we are requesting almost a doubling of funds. HEALTH RESEARCH I would like now to discuss the other programs of the National Institutes of Health. Thanks to the interest and support of this committee, the appropriations for the National Institutes of Health have grown from about $70 million in 1954, the first year after the Department was created, to about $14 billion in 1966. And with these funds an organization of excellence has been created. Our health research expenditures have been credited as being among the most worthwhile of all Federal expenditures. We have made every effort to continue the forward progress of recent years by applying the 1967 increases selectively. Our budget of over $1.3 billion for NIH will permit a considerable degree of progress in our health research effort. The largest single increase for NIH in the 1967 budget is for research grants. This includes an increase in the regular research grant program to finance continuation projects, and increments of new and supplemental projects. The 1967 budget request for special research grants includes increases for the general research support program, the animal resources and primate center programs, and for multidisciplinary research and training centers to study the possible toxic effects of drugs on man. The NIH training grant and fellowship programs will be increased in the 1967 budget, particularly in the area of mental health. Direct operations also receive a higher level of support in the 1967 budget, with the largest single increase for the intramural research program. ENVIRONMENTAL HEALTH AND CONSUMER PROTECTION Mr. Chairman, I would now like to turn to the area of environmental health. It is a grim fact that in this country today we are polluting our environment more quickly than we can devise ways of dealing with that pollution. The 89th Congress has already given this Department broad new authority to combat the problems of pollution including the establishment of a new Federal Water Pollution Control Administration but we will have an uphill struggle for some years to come. WATER POLLUTION Since the Federal Water Pollution Control Act became law, over 5,000 waste treatment facilities have been constructed and an additional 900 now under construction will be completed by the end of 1967. Last year, the Congress amended the act to raise the authorization for construction support. With the new maximum authorization, which we are requesting in 1967, construction of an additional |