So what you really have in your general health programs and to a certain degree in the categorical is that in many cases the Federal money only represents 1 percent of their total expenditures, so that it becomes a very small factor really in the big States as far as the support is concerned. It is an important factor because any money is important these days, but it is a relatively small factor. However, the point Senator COOPER. I am thinking of a situation where, because of the facilities those States have, they probably have more advanced programs in those fields. Then, in a State like Wyoming do you think the cutting of their funds which would probably result from the change of this formula would possibly affect the programs which can perhaps only be carried on successfully in those larger States where they have better hospital facilities, like cancer control? Mr. ROCKEFELLER. I think the answer would be "Yes," if there would be only a support program based on the equalization formula found in the Hospital Survey and Construction Act. However, that is only a part of it. The extension and improvement grant is allocated on a population basis. Therefore the big States would get more money because of larger population, and that money would be applied for the improvement of their program. So that they will benefit proportionately more here because of the larger populations that they have. That will create a balance. Senator COOPER. It will correct inequities? Mr. ROCKEFELLER. That is correct. So the answer to your question is that the new formula would not adversely affect it. Senator COOPER. I have another question. Secretary HOBBY. May I add one thought there, Senator? Senator COOPER. Yes. Secretary HOBBY. In the application of the Hill-Burton formula, in the Hospital Survey and Construction Act our experience demonstrates that these so-called rich States were not deterred in their hospital construction. In the States with lesser fiscal capacities, however, the programs were greatly helped. That has been the experience in hospital construction as among the States. Senator PURTELL. Mrs. Secretary, may I say-and this may be helpful to Senator Cooper, although I am not sure that it will be--but it may be if I asked this question now: Is it not true in the long run, and in the overall picture, that every State will be better off financially, that is, the financial participation will be greater than it is today? Also have you some figures that will demonstrate that so that we can include them in the record? I believe you do have some. We have one set of figures which I received from your Department, and I think we ought to have it in the record. Secretary HOBBY. Could we submit that for the record? Senator PURTELL. Yes. I am sure it would be a help and it will be included, if there is no objection. I have one here and that is the reason why I mentioned it. (The document referred to is as follows:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, WASHINGTON NOTE-The attached tables have been prepared to show the fiscal effect of the President's recommendations in respect to Federal grants to States for health services and facilities, vocational education, vocational rehabilitation, and mater nal, and child health, and welfare services. The explanatory notes indicate the assumptions which have been made in the preparation of the tables. The budget levels for fiscal year 1955 have been used, for purposes of comparison, in the 1956 table. It should be particularly noted that the second table, labeled “Projected Impact of Legislative Recommendations-Fiscal Year 1956," is not intended to be a prediction of the budget recommendations of the President for fiscal year 1956 except in the case of vocational rehabilitation. The levels of appropriations in fiscal year 1956 will be determined through the regular budget process in the light of all circumstances existing at the time of the budget recommendation. The maximum authorizations for the five programs as proposed in the bills to carry out the President's recommendations are as follows: Hospital construction_____ Public health services. Maternal and child health and welfare.. Vocational rehabilitation_ Vocational education 1 No limit. $210, 000, 000 36, 000, 000 Projected impact of legistative recommendations, fiscal year 1956—Federal grants to States vocational rehabilitation, and maternal and child health and welfare services (covers & program services and facilities, vocational education, which will use, if proposed legislation is enacted, the basic allotment formula of the Hospital Construction Act) Important: This table presents, upon the basis of certain assumptions, the fiscal effect of proposed new legislation covering Federal grants-in-aid for health services and facilities, vocational education, vocational rehabilitation, and maternal and child health and welfare services. The assumptions are: 1. That the sums to be appropriated in 1955 are the same as those contained in the President's budge, for 1955. 2. That the President's legislative recommendations will be enacted and effective on the dates indicated in the appropriate footnotes. 3. That the appropriations for each program in 1956 will be the same as the assumed appropriations for 1955, with the exception of "Surveys for hospital construction" and "Vocational rehabilitation." (The hospital survey money is a nonrecurring appropriation for 1955. The vocational rehabilitation figures for 1956 reflect the Presi dent's recommendation that the funds for this program be markedly increased during the next several years.) The figures contained in this table represent allotments to the In the event that any State should not appropriate sufficient funds to match the Federal allotments in accordance with the proposed formulas, the full allotment would States. Since the actual 1956 figures will be determined through the budget and appropriations process in 1956, the 1956 figures presented in this table are not be available to the State. purely hypothetical and are only for the purpose of indicating the approximate effect of the proposed new legislation. United States total.. $20,000,000 $10,000,000 $20,000,000 $10,000,000 $50,000,000 $110,000,000 $12,707, 781 $4,806, 219 $17, 514, 000 $25, 500,000 $1,500,000 $27,000,000 9/2,010 9, 292 220, 301 Arkansas. 423, 292 211,646 423, 292 211,646 1,076, 964 2,346,840 275, 084 55, 587 330, 671 547, 157 19,762 566, 919 California. 810, 232 405, 116 810, 232 405, 116 2,061, 436 4,492, 132 511,879 337, 481 849,360 816, 091 98,766 914, 857 Colorado. 165, 461 82,731 165, 461 82, 731 420,976 917,360 112,320 42, 400 154, 720 244, 680 13, 288 257,968 Connecticut. 140,814 70,407 140, 814 70, 407 358,267 780,709 100, 247 62,313 162, 560 246, 001 17, 201 263, 202 Delaware 100,000 50,000 100,000 50,000 200,000 500,000 42, 921 19, 522 62, 443 166,316 District of Columbia 100,000 50,000 100,000 50,000 200,000 500,000 57,080 25,000 82,080 173, 652 Florida.. 491,285 245, 642 491, 285 245, 642 1,249,954 2,723, 808 309, 624 90,977 400, 601 524,896 Georgia.. 707,915 353,957 707,915 253,957 1,801, 115 3,924,859 424, 404 97,844 522,248 894, 009 37,995 932, 004 Idaho. 100,000 50,000 100,000 50,000 215,009 515,009 72, 520 25,000 97, 520 202,743 6, 076 208,819 Illinois 622,885 311,443 622, 885 311, 443 1,584, 779 3,453, 435 404, 483 264, 237 668, 720 645, 714 77, 125 722, 839 Indiana. 459, 780 229,890 459,780 229,890 1, 169, 799 2,549, 139 290, 586 121,603 412, 189 543,377 39, 109 582,486 Iowa. 314,659 157,329 314, 659 157,329 800, 572 1,744, 548 203,858 78,371 282, 229 464, 232 24, 071 488, 303 Kansas. 260, 574 130, 287 260, 574 130, 287 662,966 1,444, 688 169,072 59,317 228,389 321,888 17,365 339,253 Kentucky. 611, 102 305, 551 611, 102 305, 551 1, 554, 801 3,388, 107 378, 869 84, 805 463, 674 773, 557 31,768 805, 325 Louisiana. 526,382 263, 191 526, 382 263, 191 1, 339, 251 2,918, 397 317,947 77, 253 395, 200 633, 742 28, 667 662, 409 Maine 140,911 70, 455 140, 911 70, 455 358, 513 781, 245 93, 808 26, 192 120,000 218, 085 8, 854 226, 939 Maryland. 248, 579 124, 289 248, 579 124, 289 632, 447 1,378, 183 158, 041 74, 843 232, 884 313, 567 22, 913 336, 480 Massachusetts. 440, 638 220, 319 440, 638 220, 319 1, 121, 096 2,443, 010 283, 483 142, 076 425, 559 438, 726 38, 733 477, 459 Michigan 633, 026 316, 513 633, 026 316, 513 1,610, 580 3,509, 658 405, 454 198,755 604, 209 741, 137 62, 991 804, 128 Minnesota. 392, 696 196, 348 392,696 196, 348 999, 118 2,177, 206 251, 341 89, 513 340, 854 496, 211 29, 141 Mississippi... 525, 352 558, 080 279, 040 558, 080 279,040 1, 419, 898 3,094, 138 357,970 64, 388 422, 358 773, 457 25, 106 798, 563 Missouri. 485, 490 242, 745 485, 490 Montana... 100,000 50,000 100,000 242, 745 50,000 1,235, 211 2,691, 681 316, 514 120, 177 436, 691 532, 411 33,728 566, 139 200,000 500,000 67,080 25,000 92,080 198, 375 6, 023 204,398 See footnotes at end of table. Projected impact of legislative recommendations, fiscal year 1956-Federal grants to States for health services and facilities, vocational education, vocational rehabilitation, and maternal and child health and welfare services (covers 5 programs which will use, if proposed legislation is enacted, the basic allotment formula of the Hospital Construction Act)-Continued |