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United States total
Alabama
Arizona
Arkansas.
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi.
Missouri.
Montana.
Nebraska
Nevada
New Hampshire.
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island

See footnotes at end of table.

286

PRESIDENT'S HEALTH RECOMMENDATIONS

119 L20 12. 4 31 1 18 3 22.3 22 3 47.9

-I thought that might be along the line you were

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11, 240, 250
1.210,936
1,004, 399
5,791, 246
2, 66, 003
3,749, 482
4, 295, 760
1,040, 233

982, 521
1, 123, 031
5, 583, 154

578, 582

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= I have one other question. I know most poor

oing for money and searching for money. Do cuzdanger in this in that there is any tendency to i lepentage of support into these poor States, or ' at the approval of the Department? It would depend on the level of the appropria2. The level in support and in extension and imtral projects. Tist is the tendency for local governments to get

omsts on somebody else's back. a I think the Secretary's point is very important. yar over how much it gets in support grants, Till determine what funds will be allocated to **T-part grant program. Then the money would

tto the Hill-Burton formula, so that it would go ind get their share automatically. 7 Take that list with Public Health on it. Would Twithin the State of making a plan within the

to channel its funds more into its operating pe under general health, than it would be in the are termed categorical! Let us say in research,

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1955 Budget of the United States under present title V of the Social Security Act, as

Assumes $3 million special project grant distributed on basis of population for "subst antial nationwide expansion and excludes $500,000 for grants on an individual project

* Includes $7,138,330 permanent appropriation under Smith-Hughes Act, and $17.500.000 estimated in 1935 Budget of the Inited States under the (teorge-Barden Act. arnen led basis

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2 That would really be up to the State health offi

Iquine, working with the governor and the county

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2, 140
9, 457
41, 58

l'iscal year 1953: State breakdown of proposed grants to states in 1955, assuming enactment of proposed legislation for programs which

acill use, if propose d legislation is enacted, the basic allotment formula of the Hospital ('onstruction Act-('ontinued

Vocational rehabilitation

Special projects

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:l's a great temptation, though, to get rid of some

'Te any control or possibility of reviewing those 11. I will let Dr. Scheele answer that particularly; uz vie state plan. I would like him to simplify that. 5:55 States would be required to submit their plans

lolare our working relationship with them is such Tth them on a friendly basis and avoid that very eYou recognize there is always that possibility zle, sir

. This has always been a problem and it is a

Maternal and child welfare

It issumed that threr programs, freut men led by the President, will become effer
Jals 1. In' of

farls' re mine
II. Nutant luon 1955 : et estimate under title VI of the Puric

· Final Todos los amants for all it'nnt grants to states inclu led in
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..ciude $2.8.')"reurielund B" for allotinent lors i projits, contained in Hul!). Pilave linii

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Tebare $10 million in the general-assistance grant, hitrith that money today. So this is not new, but it themer up certain administrative expenses they wanted a. We found them very good about not using that funds from, and also in the budgets in TB and venereal

the State and local money into those special programs.

out of the bars on this chart show they have been in

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That is right. They are actually overmatching and

Prenal grant to cover those programs which are im. The reason why I asked that is for this reason: ning to testify later on this. It is the statement for the

health people.

Senator PURTELL. I thought that might be along the line you were talking about, Senator.

Senator COOPER. I have one other question. I know most poor States are always looking for money and searching for money. Do you think there is any danger in this in that there is any tendency to channel too large a percentage of support into these poor States, or could they do it without the approval of the Department? Secretary Hobby. It would depend on the level of the appropriation. Senator Cooper. The level in support and in extension and improrement, and in special projects.

Senator Cooper. That is the tendency for local governments to get some of their operating costs on somebody else's back,

Mr. Rockefeller. I think the Secretary's point is very important. The State really has no say over how much it gets in support grants, because the Congress will determine what funds will be allocated to that phase of the three-part grant program. Then the money would be divided according to the Hill-Burton formula, so that it would go to them and they would get their share automatically.

Senator COOPER. Take that list with Public Health on it. Would there be a possibility within the State of making a plan within the State? For example, to channel its funds more into its operating costs, let us say, perhaps under general health, than it would be in the programs which you have termed categorical! Let us say in research, perhaps?

Mr. ROCKEFELLER. That would really be up to the State health officer to determine, I suppose, working with the governor and the county

Senator Cooper. It is a great temptation, though, to get rid of some of those operating costs.

Would you all have any control or possibility of reviewing those programs?

Secretary Hobby. I will let Dr. Scheele answer that particularly; but he does review the State plan. I would like him to simplify that.

Dr. SCHEELE. The States would be required to submit their plans for approval. I believe our working relationship with them is such that we could talk with them on a friendly basis and avoid that very situation happening. Senator COOPER. You recognize there is always that possibility. Dr. SCHEELE. Yes, sir. This has always been a problem and it is a problem today. We have $10 million in the general-assistance grant, and they can do it with that money today. So this is not new, but it is an old problem. We found them very good about not using that money just to cover up certain administrative expenses they wanted to relieve State funds from, and also in the budgets in TB and venereal disease and mental health.

The white parts of the bars on this chart show they have been interested in getting State and local money into those special programs. I think there is some evidence. Mr. ROCKEFELLER. That is overmatching. Dr. SCHEELE. That is right. They are actually overmatching and just won't use the Federal grant to cover those programs which are not going to add very much to public health.

Senator COOPER. The reason why I asked that is for this reason: Someone is going to testify later on this. It is the statement for the

of the Federal grants-in-aid published by
Dunt seems completely inadequate, as do the
. e) appropriated in recent years, which were

also appear to be inadequate.
pamiated for Federal grants-in-aid for the Public

A. From that time each year the appro-
botantially reduced, so that in the year 1954 we
stulbion for all of these grants-in-aid, as com-

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Festimated, although I realize without any real int that would be available to grants-in-aid in sve only $17 million. What I am trying to do umplete inadequacy of the amount that is made neral Government in grants-in-aid to the States.

Pynt to help the States and get them to welcome s top have to make the program more attractive min be at the moment. There is one point that should be called to your bere is a 10 percent reduction from that figure el project grants, which are not allocated on a is that answers your question, because you are

nes than that, I understand.

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sociation of State and Territorial Ileaulth Officers. On page 2 there is a paragraph with a plea for more money to go into support, and it is stated :

Shoulil, for instance, as much as 25 percent of the total be allocated for extension and improvement, worthy as that is, with its biennial reduction of one-fourth of the Federal fund participation, many of the States would be embarrassed and possibly resentful, as well as hard put to take over so large a part of the loud, under our present system of taxation.

They agree in there that more funds for support rather than for what you might call categorical programs should be allotted.

That is all I have.
Mr. ROCKEFELLER. Might I comment on that, Mr. Chairman?
Senator PURTELT. Yes.

Mr. ROCKEFELLER. I think what is back of the comment in that letter is this: They are worried about this total decline as shown on this chart since 19.30 down to here. That I think is the basic concern they have. They do not mind the idea of improvement, but they are worried about the total reduction of their support funds and the effect on the States.

That is a pretty substantial decline that has taken place. I think that is the basis for their fear.

Senator PURTELL.. I want to make clear that the sheet showing the participation in the States is in the record.

Senator LEIMAX. I want to ask one question. Under the expenditures, what are the figures on mental health?

Mr. ROCKEFELLER. It is a total Federal expenditure of $11 million. I am having a little trouble reconciling that figure with your $100 million, to tell you the truth. Dr. Scheele seems to know what the newer is.

Dr. SCHIE. We do not, by regulation, permit the states to expend the funds they receive from our grant for the giving of custodial care in mental institutions. The big bulk of the expenditure in most States is for the operation of the mental institutions. Oir funds are used more in the front end of the problem, such as in treatment and diagnostic clinics. They are mental health clinics. Our funds may not be red in the actual care of patients.

Senator Leiman. I thought that chart purported to be a comparison of Federal grunts for mental health with those of the States

Mr. ROCKHILLIR. It does,

Senator LIMAX. Due to the fact that New York has $100 million that $11 million does not seem very realistic.

Senator PIRTEL. They are matcher funds.

Secretary HORRY. It does not in the framework of the Federal law. Dr. Schrole made the important point that all of the states spend in cu-todial care great sums for the care of the mentally ill. These are not whown as matching funds.

Senator LEV. May I ask you one other question which I failed tork before!

The statement was made by somebody here that all States would fare better under this program than they have. On the last sheet in the second column of Public Health you show $17514.000. I realize perfectly well that that figure cannot possibly he binding and that it is dependent on a great many different ifs, ifs, and ifs. I realize that. But when I read the appropriations for the various

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I\. Thank you.

N. Chairman. Senator Cooper. almudice vou have a chart there which shows the

iwhich Senator Lehman referred to, and which i en 1954. Could you put in the record the was hy of those categories beginning, let us say, in alou may have those included in the record. I l'ex Because we have a statement on 1950, and

per to show what the various appropriations They'lmar since then. .. I think that sheet accompanied the chart, Senator.

- Federal grants-in-aid for Public Health Services.
21 will ask that that be placed in the record.
Yes

, and it is so ordered. I thought I had I am very sorry if I haven't.

. All right.

Taink instead of 1950 to 1954 it should be from

Diskoare right.
1: Tluat is the sheet I have.

mind to was previously submitted.)
1. Are there any other questions!

Torte is one thing. In reference to some of the

i mogram is getting smaller each

Is that not true, Mrs. Secretary? In other will called attention to the fact that in 1950 there

year

because of

spopriated and in the Korean war we had $38

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pears from 1936 to 1954 of the Federal grants-in-aid published by
the services, that amount seems completely inadequate, as do the
amounts that have been appropriated in recent years, which were
larger than that, which also appear to be inadequate.
In 1950 we appropriated for Federal grants-in-aid for the Public
Halth Services $13,135,000. From that time each year the appro-
priation was very substantially reduced, so that in the year 1954 we
appropriated only $22 million for all of these grants-in-aid, as com-
pared to $13 million in 1950.

[nder this plan it is estimated, although I realize without any real
finality, that the amount that would be available to grants-in-aid in
public health would be only $17 million. What I am trying to do
is to emphasize the complete inadequacy of the amount that is made
available by the Federal Government in grants-in-aid to the States.
I think if you really want to help the States and get them to welcome
Frederal aid, I think you have to make the program more attractive
than it appears to me to be at the moment.

Mr. ROCKEFELLER. There is one point that should be called to your attention. That is, there is a 10 percent reduction from that figure berause of the special project grants, which are not allocated on a State basis. Not that that answers your question, because you are talking in far bigger figures than that, I understand. Senator LEIMAN. Thank you. Senator COOPER. Mr. Chairman. Senator PURTELL. Senator Cooper. Senator COOPER. I notice you have a chart there which shows the appropriation in 1950 which Senator Lehman referred to, and which continues on from 1950 to 1954. Could you put in the record the appropriations in each of those categories beginning, let us say, in 1o down to this year! Senator PURTELL. You may have those included in the record.

Senator COOPER. Yes. Because we have a statement on 1950, and I think it would be proper to show what the various appropriations have been in all the years since then.

Senator PURTELL. I think that sheet accompanied the chart, Senator. Did you get one! Senator COOPER. No. Senator PurTELL. Federal grants-in-aid for Public Health Services, Senator Cooper. I will ask that that be placed in the record. Senator PURTELL. Yes, and it is so ordered. I thought I had ordered it, Senator. I am very sorry if I haven't. Senator Cooper. All right. Senator LEHMAX. I think instead of 1950 to 1954 it should be from 1936 to 1954. Senator Cooper. I think you are right. Senator LEHMAN. That is the sheet I have. (The table referred to was previously submitted.) Senator PURTELL. Are there any other questions? Senator Hill. There is one thing. In reference to some of the figures

, it seems the program is getting smaller each year because of the reduction in funds. Is that not true, Mrs. Secretary? In other Words, Senator Lehman called attention to the fact that in 1950 there were $13 million appropriated and in the Korean war we had $38

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