Page images
PDF
EPUB

PRESIDENT'S HEALTH RECOMMENDATIONS AND

RELATED MEASURES

TUESDAY, APRIL 6, 1954

UNITED STATES SENATE,

COMMITTEE ON LABOR AND PUBLIC WELFARE,

SUBCOMMITTEE ON HEALTH,
Washington, D. C.

The subcommittee met at 10 a. m., pursuant to recess, in room P-63 of the Capitol, Senator Barry Goldwater presiding.

Present: Senators Goldwater (presiding), Hill, and Lehman. Also present: Roy E. James, staff director; Melvin W. Sneed and William G. Reidy, professional staff members.

Senator GOLDWATER. The meeting will come to order.

Our first witness this morning is Mr. Ray Power.

Is Mr. Power present?

Mr. Power, I want to explain the absence of the chairman. He is not well this morning. He called me and asked me if I would take over, which I am very happy to do because I am very anxious to hear what you have to say. Virginia and West Virginia have always been pretty close to my heart. I went to school in both States.

STATEMENT OF F. RAY POWER, EXECUTIVE OFFICER AND DIRECTOR, WEST VIRGINIA DIVISION OF VOCATIONAL REHABILITATION

Mr. POWER. Mr. Chairman, I have prepared a statement which I wish to file for the record.

Senator Goldwater. That will be done.

Mr. POWER. And I will talk briefly from an outline.

Senator GOLDWATER. Fine. You proceed any way you want, Doctor. (The prepared statement of Mr. Power is as follows:)

STATEMENT OF F. RAY POWER, EXECUTIVE OFFICER AND DIRECTOR, WEST VIRGINIA DIVISION OF VOCATIONAL REHABILITATION

The President's proposal that the Federal-State program of vocational rehabilitation should be strengthened and expanded is laudable. Despite the progress that has been achieved since the enactment of Public Law 113 in 1943, only a good beginning has been made in rehabilitating the Nation's disabled men and women into suitable jobs. When we consider that the Federal-State rehabilitation program is currently rehabilitating only 60,000 annually of the 2 million eligible disabled men and women who could be rehabilitated, and that 250,000 become eligible for rehabilitation each year, it is obvious that the present program of vocational rehabilitation needs to be strengthened and expanded.

Proposed rehabilitation legislation should be carefully examined to determine whether or not it will be practical and effective in contributing toward the

expansion and improvement of vocational rehabilitation. There is no justification for changing basic legislation just for the sake of change. Furthermore, we need to guard against changes in the law which may do harm to the program of vocational rehabilitation of the handicapped. Last year's amendment to the Federal rehabilitation law, in the form of restrictive appropriation language which was designed to reduce Federal financial participation, in my opinion, is harmful to the program. Any proposed new legislation can be best evaluated by comparing it with our basic rehabilitation law (Public Law 113, 78th Cong.) under which the program successfully operated from 1943 to 1953. It is generally agreed that this was an excellent law prior to the restrictive amendment of 1953. I refer to the allotment provisions of Public Law 170, 83d Congress, under the subheading "Office of Vocational Rehabilitation," the second and third provisos relating to appropriation, which repealed the matching provisions of Public Law 113 requiring the Federal Government to reimburse each State for 100 percent of the necessary costs of administration, and vocational guidance, and for 30 percent of the necessary cost of case service.

My discussion will relate to the implications of certain provisions contained in H. R. 8149, S. 2758, and S. 2759 and other bills on the same subject matter. I will limit my comments and recommendations to those matters which I believe to be most important. Other provisions will not be dealt with due to the limi tations of time and space. It is obvious that this approach will enable me to comment on only a few of the provisions of the several rehabilitation bills under consideration by Congress.

AMENDMENTS TO HOSPITAL SURVEY AND CONSTRUCTION ACT
(S. 2758, H. R. 8149)

Rehabilitation facilities

The present Federal vocational rehabilitation law does not authorize the granting of Federal funds to assist the States in the establishment of rehabilita tion centers. Such facilities are essential to the rehabilitation of certain types of severely disabled persons. There are few now available which can be used in a satisfactory manner by State rehabilitation divisions. Federal aid should result in an expansion of this type facility and thereby improve vocational rehabilitation services.

S. 2758 and H. R. 8149 contain provisions relating to the authorization of appropriations to aid in the establishment of rehabilitation facilities and the allotment of funds to the States. These bills also define a rehabilitation facility. The definition of rehabilitation facility differs slightly in the two bills. However, both appear to give major emphasis to the medical aspects of rehabilitation and minor emphasis to the vocational aspects. From the the vocational rehabilitation standpoint, there is danger of developing rehabilitation facilities as superspecialized hospitals and not as well-balanced facilities which will contribute to the preparation of severely disabled persons for suitable employment. A practical rehabilitation facility should provide for vocational training concurrently with treatment. In many instances, a sound evaluation of the client cannot be made apart from training. It is also a waste of public funds to keep a disabled person for a long period in a center where he receives only evaluation and treatment when, at the same time, he would profit from vocational training. A major problem now facing the States is to secure appropriate rehabilitation center services and to get such services at a price which rehabilitation divisions. are able to pay. Sufficient State funds are not available to pay $30 a day per client for rehabilitation center services except for a small number of clients. A facility is needed which can provide appropriate services at a rate of from $6 to $8 per day per client. The Woodrow Wilson Rehabilitation Center at Fishersville, Va., is the most practical and effective rehabilitation facility I know of, and the excellent features of this type of center should be carefully considered in planning for establishing of additional rehabilitation centers to assist in the Vocational rehabilitation of severely disabled men and women.

A rehabilitation facility giving major emphasis to the medical aspects of rehabilitation with a small daily capacity and very high cost per client per day will not make a substantial contribution toward the vocational rehabilitation of the thousands of severely disabled persons on State rehabilitation rolls. On the other hand, a facility which provides for a balanced emphasis on the medical and vocational aspects of rehabilitation, with a large daily capacity and a low cost per

-day per client, can make a worthwhile contribution to the rehabilitation of the severely disabled. If rehabilitation facilities of the latter type can be established through Federal aid and State appropriations, I am heartily in favor of such a program.

[ocr errors]

AMENDMENTS TO VOCATIONAL REHABILITATION ACT (S. 2759)

Authorization for grants

Section 1 of S. 2759 authorizes three types of grants for vocational rehabilitation purposes. I strongly recommend that the No. 2 type be eliminated and that all funds to be allotted for the No. 2 type be allotted to the No. 1 type.

The No. 2 type includes “grants to States to assist them in initiating projects for the extension and improvement of their vocational rehabilitation services." As I understand it, this provision would not give States authority to provide any services that they could not make available under type 1 provided they had sufficient funds.

It would be a much better arrangement to provide the States the additional funds needed to initiate projects for the extension and improvement of their vocational rehabilitation services under No. 1 type where they would have authority to develop such projects as they might determine to be necessary. State authorities operating their rehabilitation programs are well qualified to determine what kind of a project constitutes an extension and improvement of rehabilitation services in their States and should not be required to seek special Federal approval for such projects, and a special grant of funds to initiate them.

The section suggests that projects for the extension and improvement of rehabilitation services are to be an integral part of the State-operating program, and that they may be any one of a variety of activities depending on whether the Secretary of Health, Education, and Welfare finds they constitute an extension or improvement of vocational rehabilitation services in a particular State. In fact, the bill implies that it may be difficult to distinguish such projects from other activities in the provision of vocational rehabilitation services since it prohibits the payment for any project under type 2 for which any payment is made under type 1. This action would require Federal participation in the management of the rehabilitation program in the States and could well result in discrimination and favoritism among the States. Such an arrangement would also open the way for the use of political pressure and emotional appeal to secure approval and grants of funds to carry on a part of the State rehabilitation program.

The States and the Federal Government should work together in the promotion of the entire vocational rehabilitation program. Special approval for a part of the operating program in a State and special grants to assist in financing such a part, in my opinion, would be unnecessary interference with the operating program in a State by the Federal Government and could hinder rather than help in extending and improving rehabilitation services.

Priority in serving cases

Section 5 (a) (3) of S. 2759 provides that in case vocational rehabilitation services cannot be provided all disabled individuals who apply for such services, that the State plan show the order to be followed in selecting those to whom Vocational rehabilitation services will be provided.

States failing to meet this requirement would jeopardize their grants of Federal funds. This is a most difficult requirement to meet. It requires a selection of certain types of disabled persons from among a group of eligible disabled persons and giving such persons service while at the same time deferring or denying service to other eligible disabled persons. This requirement presents two major problems: (1) The development of criteria which will equitably classify eligible disabled clients in priority groups, and (2) the operation of an efficient production program when certain cases have to be given priority in contract, followup, and in the provision of service. This could result in great waste since it would likely require the processing of many eligible cases that could not be rehabilitated because of low priority rating after classification.

Experience indicates that as yet no valid criteria have been developed for an equitable grouping of eligible rehabilitation cases on a priority basis. Picking and choosing cases from an eligible group in accordance with a priority system is a waste of time and greatly retards production. In my opinion it is not practical, at present, to provide services to eligible disabled persons in accordance with a priority system, and the inclusion of such a requirement in

the law would lead to confusion and inefficiency in the operation of a vocational rehabilitation program. I am therefore opposed to any such legal requirement. Method of financing rehabilitation

After a careful study of the proposed method of financing vocational rehabilltation in sections 10 and 11 of S. 2759, I am convinced that this method will not result in an expansion of the Federal-State program of vocational rehabilitation but a further reduction in service.

Vocational rehabilitation does not operate satisfactorily under an allotment system of distributing Federal funds to the States. It is a type of program which is peculiarly adapted to a Federal matching plan which provides Federal funds in accordance with State expenditures. Rehabilitation, by its nature, is a long-term continuing process. Cases are referred, contacted, followed up, and service is authorized. Later service starts, frequently after considerable delay. It may be physical restoration, or training, or a combination of the two. It may also include a number of other services. Whatever the service or services may be, they do not conform to fiscal years. There are hundreds of disabled persons receiving services at all times. Their cases start in service from the first day of the fiscal year until the last day. The disabled person may be undergoing rehabilitation for 4 months or for 4 years. When a client's rehabilitation program extends from one fiscal year to another, it is desirable that there be assurance that the financial support of the program will be such that it will permit the service to be carried out. In other words, it is essential to efficient operation for a State director to be able to estimate from year to year what Federal grants can be expected on the basis of a given State appropriation.

In providing services to clients and in assuming financial obligations in behalf of clients, vocational rehabilitation operates much like public assistance. Caseloads cannot be arbitrarily adjusted to bring expenditures within balance at the end of any quarter without wasting of funds and adversely affecting services for the next quarter. This situation can best be met by legislation which will authorize the Federal Government to match State expenditures in accordance with a definite formula which will assure a fixed percentage participation in proportion to State expenditure.

It is my understanding that under existing law a State can depend on a definite Federal public assistance grant if the State makes its expenditure. In order for vocational rehabilitation to maintain a sound program, it is essential that the method of Federal financial participation be adapted to its peculiar needs. Since one of the major purposes of vocational rehabilitation is to prevent the expenditure of public funds for relief grants to disabled people, it would seem to be a wise policy to place rehabilitation on an equally favorable basis of Federal financial participation with public assistance. In other words, since vocational rehabilitation provides a direct individual case service, the method of Federal financial participation should be adapted to that type of operation, and the grant of Federal funds should be as liberal as public assistance. I am advised that approximately 70 percent of the expenditure for public assist ance in West Virginia is reimbursed from Federal funds on a formula matching basis.

Under the provisions for Federal participation in vocational rehabilitation as outlined in S. 2759, State administrators and State legislatures will be unable to plan their rehabilitation programs with any certainty. It contains no provision requiring the Federal Government to match State expenditures for voca tional rehabilitation on any fixed formula matching basis in relation to State expenditure. The only assurance that any State will have is that it will receive a pro rata share of such Federal funds as may be appropriated from year to year. It would appear next to impossible to operate an efficient rehabilitation program under this method of Federal financial participation. To begin with, Congress will not, under the proposed law have an obligation for appropriating funds for rehabilitation in accordance with a fixed relation to estimated State appropriations and expenditures. After funds are appropriated by Congress it appears that 2 or 3 proposed ways of allocating funds in this bill will be at the discretion of the Secretary. Such a financial arrangement limits program planning to a yearly basis. It definitely discourages starting cases in rehabilitation during a fiscal year when it is known that services will need to continue into the next fiscal year, since there is no way of estimating the percentage of Federal participation in the program from one year to the next.

I think it is clear that the allotment system of distributing Federal funds for vocational rehabilitation without any obligation to match State funds on a fixed

formula basis will definitely retard rehabilitation service in the States, because of the increased uncertainty of Federal funds which will seriously interfere with program planning.

Preliminary computations on the basis of the financial provisions of S. 2759 indicate that approximately 20 States would each lose a maximum of 10 percent on their Federal grants this coming fiscal year provided the appropriations for Vocational rehabilitation services remain the same as for the current year. Many of these States would also lose another 10 percent the next fiscal year if the appropriations remain the same.

It is very questionable if many of these States will be able to get additional funds from their legislatures to make up for the reduction in Federal funds. A number of governors have stated that it will be practically impossible for their States to assume a greater proportion of the cost of Federal grant-in-aid programs until the Federal Government moves out of the taxing field sufficiently to give their States an opportunity to collect more taxes. If these States were unable to appropriate more funds when Federal grants were on a fixed formula matching basis and more liberal in relation to State funds, it looks as if the problem would be much more difficult under an allotment system which does not provide for fixed matching of State funds.

West Virginia loses funds

The financial provisions of S. 2759 will drastically reduce Federal financial participation in the West Virginia vocational rehabilitation service on the basis of the current Federal appropriation. The amendment to Public Law 113 by the first session of the 83d Congress which repealed the matching provisions and provided an allotment plan for the distribution of rehabilitation funds, reduced Federal financial participation in the West Virginia program from 67.53 percent in 1953 to 60.51 percent in 1954, or $156,000. The provisions in this bill would further reduce Federal participation in the provision of rehabilitation services to approximately 55 percent, or $84,000, on the basis of present appropriation. This would mean a drastically reduced rehabilitation program for West Virginia despite a backlog of approximately 5,300 disabled men and women on the rehabilitation rolls awaiting service. It is also true that West Virginia has the largest number of children on relief rolls per capita of any State in the Nation, and more than half of them are on relief because of disabled parents.

The people of West Virginia have made a very great effort to solve the problem of rehabilitating their disabled citizens into employment. The State appropriation for rehabilitation is among the highest per capita in the Nation. West Virginia also is third highest in the Nation in the number of disabled persons rehabilitated per capita. Our State appreciates the rehabilitation aid that has been provided by the Federal Government. We do not see how the reduction of Federal aid for rehabilitation services to West Virginia and in many other States next year, can result in an expansion of rehabilitation services. On the contrary it will certainly reduce vocational rehabilitation services. It would appear that the financial provision of S. 2759 would reduce Federal financial participation in the States that have a demonstrated need for vocational rehabilitation and urgently need funds, and would transfer funds to other States that have not demonstrated so great a need and would probably be unable to use the funds because of lack of State funds and organization.

The financial provisions of Public Law 113 in effect from July 1943 to July 1953 required the Federal Government to reimburse each State for 100 percent of the necessary costs of administration and vocational guidance and for 50 percent of the necessary cost of case service. The result was that the Federal grant to each State for rehabilitation was largely determined by the amount of State matching funds. If a State put more money into the program it automatically acquired a claim to a larger Federal grant.

The matching arrangement described above has many desirable features and worked well over a period of years. It gave encouragement to States with serious disability and rehabilitation problems by making Federal grants available in proportion as the State appropriated its own money to meet the problem. The fact that a State appropriated more money for rehabilitation was not only evidence that it had a serious rehabilitation problem, but it also demonstrated that it was willing to spend its own funds to solve this problem. For the Federal Government to aid in proportion to the State's effort in solving its acute rehabilitation problem is good American practice. Another excellent feature of the plan was the assurance given the States by the law that the Federal Government would give aid for future efforts in rehabilitation in proportion as

« PreviousContinue »