new title XVI to read “(12) provide that, in determining whether an individual is blind, there shall be an examination by a physician qualified in the diseases of the eye." It is further requested, for consistency, that section 1002(a) (10), title X, be amended by deleting "or by an optometrist." We would appreciate having the above made a matter of record as a part of the hearing. JOHN W. FERREE, M.D., Executive Director. Hon. WILBUR MILLS, JACKSON, MISS., February 13, 1962. Chairman, House Committee on Ways and Means, Urge you oppose section 1602(A) (12) (H.R. 10032 regarding determination of blindness by optometrists. Law should logically require more than mere determination of visual acuity for assistance under title X. Presence of pathology can be detected only by doctor of medicine as State supervising ophthalmologist of welfare board can site numerous examples where incorrect diagnosis made by optometrists (due to their lack of medical knowledge) under present law and bill greatly impeded rehabilitation and sight restoration opportunities. Request this statement be included in record of current hearings. VAN DYKE HAGAMAN, M.D., Jackson, Miss. STATEMENT OF IRVIN P. SCHLOSS, LEGISLATIVE ANALYST, AMERICAN FOUNDATION FOR THE BLIND, ON H.R. 10032 Mr. Chairman and members of the committee, I appreciate this opportunity to present the views of the American Foundation for the Blind on certain provisions of H.R. 10032. The American Foundation for the Blind is the national voluntary research and consultant agency in the field of services to blind persons. As such, we are specifically concerned about the needs of approximately 355,000 blind persons in the United States, almost half of whom are on the public assistance rolls as recipients of aid to the blind or old age assistance payments. Generally speaking, the adult public assistance programs as administered in most of the States have been essentially static in character and limited to financial aid at a bare subsistence level, and minimum medical care for people unable to support themselves owing to advanced age, severe disability, or both. As is the case with any illness, the best cure lies in its prevention and this maxim holds equally true for the debilitating social illness in our society called chronic dependency. Fortunately, we already have the preventive mechanism in our social insurance programs; and through their continuing expansion and improvement to provide more adequate benefits for all types of beneficiaries. including health care for the aged, we have the means of preventing in the future the problem of chronic dependency which besets a substantial number of public assistance receipients today. Other aspects of prevention of dependency not attainable through the social insurance programs are provided in H.R. 10032. Consequently, we welcome this effort to ameliorate the condition of those already on the public assistance rolls. It appears to us that H.R. 10032 has this as its purpose through infusing into these static programs a rehabilitation emphasis designed to promote self-care and self-support and, hopefully, movement off the relief rolls. The bill provides for increased Federal financing to achieve this purpose; and it also provides for the vital ingredient of well-trained personnel at the operating worker-to-client level in the States. These are desirable and commendable provisions. However, we would urge the committee to make certain changes in the bill which, we believe, will contribute substantially to assuring that its intent is achieved. First, we would strongly recommend that the provisions permitting the State public welfare agency to make agreements with the State agency providing vocational rehabilitation and the State health agency be made mandatory. The present permissive language would make it possible for a State public welfare agency to use Federal funds to duplicate staff and services already pro vided with the aid of other Federal funds by existing State agencies. In the interest of efficiency, economy, and adequacy of services to people, it is certainly logical to require the utilization of existing State agencies for services clearly within their special area of competence. Similarly, we would strongly urge the committee to make a change in the proposed title XVI, which gives the States the option of combining old age assistance, aid to the blind, aid to the permanently and totally disabled, and medical assistance to the aged under a single State plan to be administered by a single State agency. Although this simplification of administrative procedures and the implicit increase in Federal funds owing to the method of payment to the States may be highly desirable in the 45 States which already have a single State agency administering all of the public assistance categories, it could be detrimental in terms of services to aid to the blind recipients in 5 States. These 5 States-Delaware, Massachusetts, New Jersey, North Carolina, and Virginia—have a separate State agency administering or supervising the administration of the aid to the blind program; and in all 5, the same State agency also administers the Federal-State vocational rehabilitation program for blind persons. Should one of these States, owing to the Federal financial inducement or other pressures, elect to participate in the program under the new title XVI as it now stands, the result would be to deprive aid to the blind recipients of the specialized staff and services holding greater potential for their movement from the public assistance rolls. This is clearly contrary to the intent and purpose of H.R. 10032, with its emphasis on the rehabilitation of public assistance recipients. We believe that a satisfactory solution is possible through which both a separate State agency administering aid to the blind and the general State agency administering the other categories could function and still obtain benefits provided by title XVI. We would urge the committee to alter section 1602 (2) (3) to permit the administration of the part of the plan affecting blind persons by the State agency currently administering aid to the blind and to make the necessary conforming amendments. Similar provisions in the Vocational Rehabilitation Act have worked satisfactorily for many years, and there are many more specialized State agencies for the blind involved in that program. In conclusion, I should like to say that the American Foundation for the Blind regard H.R. 10032 as generally forward-looking legislation, which, with the specific changes we have recommended, should have a considerable impact on public welfare programs in the years ahead. STATEMENT OF AMERICAN ASSOCIATION OF WORKERS FOR THE BLIND RE H.R. 10032 Mr. Mills, ladies and gentlemen of the committee, my name is George Keane. I serve as chairman of the legislative committee of the American Association of Workers for the Blind and have been directed by the executive committee of this association to express its views on the above-mentioned bill, the administration's public welfare measure for 1962. First, may I thank you sincerely for the opportunity of presenting this state ment to you, and may I ask that it be made a part of the record. Work for the blind in the United States must have a feeling at this time of very profound satisfaction when it is possible for a magnificent proposal such as Mr. Mills' bill to be presented to a distinguished body of legislators who are ready and willing to consider such a vast change in the structure of American public welfare. We are all profoundly grateful, too, that finally the administration has begun to accept principles laid down by our programs over the past 40 years. We have always believed that relief-money support as such is in itself inadequate, and sometimes even damaging to the recipient. The members of the committee, I am sure, must recall that year after year we have brought before you suggestions that title X grants-in-aid to the blind be related more closely to rehabilitation and that the incentive needed for rehabilitation be written specifically into title X. A member of your committee has before you now several proposals amending title X, most of which we heartily approve as providing the incentives needed to make relief a true tool for the return of the recipient to a fuller self-supporting life. These are Mr. King's bills, with which I am sure you are familiar. We were delighted to find that H.R. 10032 contains provisions which though general in nature, do provide these incentives. We had only hoped that they would be more specific and less general. We were particularly grateful for the amendments proposed here to title X itself, making the present exempted $85 of earned income permanent (p. 53, sec. 1602(a)(14)). And, further, that Mr. Mills had added to this a most important additional incentive in section 106(e) of his bill (p. 31), amending section 1002(a)(8) of the Social Security Act as follows: "as well as any expenses reasonably attributable to the earning of any such income." This, we believe, creates a true incentive and will do more to encourage rehabilitation than almost anything else that has been written into law recently. We were very glad to see that similar amendments are provided in all of the categories. We have, however, one very real concern. We believe most sincerely that the present wording of the new title XVI may create some very profound problems. Throughout the United States there has been a slow but very certain development toward specialization in all areas of education and rehabilitation, as well as in medicine, law, engineering, and all of the sciences. In education and rehabilitation work for the blind, one always felt that a categorical approach to the particular problems arising out of blindness was an absolute essential to success, either in education or in rehabilitation. We know that this is equally true in programs for the deaf, and possibly in these two areas of impairment because they are communication faculties, it is more important than in other areas of disability; but it must be equally true of all impairment that a highly skilled personnel in all of the disciplines is needed, both in education and in rehabilitation. The States have not been uniform in the way in which they have provided these categorical services, some of them being offered by departments of social welfare, others by commissions for the blind, others through vocational rehabilitation services of education departments, others by health departments or mental hygiene departments, and in some cases combinations of these departments. However, a large body of information and of special skills has been developed in each State certainly insofar as handling problems arising out of blindness is concerned-and we feel very strongly that this skill should not be disrupted by a change in the Federal mandate arising out of a new service as defined in title XVI. We were very glad, indeed, to see in section 1603(a) (7) on page 61 that the designated State agency could purchase services by contract. We feel, however, that this should be mandated on the States rather than permissive, for it seems illogical to develop a new program of services when they already exist in other departments. We are confused, however, by the content of another section under "Definitions," related to title XVI on page 66, section 1605 (b): "No payment may be made to a State under title I, X, or XIV of the Social Security Act for any period for which such State receives any payments under title XVI of such Act or any period thereafter." This would seem to say in effect that if any State continues to function as in the past receiving payment from Federal funds under titles I, X, or XIV, it cannot receive moneys under title XVI. If this is true, it will deny to all commissions for the blind who function under categorical programs any new funds available under title XVI (medical care). It would seem that this would be reactionary and would do much to destroy many excellent programs now functioning under categorical aid. We cannot believe that this is Mr. Mills' intent, and we learned that when Secretary Ribicoff appeared before the committee last week and was questioned by Mr. Harrison, of Virginia, on this point, he agreed that some change in this provision and in any other provisions of H.R. 10032 which seem to deny to commissions for the blind the benefits of the new provisions should be made. We hope that this is true, and that revision is being planned, for it is inevitable that those States which need more Federal help will abandon categorical programs to secure it if this becomes necessary. We would hope that rather than have such limitations as are implicit in this wording a very broad application of the provisions of title XVI should be possible on a highly specialized level throughout the whole public assistance program. May we urge, therefore, that the new formula be applicable to all categories and that the new services made possible under title XVI be written in some way into each of the other four titles, either by reference in title XVI itself or by amendment to each of the four titles. I know that you must have had pointed out to you by anyone who has come before your committee the enormous problem that the States are going to be confronted with in securing additional personnel which this new title will demand. It would seem wiser, indeed, to use to the utmost all of those existing services, including the personnel available through them, which have been developed categorically over the years and which, with this additional money, can offer more significant and more fruitful social benefits. May we respectfully urge, Mr. Mills, that you and the members of the Ways and Means Committee remember that work for the blind has been a pioneer in most of the rehabilitative procedures that have become available on such a broad scale in the United States, and that it deserves and should have very real consideration by the committee when such an important Federal service is being offered as is contained in H.R. 10032. Without the early demonstrations made by work for the blind there would have been no evidence available to prepare such a bill as this, and we feel that its experience and sophistication in incentive planning should have great weight with your committee. May we again urge whatever revision you feel is necessary to extend all of the new services to all of those receiving benefits through other titles of the social security laws, by mandate rather than by secretarial regulation. Respectfully, GEORGE E. KEANE, Chairman, Legislative Committee, American Association of Workers for the Blind. Mr. LEE H. IRWIN, ASSOCIATION FOR PHYSICAL AND Chief Counsel, Committee on Ways and Means, DEAR MR. IRWIN: Reference is made to the announcement by Congressman Mills, chairman of the above committee, under date of February 1, 1962, for public hearings on the President's proposal to make changes in public welfare programs. The Association for Physical and Mental Rehabilitation desires to file this written statement containing specific requests to be made a part of the printed record. Our association concurs in the stated purpose of H.R. 10032 entitled "The Public Welfare Amendments of 1962" stressing, in the words of Hon. Abraham Ribicoff, "services instead of support, rehabilitation instead of relief, and training for useful work instead of prolonged dependency." We believe this concept represents a sound and, in the long run, an economic and socially productive policy. For the record, allow me to state that John Eisele Davis, Sc.D., executive director of our association, appeared as my representative before your committee on July 31, 1961, on H.R. 4222, the Health Insurance Benefits Act of 1961. His statement on that occasion represents the basic philosophy and specific recommendations of our membership pertaining to the inclusion of paramedical disciplines which have an established and definite specialized service to render in the implementation of public welfare legislation. Our viewpoints on these issues remain unaltered and are in many respects applicable to the Public Welfare Amendments of 1962. Allow me to explain that members of the Association for Physical and Mental Rehabilitation, designated by the U.S. Civil Service Commission as corrective therapists, provide a specialized service of therapeutic exercise to assist the disabled to regain an area of normal living, to utilize their latent and often unrealized abilities to walk, get in and out of bed, feed oneself, and gain or regain the skills for other activities necessary for normal daily living. Working with the aged, the young, the blind, the paralyzed, and other disabled, the corrective therapist is making a sincere and, we believe, intelligent effort to provide a much-needed service in modern rehabilitation and vocational restoration. He is a specialist in therapeutic exercise in many forms including retraining, reconditioning, and other exercise regimens to meet the changing needs of the young and old for continued independence, for ambulation, self-care, and productive work when feasible. All of these services are administered under the prescription of a doctor of medicine. The membership of the association's advisory council, including leading physicians, its high educational and clinical requirements, professional objectives, and certification standards assure the high professional competence of corrective therapists. We are making the above statement as an introduction to the background and experience of our membership so as to clarify our position and recommendations pertaining to the Public Welfare Amendments of 1962. As previously stated, we agree with the philosophy underlying this modern approach which replaces money payment for disability with increased funds to help the individual help himself and thus create a positive, stimulating, and, we might add, more scientific climate for rehabilitation. Realizing that we have an important stake in this program, we are hopeful that our experience and skills will be utilized in the implementation of any new legislation that may come out of the President's proposal. To this end, our association makes the following specific requests: 1. In the program contemplated by this bill which emphasizes "the return of the individual to the highest degree of self-sufficiency of which he is capable," we request that the specialized services of the corrective therapist be authorized and specifically included in the field of therapeutic exercise, blind and other retraining, reconditioning, ambulation, self-care activities, and other areas in which therapeutic exercise is medically indicated as an aid in rehabilitation and Vocational restoration. 2. If the bill mentions paramedical specialities by name that corrective therapy be included by name or that the term "other rehabilitation therapies" be specified. 3. That no statement in the bill or omission preclude the participation by corrective therapists and remuneration for their services as part of the total program envisaged by its provisions. We greatly appreciate this opportunity to express our viewpoint in these Public Welfare Amendments of 1962. Sincerely yours, RICHARD G. FOWLER, President. THE UNIVERSITY OF CHICAGO, Hon. WILBUR D. MILLS, House Ways and Means Committee, DEAR REPRESENTATIVE MILLS: One of the most serious problems in the development of sound public assistance programs has been the lack of qualified social workers. Experts in public welfare agree that qualified staff members are essential if families are to get the services they need. Yet there are severe shortages of social workers, especially in the public assistance agencies. For that reason, it is important that Congress act promptly on the educational provisions of the public welfare bill (H.R. 10032). Few students in schools of social work are able to finance graduate training without scholarships. We have had a number of excellent students on scholarships from State child welfare agencies throughout the country. These students have returned to their States to provide skilled professional services. If Federal funds were also available for training more public assistance workers for the States, we believe that the supply of workers and the quality of service could be sharply increased. If the educational program is to be carried out, it is important that the law be acted on promptly. Students are already applying for admission to schools of social work for the autumn term. We hope that there will be no delay in action on this legislation. Sincerely yours, RACHEL MARKS, Associate Dean. |