Mr. PREYER. I would like to ask one other question in another area Secretary WEINBERGER. Maybe this would be useful. Dr. Cooper has some facts about current Federal matching. Dr. COOPER. Yes. At the present time the project grants pay for about 25 to 30 percent of the community mental health program operating budget, 75 percent of the community health centers budget, 74 percent of the neighborhood health center budget, and 69 percent of the migrant health program clinic. Mr. PREYER. I would like to ask one other question in the family planning area. This bill covers so many areas, I know everyone here has a lot of questions on different things. This is a general question. One of the most vexing and controversial subjects before the country today is the subject of abortion. I think no matter how we stand on abortion, everyone would agree that it certainly ought to be the last resort and it is certainly not the primary means of family planning. I think we can make a pretty good case that the high incidence of abortion is directly related to the unavailability of adequate family planning services. So that the question that occurs to me on your cuts in family planning is if we are interested in discouraging the use of abortion, is it really worth the price to cut family planning funds so drastically as you are? Secretary WEINBERGER. Well, two points, Congressman Preyer. First of all, I agree with you. I have always felt abortion represents a failure of family planning and it isn't a part of the programs. It represents a confession that family planning has failed. Also, as I am sure you know, title X forbids the specific use of family planning funds for abortion. Under medicaid, abortions can be authorized by States and funds are expended for that purpose. The important thing to point out is that our proposals, even though they involve reductions in some of the specific Federal funding for the title X program, contemplate an increase in the medicaid and social services funds, so that the same number of women, namely 4 million, will continue to receive family planning services through our departmentally supported programs. I don't think the reductions in the specific Federal funding in any sense should be taken as connoting a reduction in the number of people served. The number of people served, we believe, will remain the same. We also believe that this can best be done through medicaid and other sources and that the specific program can well be subjected to a reduction of Federal funding. Mr. PREYER. Thank you. Mr. CARTER. Would the gentleman yield? Mr. PREYER. Surely. Mr. CARTER. What about the rate now of births per family in the United States? Secretary WEINBERGER. Well, the general rate of increase of the population at the moment, if I recall the figures correctly, is somewhere around 712 percent a year.1 It was 10 percent. 1 EDITOR'S NOTE.-See correction of these figures in explanation of Secretary Weinberger on p. 201 of this hearing. Mr. CARTER. Per family it is 1.9. Actually that is really a little lower so far as family planning is concerned than the replacement rate; is that correct? Secretary WEINBERGER. Well, there are different definitions of this, Congressman Carter. The population of the United States was increasing roughly at the rate of about 10 percent about 3 or 4 years ago. It is now down to something between 7 and 8 percent at the present time. The family division of this I don't have specifically in mind. We are, I believe, a little above the replacement rate, right at or a little below zero population growth. Dr. Hellman, who is our specialist on all population matters, is here and he can certainly give you the specific technical answers or we can put them in the record, whichever you prefer. But we have substantially reduced the rate of increase of America's population as we pointed out at Bucharest and at various other meetings. In fact, it is one of the major problems with the Social Security system today. But, in any case, we have substantially reduced the rate of growth of the American population. [The following information was received for the record:] REPLACEMENT-LEVEL FERTILITY Fertility is said to be at replacement when the total fertility rate equals 2,100. According to the U.S. vital statistics data, the total fertility rate fell to 1,896 in 1973 and to 1,862 in 1974. This means that if women continue to bear children at the age-specific rates observed in 1974, they would end their reproductive careers having born 1,862 children per 1,000 women. There is, of course, no guarantee that women will continue to bear children at the rates observed in 1974. The total fertility rate only tells what would happen if these rates continue. Fertility rates below replacement do not necessarily mean that a country has achieved zero population growth since the current growth rate is influenced by the age structure of the population and immigration. While the total fertility rate for 1974 was the lowest ever recorded for the United States, the population grew by .75 percent or 1.6 million persons. Mr. CARTER. I would certainly want to agree with the gentleman from North Carolina in that the family planning program we have had has been effective. I have got here 2.1 children per family is replacement. Anything below that is below zero population growth and it is 1.9, as I recall at the present time. The other factor must be increased immigration or something of that nature. Thank you, Mr. Preyer. Mr. PREYER. If the gentleman would yield back Secretary WEINBERGER. All of this great work we are doing is also increasing the length of life of each individual. I don't think the immigration rate has a significant effect on it at the moment, but we do have substantial improvement in the life expectancy. We are continuing to work for that, and obviously will continue to work for it. Mr. PREYER. If the gentleman would yield back for 30 seconds, I agree the growth rate is declining and I am glad to see it, but I think on family planning we want to focus on the number of and the rate of unwanted children. That may be going up while the growth rate is actually going down. Thank you, Mr. Secretary. 49-210 O 75 13 Mr. HEINZ. Thank you, Mr. Chairman, and Mr. Secretary. I am glad to have you back before our subcommittee. I would like to talk with you for a moment about the community mental health center program. First of all, I would like to say that I think the committee appreciates your effort and all these efforts to try to make them as efficient and economical or as cost-effective as possible. Clearly, when we have a situation where the budget is heading into progressively larger deficits, attention to management is greatly appreciated. Of course, it always remains our responsibility to make the priority decisions as to how the moneys which you spend would be allocated. But we are grateful for your assistance to us. A couple of things you discussed regarding the mental health center program bothered me a little. Perhaps when you delivered the testimony you may have dropped out the word that particularly causes me a problem. On page 10 you described the way the community health center program would include six new support mechanisms, and I hope we understand each other that actually there were at least two support mechanisms in the old bill, namely a grant program and a construction authorization, so that there you might be able to say that there were four new, two old. But, just so that we are all talking about the same thing, I would like to indicate what we have tried to do in the committee bill is make a distinction which the previous legislation didn't make between the grant for planning a center and the grant for operating a center. As you must know, Mr. Secretary, because I know we have discussed the General Accounting audit report, one of the problems with the program was that centers received large chunks of money before they knew what they were going to do. It was for this reason we split what was previously the operating grant program into two parts so that we could provide some seed money and therefore save money. Similarly, I believe even the department testified in favor of financial distress grants. My memory may be wrong on that, but I have the feeling that you were favorable to financial distress grants last year. So I think there are some differences between us that are narrowing, if my memory serves correctly. Now, I do understand that the testimony you are presenting here today is testimony that represents a Presidential and OMB-a White House position. Secretary WEINBERGER. An administration position. Mr. HEINZ. An administration position. May I ask whether the departmental position on the legislation we are discussing here, including the Community Mental Health Center, was any different-did the department favor or oppose anything that was different from what the administration is for? Secretary WEINBERGER. There are no distinctions between administration and departmental policy, Mr. Congressman. They all merge together with the publication of the budget and state of the Union message and they are all part of the process of developing a policy. This is the same situation where, for example, members of your staff might develop preliminary drafts for a speech at some occasion. Then you yourself make the final decision as to what is to be said. The testimony presented today is the administration policy. We have been quite consistent with respect to Community Mental Health Centers. We argued last year and this year for a termination of new starts and for completing the Federal commitment of 8 years that was in the initial act. Actually, the initial act was five and later extended to eight. We argued for completing and honoring that Federal commitment, not for starting anything new, on the theory that we now have 626 of these centers; that we have a very large proportion of the public that requires services served by these Community Mental Health Centers; and that over an 8-year period, they should now be working toward a situation where the Federal Government does not pay for the operation or direct delivery of this service. I believe this is practical and feasible. When I was in the California Legislature, long before there was a Federal Community Mental Health Act I was, I think it is reasonable and fair to say, partially instrumental in securing the enactment of an entirely State Community Mental Health Center bill. For that reason, I know not only about the tremendous value of these centers which is far superior to any large State mental institution, but I also know that it is entirely feasible to do without Federal assistance provided the community assign a high enough priority to it. We don't secure that by simply continuing permanently 8-year commitments or starting more and more centers until we have covered 115 percent of the country or something of that kind. Mr. HEINZ. I think, Mr. Secretary, you know that we aren't at 115 percent of the country. It is more like 1,500 areas of which 626 might be served by the end of 1975. It is always difficult for me to fully understand the description of a program which serves one-third of the United States as a demonstration program. I am pleased that you agree, in spite of the fact that the programs can stand some improvement, that it has been a success, and I do hope we can work together to improve the program. I suppose I do have some differences with you in terms of priority on community health centers. I think personally we can afford to continue to build them, although I must say I think we all have to recognize that there are a limited number of dollars around and maybe we could work out some kind of agreement between the committee and you on the rate at which we proceed because I think everybody realizes you can't build Rome in a day. Secretary WEINBERGER. Well, or even in 12 or 15 years. We have 626 of the centers. They serve about 45 percent of the population, not a third. Eleven of the States where many of the critical problems occur, including the District of Columbia, they serve three-quarters of the population who live within the areas that are served by the Center. Again, I don't think what started out as an attempt to demonstrate the feasibility of a specific kind of technique should be considered an obligation of the Federal Government to demonstrate over and over again until we have demonstrated to the point that covers 100 percent of the population. I think we have demonstrated that this is a very much better way to deal with mental illness than was formerly the case. I think we have amply demonstrated that it works very well. It is now time for the 626 centers to make provisions for eliminating or replacing the Federal funding over a very gradual 8-year period. Those areas where the local communities determine that more centers are necessary, would see the feasibility of funding them without the permanent continuation of Federal operative support. Mr. HEINZ. Mr. Secretary, I think my time is about to expire, but I would like to enter for the record, if I may, Mr. Chairman, a question perhaps you could supply us an answer for the record. The question is this: Some of my constituents recently informed me that family planning programs funded by the Department of HEW discriminate against natural family planning processes, at least that is the allegation. Now my two questions for the Department are these: Does the Department have a policy which has the effect of discriminating against natural family planning processes, and by that we mean such things as the rhythm method of birth control; and secondly, do you believe and does the Department believe that all family planning techniques such as the techniques described as natural family planning processes ought to be made equally available to people so that all people can have full and free choice in family planning methods? You don't have to answer that here because I am going to eat into somebody's else's time. Secretary WEINBERGER. Let me briefly answer no and yes, and we will supply additional data too, but we do believe that those are the answers to the two questions you posed. [The following information was received for the record:] DHEW POLICY WITH REGARD TO NATURAL FAMILY PLANNING The regulations for Public Health Service Act Title X project grants require projects to provide "for use of a broad range of medically approved methods of family planning including the rhythm method." Therefore, the Department does not discriminate against, but rather requires the inclusion of natural family planning methods among the broad range of medically approved methods which a project must offer. "Free-standing" natural family planning projects are not eligible for independent funding under the regulations since they do not offer the required broad range of methods. However, natural family planning providers have been funded as part of an umbrella grant, where the other required methods are available from other service providers also receiving funds through the umbrella grant, e.g., Pittsburgh and Wilkes-Barre, Pennsylvania. Mr. HEINZ. Thank you, Mr. Chairman. Mr. ROGERS. I think it might be well to clarify for the record, and particularly for new members who were not here when we wrote the Community Mental Health Centers Act, that it was not written as a demonstration program. It was written as a seed money program. In other words, to get communities to come in and start programs, to encourage them to do it, not just have a few demonstration projects. In fact, the original goal was some 2,500, Mr. Secretary. That since has been modified to some 1,500, I believe. So I would beg to differ in the description of the community mental health centers program as a demonstration program. It was never intended as just a demonstration program. It was a program where we would encourage and get things going and hopefully then the communities could continue after a certain time. Secretary WEINBERGER. We believe that effective initially for 5 years, later extended to 8 years total authorization for the whole act, that |