Fiscal year 1955; State breakdown of proposed grants to States in 1955, assuming enactment of proposed legislation for programs which cill use, if proposed legislation is enacted, the basic allotment formula of the Hospital Construction Act-Continued

582, 771

3,511, 822

4,295, 760

22.3

5,826

78, 186

158, 654

703, 238

1,040, 233

47.9

2,440

52, 440

128,654

724,663

982, 521

35.6

9,457

146, 998

158, 654

939, 549

1, 123, 031

19.5

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 improvement, 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 health people.

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

Association of State and Territorial Health Officers. On page 2 there is a paragraph with a plea for more money to go into support, and

it is stated:

Should, 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 load, 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 PURTELL. 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 1950 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 LEHMAN. I want to ask one question. Under the expendi tures, what are the figures on mental health?

Mr. ROCKEFFI LFR. 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 answer is.

Dr. SCHFLE. 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. Our 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 used in the actual care of patients.

Senator LEHMAN. I thought that chart purported to be a comparison of Federal grants for mental health with those of the States. Mr. ROCKEFELLER. It does.

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

Senator PURTF11. They are matched funds.

Secretary HORRY. It does not in the framework of the Federal law. Dr. Schoole made the important point that all of the States spend in custodial care great sums for the care of the mentally ill. These are not shown as matching funds.

Senator LEHMAN. May I ask you one other question which I failed

to ask 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 $17.514.000, I realize perfectly well that that figure cannot possibly be 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

rears 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 Health Services $43,135,000. From that time each year the appropriation was very substantially reduced, so that in the year 1954 we appropriated only $22 million for all of these grants-in-aid, as compared to $43 million in 1950.

Under 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 Federal 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 because 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 LEHMAN. 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 1950 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 LEHMAN. 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 $43 million appropriated and in the Korean war we had $38