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Senator CURTIS. All of these recent remarks are in reference to a bill that passed the House.

Mr. COHEN. Yes.
Senator CURTIS. Not as to Mr. Flemming?

Mr. COHEN. No, I am speaking now of the more limited plan of what might be called the medically indigent proposal in title 16.

Senator CURTIS. What are you say—a big change in that in existing law is a definition of who is in need ?

Mr. COHEN. Absolutely. All really title 16 does is create a legislative history that says "The definition of need in section 6 of title 1, should be looked at by the States as being a little bit more liberal than the test of economic need for cash assistance."

Now it does put in some different plan requirements which are important, but every single objective, Mr. Curtis, of title 16 can be achieved within the present arrangements of title 1.

I have gone through the whole title, and can indicate where various provisions can easily be deleted because some of them are simply repetition of what is now in title 1.

My third point is that section 602 of the bill in title VI which provides for this 5 percent improvement of medical care for old-age assistance recipients in title 1, is really very inequitable, very difficult to administer, and in our opinion ought to be eliminated. If you

will recall Secretary Flemming's testimony, he gave a halfhearted endorsement of it.

He said he thought it was worth trying, but actually, it seems that it is very inequitable. For instance, the State of Illinois wouldn't get anything out of that provision at all, because the State of Illinois already has a very broad-gaged medical-care program. So because it went ahead and on its own out-of-State and local money made the improvement, it would not get anything at all. This provision also puts into the Secretary's hands the authority to determine what is a significant improvement in medical care, which in my opinion would run into a lot of controversy as to what is significant and what is not significant.

I think in the interests of good administration and sound Federal and State relations between the States and Federal Government it would be much better if that were eliminated.

Fourth, the new planning grant money that is contained in section 603 is not necessary in any way whatsoever, because the present title 1 already authorizes 50 percent Federal grants to the States for the administration of medical-care programs for public assistance. So there is a whole new section in here authorizing 50-percent funds to the States up to $50,000 per State, which absolutely is not necessary whatsoever.

The States already have that opportunity to get full Federal matching for planning in medical care, and it would seem to me that that section is unnecessary and just can be eliminated.

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It is already in existing law.

Fifth, if title 16 is retained in the wisdom of this committee, if you should decide that you do want to create a whole new medical-care program for the medically indigent, then we do have some specific suggestion for elimination of what we think is much of the surplus language in title 16, which is not designed in any way to assist the States in giving them latitude but rather to curtail them in meeting the needs of people in the medical-care field.

For instance, certain limits are put on laboratory and X-ray expenditures which the States do not have any limitation on now, if you are to meet the laboratory and X-ray costs of individuals on a matching basis, well, you ought to meet them.

So it seems to us that these various limitations and specifications in the bill are not consistent with title I. Title I at the present time now just uses the term “medical care” and leaves it entirely up to each State to determine how much or how little of medical care it wants and matches the Federal funds on that basis.

So we think if you do include title 16 in principle you ought to go over it with a very fine-tooth comb and remove much of what is really unnecessary to effective Federal-State relations.

Sixth, there is a section 705 in the bill which carries out the recommendations of the advisory council on public assistance, of which I was a member establishing medical care guides and reports for public assistance and medical services for the aged.

We think this is highly desirable and we endorse the provisions.

However, in our report of the advisory council on public assistance we did recommend that there should be established an advisory committee on public assistance medical care.

We repeat that recommendation and urge that you include it into the law, and provide that the Secretary in establishing any such guides or standards shall consult with this committee. We believe that on this committee should be representatives of doctors of the medical association, and other persons, including the professions that have an interest, in order to assist the Secretary in establishing those guides and standards so that medical care in this country can be improved. We think that should be incorporated in the section 705 of the bill which creates section 1112 of the act.

Seventh, I would like to make this point, and I think Senator Byrd may be interested in it in connection with the points he made yesterday with the Secretary.

When we made this report, Mr. Chairman, the advisory council on public assistance, which I hope all of the members will study because it was made to the Senate, we asked that the Department do a study of what was the existing deficiencies in the State public assistance programs at the present time for just the present beneficiaries, not broadening the program with respect to new classes. When you are

. considering the fiscal implications of this program, I would like to draw attention to the table on page 69 of our report, which points out

that at the present time for medical care of just the old-age assistance recipients on the rolls, there is an estimated deficit of $268 million in the present program to meet a reasonable standard of medical care throughout the United States for just the 2.4 million aged persons on the existing assistance rolls. I am not talking about any other group.

(The tables are as follows:)

TABLE 1.-01d-age assistance and aid to dependent children combined-Estimated

annual increase needed in public assistance payments under specified measures


(Based on numbers of recipients and amounts of assistance expenditures for public assistance at end of

calendar year 1958)

[blocks in formation]

Cost measure of recipients' requirements other than for medical care:

$3, 335

$51, 565 $192, 540


1. State cost standards, end of calendar year 1958. $254, 505
2. Twice cost of USDA low-cost standard food

plan (for basic items only; special nonmedi-
cal needs as in State cost standards):
(a) Average U.S. cost...

786, 150
(6) Average cost in specified region.. 774, 260

63, 650
98, 030

142, 010
162, 975

546, 640
458, 065

33, 850
55, 190

C. Estimated increase needed in medical care ex

penditures (annual rate in thousands)

Average amount for medical care per recipient in all

States estimated at median amount for 24 States
with expenditures above the national median:

Total, old-age assistance and aid to dependent
children combined.-----

$322, 185

$15, 270

$44, 490

$230, 795

$31, 630

Old-age assistance.
Aid to dependent children.

268, 270
-53, 915

10, 230
5, 040

34, 890

194, 535
36, 260

28, 615

1 To meet full need for public assistance for costs of basic living requirements and special needs other than medical care and to provide, through public assistance, medical care in all States similar in scope and cost to care provided in 24 States with average medical care costs per recipient above the national median.

2 As defined by the U.S. Bureau of the Census; see footnote 3 of text of report, p. 60, for listing of States included in each region.

3 Estimated increases under the special adaptation of the standard food plan for the South would be about $31,000,000 less annually than under the estimate based on costs of the standard food plan at average cost in the southern region.

NOTE.-See tables 2, 3, and 4 for detailed figures from which above totals are computed.

TABLE 2.-Old-age assistance and aid to dependent children, separately-State cost standards: Financial need met by public assistance payments

for basic requirements and special needs other than for medical care under State cost standards at end of calendar year 1958

$19, 074

2, 657
16, 417
16, 057


6. 45
39. 89
39. 01





Data for old-age assistance were estimated by staff of the Social Security Administration on the basis of selected data reported by the States as explained in the attachment "Sources Used for the Estimates."

2 Basic data for aid to dependent children were reported by the individual States, as indicated in table 4.

3 As defined by the U.S. Bureau of the Census.

4 For old-age assistance amount of requirements estimated includes (1) cost of basic
requirements and of special needs other than medical care as in State cost standards and
(2) amounts for medical care as paid; that is amounts included in money payments to
recipients and paid to suppliers of goods and services. For aid to dependent children
amount of requirements which was reported by the States, includes only costs of require-

ments to which money payments to recipients were related; these requirements include
basic items and special needs including medical care. Amounts directly paid to suppliers
of medical care for aid to dependent children recipients were excluded from the amount
of requirements because they were excluded from the data reported by the States; their
inclusion for purposes of this report would have introduced contradictions in relating other
data reported by the States to the total cost of requirements.

5 For old-age assistance, amounts of assistance include amounts in money payments
to recipients and amounts paid directly to suppliers of goods and services. For aid to
dependent children, amounts of assistance include only money payments to recipients
for reasons explained in footnote 4.

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