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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.-Old-age assistance and aid to dependent children combined-Estimated annual increase needed1 in public assistance payments under specified


[Based on numbers of recipients and amounts of assistance expenditures for public assistance at end of calendar year 1958]

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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

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Data for old-age assistance were estimated by staff of the Social Security Administra-
tion 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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TABLE 3.-Old-age assistance and aid to dependent children, separately-Cost standards for basic requirements estimated at twice specified food costs in USDA low-cost food plan: Financial need met by public assistance payments for basic requirements and special needs other than for medical care at end of calendar year 1958, under specified measure of total cost for basic items 1

1 Amount of needed increase shown is total of amounts under State cost standards (as shown on table 2) plus amounts by which State cost standards for basic items were inadequate under the measures in which the total cost for basic items was estimated at twice the food costs in the specified low-cost USDA food plan.

2 See table 2 for relevant footnotes.

3 See text of app. B for discussion of the USDA food plans.

4 Figure for United States includes figures for the South that were derived from the adaptation of the standard USDA low-cost food plan and figures, for other regions derived from the regional cost of the standard food plan.

In other words, when this committee is considering the fiscal implications of the program, I think you have to be aware of the fact, as I know you have been many times when proposals for changing the Federal-State formula are concerned, that the estimate shows that, if you were to bring all the States up to this minimum level there would need to be $268 million more.

Senator CURTIS. How much is spent now?

Mr. COHEN. On medical care?

Senator CURTIS. Well, on this item where you said there was a deficit of $268 million.

Mr. COHEN. Well, on medical care alone, using your staff's excellent report on this matter, they show that for vendor payments and medical care in old-age assistance in table 2 of your report that $220 million was spent in 1959.

Senator CURTIS. That is Federal funds?

Mr. COHEN. No, that is the total that is Federal-State.
Senator CURTIS. The total?

Mr. COHEN. Yes, sir.

Senator CURTIS. And you say that is $268 million short?

Mr. COHEN. Yes, sir; according to the reported based on 1958 levels. Senator CURTIS. What is the per capita cost there, if they would supply this deficit?

Mr. COHEN. The per capita cost is for medical care.

Senator CURTIS. Assuming that the Congress would provide the deficit which you say exists?

Mr. COHEN. I can give it to you.

Senator CURTIS. It would be over $200?

Mr. COHEN. About $9 per month or about $100 per year per capita. I want to also give you a much more startling figure. The study estimated what the total deficit would be for all of old-age assistance of the present old-age assistance beneficiaries because

Senator CURTIS. I don't want to remain on this too long, but maybe you ought to define what a deficit is. Do you mean checks written where there is no money in the bank?

Mr. COHEN. No, sir.

Senator CURTIS. What is it?

Mr. COHEN. Each State determines for itself what is the standard of assistance in a State. That requirement was put in this 1935 at Senator Byrd's insistence. I remember that very distinctly. Each State sets its own standard and has to submit to the Federal Government what that standard is. Now, not all the States have that money to pay that standard. They define the standard and then if the legislature does not put up enough money that biennium they pay a proportion of that amount or a maximum put in the limit.

Senator CURTIS. Is the usual deficit between what the States determine as a standard and what they actually spend?

Mr. COHEN. That is correct, sir. I will give you what the deficit is. Senator CURTIS. You have already told us.

Mr. COHEN. No, I just did that for medical care. I am now going to give you the standard

Senator CURTIS. I am just talking about medical care.

Mr. COHEN. Let me start over again. The deficit for all assistance-old age assistance and aid to dependent children-including medical care on the State's own standard for 1958-was $576 million.

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