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HELENA, MONT., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

Montana labor respectfully requests your committee adopt medical care benefits for aged within social security system and we oppose means test legislation.

JAMES S. UMBER, President, Montana State AFL-C10.

COLUMBUS, OH10, June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

The recent Ohio AFL-CIO convention passed unanimously a resolution calling for passage of Forand-type legislation in the field of health care. Our 1 million members are thoroughly convinced that the only sound approach to health care for retired persons 65 and over is through the social security system with universal coverage as opposed to the ways and means approach of matching Federal grants to participating States and coverage based on need.

ELMER F. COPE, Secretary-Treasury, Ohio AFL-CIO.

ALBUQUERQUE, N. MEX., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.O.:

The New Mexico State AFL-CIO and all of its affiliated organizations and members join the national AFL-CIO and other interested groups in urging your committee to adopt the most universal economical and dignified approach in medical care benefits for the aged by use of the social security system as opposed to the inequitable means test which would lead to manifold inequities and whose enforcement inevitably involves an affront to the dignity of millions of older people.

JAMES A. PRICE,

President,

Tom E. ROBLES, Executive Secretary-Treasury, New Mexico State AFL-CIO.

CHICAGO, ILL., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.O.:

On behalf of 275,000 members of the Building Service Employees International Union we respectfully ask your support of the principles incorporated in the Forand bill. We strongly support the contributory insurance principle for medical care benefits for the aged, and oppose the means test principle. We believe the present opportunity to amend the social security system should be used to add a practical and significant program for health care for the aged as opposed to stopgap legislation.

DAVID SULLIVAN, General President, Building Service Employees International Union.

CHICAGO, ILL., July 1, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

On behalf of 700 members represented I urge your committee adopt medical care benefit legislation for the aged under social security. We are opposed to the means test legislation. We believe it imperative when people over 65 years of age bave illness they should not be deprived of hospitalization or medical aid due to financial reasons. Therefore financial aid through social security would to a degree relieve the aged peoples medical fears after retirement.

FRED RIEHL,
The American Railway Supervisor Association, President and General

Chairman SP and PFE Lodge No. 351 and Affiliates, 2545 Carmel
Street, Oakland, Calif.

CHICAGO, ILL., June 30, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

In behalf of American Federation of Teachers respectfully urge Senate Finance Committee adapt medical care benefits for the aged within social security system. We advise that we vigorously oppose any means test as part of this legislation.

CARL J. MEGEL, President, American Federation of Teachers.

NEW YORK, N.Y., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

On behalf of Office Employees International Union AFL-CIO, I urge you to adopt Forand type medical care benefits for aged within the social security system. We are in definite opposition to means test legislation.

HOWARD COUGHLIN, President, Office Employes International Union.

COLUMBUS, OHIO, June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.

GENTLEMEN : We strongly urge your support for legislation that would provide honorable release from the hazard of medical costs in old age within the framework of the social security system and to oppose the medical aid plans proposed by the House Ways and Means Committee that only provides medical aid through State public assistance programs. Sincerely yours,

PHIL HANNAH, President, Ohio AFL-CIO.

CHICAGO, ILL., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

In behalf of membership United Cement, Lime & Gypsum Workers and international union located in 42 States permit me to respectfully urge your committee adopt medical care benefits for aged within social security system and oppose means test legislation.

FELIX C. JONES, General President.

CHARLESTON, W. VA., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.O.:

Respectfully urge the committee to adopt a medical care program for the aged which will be theirs as a matter of right within the established social security system. 'Means test legislation is not, in our opinion, a sound effective approach to an increasingly serious social problem.

MILES C. STANLEY, President, West Virginia Labor Federation, AFL-CI0.

NEW YORK, N.Y., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.O.:

On behalf of the 60,000 members of the International Alliance of Theatrical Stage Employees I respectfully request that your committee act favorably on medical care benefits for the aged within social security system and eliminate the means test requirement.

RICHARD F. WALSH, International President IATSE & MPMO of United States and Canada.

INDIANAPOLIS, IND., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

On behalf of United Brotherhood of Carpenters and Joiners of America, we urge your committee adopt medical care benefits for aged within social security system and oppose “means test” legislation.

M. A. HUTCHESON,

General President.

WASHINGTON, D.C., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.O.:

Respectfully urge committee report favorable medical care for aged under social security and reject means test.

JAMES A. CAMPBELL, National President American Federation of Government Employees.

WASHINGTON, D.C., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

International Brotherhood of Bookbinders Union, in behalf of its 65,000 members, urges committee to adopt a medical care benefits for aged bill within framework of social security system without any ability-to-pay test.

JOSEPH DENNY,

President. WESLEY A. TAYLOR,

Secretary-Treasurer.

ST. PAUL, MINN., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

The Minnesota AFL-CIO Federation of Labor, representing 175,000 affiliates, respectfully urge you to adopt medical care benefits for the aged within the social security system and we are definitely opposed to pauper's oath method of establishing eligibility.

R. A. OLSEN,

President.
R. E. HESS,
Executive Vice President.
NEIL C. SHERBURNE,

Secretary-Treasurer.

CHICAGO, ILL., June 29, 1960. SENATE FINANCE COMMITTEE, New Senate Office Building, Washington, D.C.:

In behalf of our membership (8,000), I urge that your committee adopt medical care benefits for the aged within the social security system, as all of our people are opposed to the means test legislation. Our people feel that it is imperative when a person beyond the age of 65 is confronted with an illness there should not be any financial worry attached as to medical and hospitalization security. Handling this question through social security will at least relieve one of the many financial worries that the majority of our people will have when retirement age arrives.

J. P. TAHNEY, Grand President, American Railway Supervisors Association.

STATEMENT OF THE AMERICAN PUBLIC WELFARE ASSOCIATION

This statement presents the views of the American Public Welfare Association on H.R. 12580, the Social Security Amendments of 1960, as passed by the House of Representatives.

The American Public Welfare Association is the only national organization of local and State public welfare departments and of individuals engaged in public welfare at all levels of government. Its membership includes Federal, State, and local welfare administrators, board members and welfare workers from every jurisdiction. As the result of the discussions in our councils, committees and conferences, our board of directors of 27 persons, representing all parts of the country, adopts official policy positions on issues of current significance. These policy positions govern the association's testimony on proposed legislation relevant to the field of public welfare.

Over the years the association has supported strongly all sound recommendations which have advocated broadening and strengthening the social insurance programs of our country. We have talked many times with the Senate Committee on Finance about our observations of the social insurance and public welfare programs and believe that we have unique background for evaluating the interrelationship of social insurance and public assistance.

COMMENTS ON TITLE XVI

For more than 20 years the association's medical care committee, made up of persons knowledgeable in health and welfare programs throughout the country, has studied the medical care problems of needy and low-income individuals and families and methods of administering and financing medical services required by them. The medical care committee is fully familiar with the present extent of medical care programs in public welfare and with the gaps which still remain. Despite the fact that the association, since its inception almost 30 years ago, has considered as a major responsibility the stimulation and promotion of programs of medical care of adequate quality and quantity in the public assistance programs, and although there have been very large expenditures for medical care in these programs, we find that there are gaps and deficiencies still existing in many States with respect to the provision of medical care for the needy aged and other needy persons. We do not believe there are more than 15 to 20 States in which needy persons, including the aged, can receive all the medical care they require with the assistance of public funds. We are in full agreement with the decision of the House Ways and Means Committee, therefore, that there must be action taken to improve the provision of medical care for aged persons, although we are not in complete agreement with the method suggested, nor do we believe that the proposal fully meets the need.

H.R. 12580 proposes that a new title XVI, medical services for the aged, be added to the Social Security Act. We have studied this title with care and have certain comments which we would like to submit for consideration, We approve:

1. The prohibition in title XVI against the imposition of residence requirements as an eligibility factor in determining eligibility of low-income aged persons for medical care;

2. The fact that the bill recognizes the broad scope of services needed by the aged (although we do disagree with the limitations in amount placed on certain essential services and supplies) ;

3. The requirement that both institutional and noninstitutional services be provided to the aged. This, we believe, will serve to reduce unnecessary institutionalization of older persons ;

4. The prohibition against an enrollment fee premium or similar charge to be imposed as a condition of any individual's eligibility for medical benefits under the plan. (We believe that there should also be a prohibition against any deductible or coinsurance feature since this is a needs program and not an insurance program.)

DOVETAILING TITLE XVI INTO TITLE I

We question whether there is actual need for this new title, even though we agree with the intent and the provisions we have commented on. Essentially the program described in title XVI is part of the old-age assistance program and a number of States are already assisting medically needy aged persons under title I. We believe that the same ends could be achieved by amending title I to make clear the intent of Congress that old-age assistance should include aged persons of low income who are unable to finance their full medical care requirements. It appears to us, from the viewpoint of economical and sound administration, that this revision of title I would be more satisfactory than the establishment of a wholly new title. We believe, too, from our observation of State legislative activities, that most States would find it more possible to obtain authorization, if needed, to expand services and assistance under title I than to obtain legislation establishing a new program. As one example we would point out that Texas would undoubtedly need a constitutional amendment in order to participate in title XVI.

COMMENTS ON SECTION 602 OF THE BILL

In this connection we would like to comment on section 602 of H.R. 12580 which proposes somewhat more favorable Federal matching for States (an increase in the matching ratio of 5 percent) contingent upon a showing of an improvement in their old-age assistance medical care program. There are both inequities and problems in this provision since it would provide no additional funds in OAA medical care to those States that have, at great State expense and with very limited Federal matching, financed broad programs of medical services and supplies for aged persons. These States, of course, could show no improvement in their medical care programs since they already include all essential medical requirements. We are in full agreement that the poorer States need additional help but we think that this can be accomplished through further modifications of the matching formula based upon per capita income in the States. The improvement grants suggested in section 602 would, in fact, reward a number of average or high income States that have been backward in meeting the medical care requirements of their aged persons. Our suggestion that title XVI be included in title I would do away with this provision and would make it possible, through an appropriate modification of the matching formula, to establish a more equitable method of Federal participation for both the higher and lower income States.

COMMENTS ON SECTION 705 OF THE BILL

The association is pleased to note section 705 of H.R. 12580, which would amend the general provisions of the Social Security Act to require the Secretary to develop and revise from time to time guides or recommended standards as to the level, content, and quality of medical care and medical services to be used in evaluating and improving the public assistance medical care programs, including programs of medical services for the aged. We have long felt that the Department, through its Bureau of Public Assistance, should provide more leadership to the States in this connection. We are pleased to see a recommendation of this kind in the recent report of the Advisory Council on Public Assistance. We would suggest that in addition to this provision there be a requirement that the Secretary establish a broadly constituted medical advisory committee, as was also recommended in the report of the Advisory Council on Public Assistance.

HEALTH INSURANCE FOR OASDI BENEFICIARIES

We believe, however, that even with the changes we have suggested in title XVI and related portions of H.R. 12580, our country would be far from meeting the health needs of all aged persons. In our opinion this can only be done through an extension of the old-age, survivors, and disability insurance program to include health service benefits. We will still need provisions under public

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