This Association is opposed to the addition of new hospital beds, facilities or personnel in federal facilities expressly for the care of retirees from the uniformed services and their dependents. We can see no justification whatever in the federal government drafting physicians whose services will be directed toward the care of retirees and their civilian dependents. We urge, therefore, that this section of the bill be amended so as not to provide that additional beds be programed in uniformed service construction projects for retirees. We would appreciate your making this statement a part of the record of hearings on this bill. Sincerely yours, KENNETH WILLIAMSON, Associate Director, American Hospital Association. STATEMENT OF THE AMERICAN LEGION The American Legion appreciates the opportunity to comment on HR 14088, an Act "to authorize an improved health benefits program for retired members and members of the uniformed services and their dependents, and for other purposes." One portion of HR 14088 deals with facilities operated by the Veterans Administration. I refer to lines 7 through 13 of page 2, which read as follows: "The Secretary of Defense and the Secretary of Health, Education, and Welfare may, with the agreement of the Administrator of Veterans' Affairs, provide care to persons covered by this subsection in facilities operated by the Administrator and determined by him to be available for this purpose on a reimbursable basis at rates approved by the Bureau of the Budget." The subject matter comprehended by this language falls, in The American Legion, within the jurisdiction of the National Rehabilitation Commission, with which I am associated. I am constrained to advise the subcommitee that The American Legion objects to the section quoted above. At its May 1966 National Executive Committee meeting, The American Legion adopted Resolution No. 36, copy attached. By that action, our organization recorded its opposition to the enactment of legislation which would authorize admission of retired military personnel to Veterans Administration facilities under priorities and standards of eligibility different than those applicable to war veterans. There are a number of reasons why The American Legion registers an objection to this one portion of HR 14088. Early in 1965, an attempt was made to authorize hospitalization by the VA of Public Health Service beneficiaries on a high priority basis. That arrangement was ruled illegal by the Comptroller General of the United States. The language in HR 14088 does not appear to contain the objectionable procedure invalidated by the Comptroller General. We are apprehensive, however, that the new authority proposed to be bestowed upon the Veterans Administration can be a first step toward assigning other federal beneficiaries an admission to hospital priority over war veterans. Even if HR 14088 does not authorize such a priority for military retirees, the bill does grant them preferential treatment over certain war veterans. For example, generally, war veterans may be hospitalized for nonservice-connected conditions only if they are in financial need. The test of financial need is met by the signing of the "inability to pay oath." Under the provisions of HR 14088, military retirees could receive treatment for conditions unrelated to their service without the necessity of establishing financial need. To permit this distinction in admission to hospital criteria seems unfair to veterans, for whom the VA hospital system was established. The preferential treatment proposed for military retirees separates, into classes, veterans who are in identical circumstances. For example, a military retiree would be able to secure hospitalization for a nonservice-connected condition which would be denied to the war veteran not in financial need, even though both might have identical financial resources and be seeking care for identical physical conditions. The American Legion takes the position that veterans in identical circumstances should receive identical treatment from their government. The American Legion fears that HR 14088, if enacted, would lead to future arguments that VA beds be used for the dependents of military personnel and retirees. One of the major arguments made for opening up VA facilities to military retirees is that many of the retirees are "geographically disadvantaged ;” that is to say, not residing near military facilities. The same argument can be made for their dependents. Thus, pressures would build up to hospitalize these dependents in VA facilities. The American Legion wants the VA hospital system preserved for veterans. Many of our objections to the provision of HR 14088 under discussion revolve about our opposition to the efforts by the Bureau of the Budget to mold a single federal hospital system within which all federal beneficiaries would be cared for. One step in that direction, thwarted by the Comptroller General, was attempted in 1965 when the Budget Bureau ordered a study of the advisability of transferring the marine hospitalization program to the Veterans Administration. The American Legion opposes the single federal hospital system concept. It is our conviction that the hospitaliaztion of veterans should remain the responsibility and function of the Veterans Administration, the hospitalization of military personnel and their dependents the responsibility and function of the Department of Defense, and so on. From the standpoint of the military, the offer by VA to hospitalize retirees on a space-available basis may well be illusory. Considering the present and anticipated demand for VA hospital beds by veterans, the promise contained in HR 14088 may develop into an empty one. We fear that such a development would hinder the military establishment in its effort to provide, through established facilities and arrangements, adequate medical care for those to whom it has a serious obligation. Because of the relatively small number of military retirees said to be involved, the deletion of this portion of H.R. 14088 would not constitute the withdrawal of a substantial benefit. On the contrary, the Counsel for the House Armed Services Committee said, at page 5844 of the hearings, with reference to this provision, "*** apparently this is a change of really no substance. It is more apparent than real." We feel the small benefit to be derived by military retirees does not justify the immediate inequity to war veterans and the future risk to the Veterans Administration hospital system. In conclusion, the American Legion supports the concept that the government has an obligation to provide a medical care program for military personnel, retirees, and dependents. We support the effort to fulfill that obligation by expanding the current program. We ask only that this not be done at the expense of the citizen soldier, the war veteran for whom the VA hospital system was established. NATIONAL EXECUTIVE COMMITTEE MEETING OF THE AMERICAN LEGION, MAY 4–5, 1966 Commission: Rehabilitation. RESOLUTION NO. 36 Subject: Eligibility of retired military personnel for treatment in Veterans Administration hospitals. Whereas, legislation is under consideration to authorize health benefits programs for retired members of the Armed Forces of the United States; and Whereas, this legislation would provide medical treatment and care in Veterans Administration facilities which the Administrator of Veterans' Affairs determines are available for this purpose; and Whereas, this legislation would permit retired military personnel to receive care for nonservice-connected conditions without the necessity of their establishing an inability to pay for such care or treatment at their own expense; and Whereas, retired military personnel are eligible for care and treatment in Veterans Administration hospitals for service incurred conditions; and Whereas, The American Legion is cognizant of the obligation incurred by the United States to provide within military facilities, medical and hospital care for these military personnel for any condition; and Whereas, The American Legion looks with disfavor on those administrative or legislative efforts that would modify the admission priorities to permit VA hospital care of retired military personnel or other persons ahead of eligible veterans; now, therefore be it Resolved, by the National Executive Committee of The American Legion in regular meeting assembled in Indianapolis, Indiana, May 4-5, 1966, That The American Legion oppose the enactment of legislation to provide that retired military personnel may be permitted admission to Veterans Administration facilities under priorities and standards of eligibility different than those applicable to war veterans for service-connected and nonservice-connected hospital care. STATEMENT OF AMERICAN MEDICAL ASSOCIATION Hon. STUART SYMINGTON, AMERICAN MEDICAL ASSOCIATION, Chairman, Special-Subcommittee, Committee on Armed Services, U.S. Senate, Washington, D.C. DEAR SENATOR SYMINGTON: The American Medical Association recognizes the Nation's need for men who will make a career of military service. The serviceman's concern for his dependents' health and his desire that they be adequately cared for, both during his term of service and after retirement, has long been recognized as a major factor in his decision as to whether to continue in a military career. It appears that inclusion of reservists in the programs designed to increase the attractiveness of the full-time military career may serve to defeat this end. Your Subcommittee has under consideration legislation, H.R. 14088 and S. 3169, which will affect the care available to servicemen's dependents and to retirees and their dependents. The Association would like to take this opportunity to comment on these bills. H.D. 14088 would make three basic changes in present law, affecting the scope of benefits to servicemen's dependents and retirees and their dependents, care in non-Governmental facilities for retirees and their dependents, and care for mentally retarded and handicapped children of active-duty personnel. S. 3169 deals primarily with care of mentally retarded or mentally ill or physically handicapped dependents of servicemen. We will discuss each of these changes separately. H.R. 14088 would remove the present statutory restrictions on outpatient care for servicemen's dependents, by keying the scope of the program to the most widely used high-option, Government wide, program of the Federal Employees Health Benefits (FEHB) Program. We believe that by removing unrealistic limitations on the services which can be provided in physicians' offices, the patient will receive needed care where it can be most effectively provided. Further, using as a model the most widely chosen FEHB high-option plan will, in the absence of free choice of plan by the serviceman or retiree, provide him with benefits comparable to those sought by federal employees who do have such a choice. On July 2, 1964, in a statement before the Special Subcommittee on Construction of Military Hospital Facilities of the House Committee on Armed Services, the Association recommended that retiree's care be provided through a plan similar to FEHB. While H.R. 14088 does not fully achieve the Association's recommendation, we recognize it as a significant step forward. In regard to retiree's care and that of their dependents, in our July, 1964 statement we supported the provision of civilian care for military retirees and their dependents as an alternative to the presently authorized care in military facilities on a space-available basis. We also support such civilian care in H.R. 14088. but with some reservations. Specifically, we question the portion of the new Section 1074(b) contained in Line 7-13, Page 2, of the House bill, which would authorize the use of Veterans' Administration hospital bids for retirees on a reimbursable basis. If an adequate program to pay for care of retirees and their dependents in non-Governmental hospitals is developed, such a provision would be unnecessary. In this regard. it should be recognized that, since this part of the program provides care for retirees only, considerable pressure will arise to extend VA authorization to cover dependents' care as well, or to raise the present ceiling on VA beds. We also strongly oppose the last sentence of the new Section 1086(d), Lines 15-20, Page 8 of the House bill, which gives the Secretaries of Defense and Health, Education, and Welfare the right to restrict the retiree's choice between Government and non-Governmental facilities. While we recognize the intent of this provision, to maintain adequate patient load at military hospitals, we do not feel that this is the appropriate approach. The need for a program of civilian care for military retirees and their dependents stems from the inequity of providing care only for those residing in the immediate vicinity of a military hospital. To provide free choice now between Government and private facilities only for those not residing in the vicinity of a military hospital is also inequitable. The choice between the two types of care should be the patient's, not the Government's. It is true that some retirees, given the choice, would still prefer the military hospital. We would hope that retaining this choice would serve as an added incentive to the military hospital to maintain the highest quality of care, since an individual hospital's ability to maintain an adequate retiree-patient load would depend on its attractiveness to the patient rather than on legislative fiat. We also strongly oppose that provision of the bill which would require inclusion of a specified percentage of beds for retirees and their dependents in new military hospital construction. While there may be some justification for such construction in a few scattered areas with a high number of retirees and inadequate non-Governmental facilities, in general, passage of the program of civilian care for retirees and their dependents would make statutory requirement for such beds in all military hospitals totally unnecessary. Indeed, it could well serve to defeat the laudable purpose of the program. In regard to provisions of H.R. 14088 for the care of the mentally retarded or seriously handicapped child of a serviceman, we feel the intent of this bill is worthwhile and deserves support. Care of such children is especially a hardship on servicemen, not only because of their income level but because of their frequent physical separation from their families. The mobility of our military population itself creates a hardship, since it may make the serviceman's dependents ineligible for care from some state programs. With respect to care for the mentally retarded and handicapped, we also support the bill's approach which makes use of existing facilities. Making existing community programs and facilities more readily available to servicemen's dependents appears more practical and more in keeping with the serviceman's needs. We have also considered S. 3169, which is somewhat similar in intent to the provision for mentally retarded or handicapped contained in H.R. 14088. However, S. 3169 covers care of both children and spouses of servicemen, and, instead of merely the mentally retarded and seriously handicapped, it includes mentally retarded, mentally ill and physically handicapped (with no mention of degree). Again, the intent is salutary, but we find this expansion of coverage more difficult to support, simply because the greater generality of the terms involved makes it uncertain as to how broad this coverage might be. Some definition of these terms, as used in the bill, seems necessary. We have also noted a difference in H.R. 14088 and S. 3169 in regard to the use of public and private facilities. H.R. 14088 requires the use of public facilities to the extent they are available and adequate as determined by the Secretaries of Defense and of Health, Education, and Welfare. With this proviso, the serviceman apparently contributes the same amount toward the costs of care wherever his child is treated. S. 3169, on the other hand, authorizes the use of private facilities when the serviceman so requests, even if public facilities considered adequate by the Secretaries are available, but, in such case, limits the cost to the Government to the average cost of furnishing the same or similar care in public facilities throughout the United States. Of the two approaches, we prefer that of S. 3169, since it gives the serviceman more of a voice in deciding where his child or wife is to be cared for. However, it would be more appropriate to compare the cost of care in public and private facilities in the same areas since this will reflect the true difference in costs, rather than to compare the national average costs in public facilities with the costs in a specific private facility. We appreciate this opportunity of submitting our views on this subject. Sincerely, F. J. L. BLASINGAME, M.D. DEAR SENATOR SYMINGTON: This letter is written to express the views of the Blue Cross Association on HR 14088, a bill designed to accomplish three purposes: 1. Expand the health benefits program for dependents of active duty service men by including out-patient and out-of-hospital care. 2. Include retired members of the uniformed services and their dependents in the expanded program. 3. Provide a program for the care, training and special education of the physically and mentally handicapped children of active duty servicemen. We have a number of times over the past few years expressed our views regarding the need for legislation of this nature, and the desirability of developing a risk bearing type of program similar to that in existence for Federal employees. Our most recent submission was a statement to the subcommittee of the House Armed Services Committee that was considering HR 14088. While still believing that a risk type of program is in the long run of greater benefit to all parties, our primary interest at this time is in offering our services for, and comments towards, developing a sound and effective program for the people concerned. One of the problems raised by HR 14088 as passed by the House is that the effective date is scheduled for July 1, 1966. Considering the legislative process that must follow this hearing, enactment is not likely until after the intended effective date. To implement the final act retroactively, or even shortly after the final approval, could result in decisions being made that were too hastily sought out, with a resulting hardship to all parties concerned, particularly the expected beneficiaries. Our suggestion is that consideration be given to adding the retirees and their dependents to the present Dependent's Medical Care Program promptly. This might be accomplished within ninety days following enactment, since it would involve only an increase in volume for fiscal agents, and identification of those eligible by the Department of Defense. Provisions might be made for retroactivity to hardship cases. The other parts of the proposed legislation, benefit expansion, and the handicapped children's program, would be delayed for a few additional months, perhaps to January 1, 1967. This would allow sufficient time for the Department of Defense to work out all details and established the best possible health benefits program authorized by legislation. The Blue Cross Association, and the Blue Cross plans of the nation, will begin next week, with administration of claims under the new Social Security Medicare program in nine out of ten of the voluntary hospitals from coast to coast. Selection by these hospitals for this important intermediary function is a conclusive demonstration of the pre-eminence of the Blue Cross system in the field of health care pre-payment. A growing number of state governments are selecting Blue Cross to administer their expanding welfare programs beginning to be adopted under Title XIX of the Social Security Act. The Blue Cross-Blue Shield government-wide Service Benefits Program has been the two to one choice of Federal employees since that program was inaugurated. Blue Cross will be prepared to accept assignments, the Congress and the Department of Defense wish it to undertake in the military medical care program now under consideration by this subcommittee. We would appreciate your making this statement a part of the record of the hearings on this bill. Sincerely yours, ANTONE G. SINGSEN, STATEMENT OF COMMISSIONED OFFICERS ASSOCIATION OF THE U.S. PUBLIC HEALTH SERVICE Mr. Chairman and members of this Committee, I am indeed grateful for this opportunity to present the views of the Commissioned Officers Association of |