TEXT OF AMENDMENT 6-29-60-CC

Intended to be proposed by Mr. HARTKE to the bill (H.R. 12580), viz: At the end of the bill add the following new section:

AID TO THE BLIND

SEC. 710. (a) Effective for the period beginning with the first day of the calendar quarter which begins after the date of enactment of this Act, and ending June 30, 1961, clause (8) of section 1002 (a) of the Social Security Act is amended by adding before the semicolon at the end thereof the following: "and may disregard not to exceed the first $1,000 per annum of net earned income".

(b) Effective July 1, 1961, clause (8) of such section 1002 (a) is amended to read as follows: "(8) provide that the State agency shall, in determining need, take into consideration any other income and resources of an individual claiming aid to the blind; except that, in making such determination, the Stateagency shall disregard the first $1,000 per annum of net earned income;".

24. AMENDMENT 6-29-60-X-INTRODUCED BY SENATOR HARTKE IDENTICAL TO THE FOLLOWING AMENDMENTS: NO. 8, 6-27-60-A, INTRODUCED BY SENATOR KEATING; NO. 13, 6-27-60-I, INTRODUCED BY SENATOR SCHOEPPEL; AND NO. 16, 6-28-60-C, INTRODUCED BY SENATOR HUMPHREY)

STAFF ANALYSIS

Increases the social security earnings limitation from $1,200 to $1,800 per year. Cost.-$616 million per year, or 0.19 percent of payroll, on a level premium

basis.

Financing. No tax increase provided to cover added cost to program.

VIEWS OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ON AMENDMENT 6-29-60-X

See joint report on page 480.

TEXT OF AMENDMENT 6-29-60-X

Intended to be proposed by Mr. HARTKE to the bill (H.R. 12580), viz: On page 80, between lines 3 and 4, insert the following new section:

TO INCREASE THE EARNED INCOME LIMITATION

SEC. 211. (a) (1) Paragraphs (1) and (2) of subsection 203 of the Social Security Act are amended by striking out "$1,200" whenever it appears therein and inserting in lieu thereof "$1,800", and (2) such paragraphs and paragraph (1) of subsection (g) of such section are amended by striking out "$100 times" whenever it appears therein and inserting in lieu thereof "$150 times".

(b) The amendments made by subsection (a) shall be effective, in the case of any individual, with respect to taxable years of such individual ending after 1960.

25. AMENDMENT 6-29-60-Y-INTRODUCED BY SENATOR HARTKE (IDENTICAL WITH AMENDMENT 10, 6-27-60-E, INTRODUCED BY SENATOR JAVITS)

STAFF ANALYSIS

Increases the social security earnings limitation from $1,2000 to $2,400 per

year.

Cost.-$1.33 million per year, or 0.41 percent of payroll, on a level premium

basis.

Financing. No tax increase provided for additional cost of the program.

VIEWS OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ON AMENDMENT 6-29-60-Y

See joint report on page 480.

TEXT OF AMENDMENT 6-29-60-Y

Intended to be proposed by Mr. HARTKE to the bill (H.R. 12580), viz: On page 80, between lines 3 and 4, insert the following new sections:

TO INCREASE THE EARNED INCOME LIMITATION

SEC. 211. (a) (1) Paragraphs (1) and (2) of subsection 203 of the Social Security Act are amended by striking out "$1,200" whenever it appears therein and inserting in lieu thereof "$2,400", and (2) such paragraphs and paragraph (1) of subsection (g) of such section are amended by striking out "$100 times" whenever it appears therein and inserting in lieu thereof "$200 times".

(b) The amendments made by subsection (a) shall be effective, in the case of any individual, with respect to taxable years of such individual ending after 1960.

26. AMENDMENT 6-29-60-Z-INTRODUCED BY SENATOR HARTKE

STAFF ANALYSIS

Increases the social security earnings limitation from $1,200 to $3,000 per Cost.-$2.041 million per year, or 0.63 percent of payroll, on a level premium

year,

basis.

Financing.—No tax increase provided in amendment for additional cost of the

program.

VIEWS OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ON AMENDMENT 6-29-60-Z

See joint report on page 480.

TEXT OF AMENDMENT 6-29-60-Z

Intended to be proposed by Mr. HARTKE to the bill (H.R. 12580), viz: On page 80, between lines 3 and 4, insert the following new sections:

TO INCREASE THE EARNED INCOME LIMITATION

SEC. 211. (a) (1) Paragraphs (1) and (2) of subsection 203 of the Social Security Act are amended by striking out "$1,200" whenever it appears therein and inserting in lieu thereof "$3,000", and (2) such paragraphs and paragraph (1) of subsection (g) of such section are amended by striking out "$100 times" whenever it appears therein and inserting in lieu thereof "$250 times."

(b) The amendments made by subsection (a) shall be effective, in the case of any individual, with respect to taxable years of such individual ending after 1960.

27. AMENDMENT 6-30-60-B-INTRODUCED BY SENATOR ANDERSON FOR HIMSELF AND SENATORS HUMPHREY AND MCCARTHY STAFF ANALYSIS

Eligibility.--Individuals age 68 and over who are eligible to receive, but not necessarily receiving, social security old-age and survivors insurance benefits would be entitled to health benefits.

Benefits.

1. Hospital services, 365 days with an initial deductible amount of $75, repeated after 24 days.

2. Skilled recuperative nursing home services, 180 days.

3. Visiting nurse services, 365 days.

Cost.-$1.55 billion per year, or 0.48 percent of payroll, on a level premium basis; $630 million per year, or 0.30 percent of payroll on an early year basis. Financing.-Benefits would be payable out of a medical insurance account in the old-age and survivors insurance trust fund, established for this purpose, to be financed by an increase in the contribution rate on both employer and employee of one-fourth of 1 percent, and on the self-employed of three-eighths of 1 percent, beginning in 1961.

NOTE. The revenues derived from the tax increases provided in the amendment would amount to 0.50 percent of payroll on a level premium basis; thus, the amendment is fully financed.

VIEWS OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ON AMENDMENT 6-30-60-B INCLUDED IN FOLLOWING JOINT REPORT

The Department of Health, Education, and Welfare would recommend against adoption of each of the following four amendments: Amendment No. 1, 6-24-60C (Mr. McNamara); amendment No. 11, 6-27-60-F (Mr. Morse); amendment No. 20, 6-28-60-G (Mr. Humphrey); and amendment No. 27, 6-30-60-B (Mr. Anderson). Each of these bills proposes to amend title VI of H.R. 12580 to add health insurance benefits to the existing Federal old-age, survivors, and disability insurance system. The reasons for this recommendation are as follows:

1. The proposed extension of the existing old-age, survivors, and disability insurance system to encompass health insurance would make such insurance compulsory and would not be pinpointed to the need for aid in meeting the cost of medical services. Under this approach, the individual would have no opportunity to determine for himself the particular pattern for meeting the threat of large medical expenses that best suits his own needs and desires. In addition, by compulsorily extending health benefits to aged persons eligible for old-age, survivors, and disability insurance, many persons would be included who have the resources and the opportunity to obtain protection against long-term or other expensive illnesses without Government help.

2. These amendments would establish an exclusively Federal program. This administration has consistently endeavored, however, to strengthen our system of government by encouraging State and local governments to assume responsibility for the many public needs which can be met through Federal-State partnership and by supporting programs to stimulate greater State and local effort in areas of critical national concern. Health care for the aged is an area of activity admirably suited to such a sharing of responsibility. In addition to bolstering the underlying cooperative foundation of our Federal system, with governmental powers divided between State and Nation, Federal-State partnership places the control over daily program operations at the level of government closest to the persons affected by the program. Thus, an individual's needs may be more immediately and effectively reflected in the current operations and the development of the program.

3. The approach proposed in the amendments would constitute a serious threat to the orderly development of present retirement, survivorship, and disability benefit features of the social security system.

The payroll tax for old-age, survivors, and disability insurance is already scheduled ultimately to be 42 percent each on employees and employers and 6 percent on the self-employed. Further liberalization in retirement, survivorship, and disability benefits may call for additional revenues, which can only come from increases in the payroll tax or increases in the earnings base, or both. If health insurance as envisaged in these amendments were to be added to the system, the payroll tax would need to be increased by a total of one-half to 1 percent. As in the case of cash benefits, there would undoubtedly be insistent demands for improving the medical benefits beyond those which can be financed by the tax increase for medical benefit purposes. Increases in both health and cash benefits would place the retirement, survivorship, and disability portions of the system in competition with the health benefits, for available funds, since the revenue possibilities from a payroll tax are not limitless.

It is therefore far better to reserve the payroll tax for the retirement, survivorship, and disability features of the social security system so that the revenue source is not overburdened. Whatever the Government needs to do in the area of health care for the aged should be done by the appropriation of general reveSuch appropriation would provide for a more equitable distribution of the fiscal load than would a payroll tax on earnings of $4,800 or less.

nues.

TEXT OF AMENDMENT 6-30-60-B

Intended to be proposed by Mr. ANDERSON (for himself, Mr. HUMPHREY, and Mr. MCCARTHY) to the bill (H.R. 12580), viz: On page 172, after line 18, insert the following:

SEC. 605. (a) Title II of the Social Security Act is amended by adding after section 225 the following new section:

"MEDICAL INSURANCE BENEFITS

"SEC. 226. (a) (1) Every individual who

"(A) (i) has attained the age of 68, and

"(B) is entitled, or is deemed entitled, to monthly benefits under section 202, and

"(C) has filed an application under this subsection,

shall be eligible to receive medical insurance benefits during his benefit period (as defined in subsection (b) (3)). Any individual who meets the conditions of subparagraph (A) and (B) shall be deemed to have met the condition of subparagraph (C) upon the filing of an application in accordance with the provisions of subparagraph (A) of subsection (b) (1).

"(2) For purposes of this subsection

“(A) an individual is deemed entitled to monthly benefits under section 202 for a month if in such month such individual is not entitled to monthly benefits under such section, but would be entitled to such benefits (i) had he filed application therefore in such month, and (ii) for purposes of subsections (b) and (c) of such section 202, had such individual's spouse, if such spouse is not entitled to monthly benefits under subsection (a) of such section for such month, been entitled to benefits under such subsection for such month upon the filing of an application in such month;

"(B) an individual shall be deemed entitled to monthly benefits under section 202 for the month in which he died if he would have been entitled, or deemed to be entitled, to such monthly benefits for such month had he not died in such month;

"(3) Medical insurance benefits shall mean inpatient hospital services, skilled nursing home recuperative services, and visiting nurse services (as defined in subsection (d)).

"(4) No application filed pursuant to subparagraph (C) of paragraph (1) prior to the third month preceding the month in which the applicant attains the age of 68, shall be accepted as an application for purposes of such paragraph.

"PAYMENT OF MEDICAL INSURANCE BENEFITS

"(b) (1) Payment of medical insurance benefits which an individual is eligible to receive during his benefit period shall be made in accordance with the provisions of this section, but only if

"(A) application is filed for such payment in such form and in such manner and by such person as the Secretary may by regulation prescribe, and such application is filed no earlier than the first day of the third month preceding the month in which his benefit period begins or no later than the last day of the twelfth month succeeding the month in which his benefit period ends, and

"(B) the impatient hospital services, skilled nursing home recuperative services, or visiting nurse services, as the case may be, are furnished after referral by a physician, and such physician certifies in writing that such services are or were required for his medical treatment, except that such referral shall not be required for inpatient hospital services in case of an emergency which makes such referral impracticable; periodic recertification that such services which extend over a period of time are required shall be a condition of the continuing payment of such benefits.

"(2) Payment of medical insurance benefits which an individual is eligible to receive may be made for the following services if furnished in the United States

"(A) inpatient hospital services furnished to such individual during a benefit period on a total of not more than 365 days; provided that the payments made with respect to any benefit period of an individual shall be reduced (but not below zero) by an initial deduction equal to $75. In the case of continuous hospitalization in excess of 24 days in a benefit period. the payments shall be reduced by a further deduction equal to $75,

"(B) skilled nursing home recuperative services furnished to such individual during a benefit period on a total of not more than 180 days; except that this subparagraph shall not apply unless such services are furnished to such individual upon transfer from a hospital to a skilled nursing facility, and

"(C) visiting nurse services furnished to such individual during a benefit period on a total of not more than 365 visits.

"(3) For purposes of this section

"(A) a benefit period with respect to an individual shall mean a period (i) beginning with the first day in which such individual both is furnished inpatient hospital services, skilled nursing home recuperative services, or visiting nurse services and is eligible to receive medical insurance benefits and (ii) ending with the three hundred and sixty-fourth day following such first day; except that if any of such services are being furnished such individual in a continuous period in which occurs such three hundred and sixty-fourth day and the succeeding day, then, for purposes of determining the beginning of a benefit period, such succeeding day shall be the first day in which such services are furnished,

"(B) a continuous period during which the services referred to in subparagraph (A) are being furnished to an individual for purposes of such subparagraph shall mean

"(i) with respect to inpatient hospital services or skilled nursing home recuperative services, a consecutive number of days in which such services are furnished; and

"(ii) with respect to visiting nurse services, one or more visits in which such services are furnished, but only if the number of days elapsing between two successive visits in which such services are furnished does not exceed thirty.

"EVIDENCE AND DETERMINATIONS OF ELIGIBILITY

"(c) The provisions of section 205 relating to the making and review of determinations shall be applicable to determinations as to (i) whether an individual is eligible to receive medical insurance benefits, (ii) the number of days of services or visits, as specified in subsection (b) (2), for which an individual is eligible by reason of the provisions of this section, and (iii) whether, or the extent to which, the cost of the services furnished to an individual may be paid for out of the Medical Insurance Account of the Federal Old-Age and Survivors Insurance Trust Fund, and the amount of such payment.

"DESCRIPTION OF MEDICAL INSURANCE BENEFITS

"(d) For the purpose of this section

"(1) The term 'inpatient hospital services' means the following items furnished to an inpatient by a hospntal: (A) bed and board in a hospital, in semiprivate accommodations unless they are unavailable, or unless other accommodations are required for medical reasons; and (B) such medical, nursing, interns', laboratory and X-ray, ambulance, and other services, and such drugs, supplies, and appliances required for his care and treatment in the hospital or provided in connection with surgery which in the opinion of medical authority is medically necessary (whether furnished directly by the hospital or by arrangement through other persons);

66

(2) The term 'skilled nursing home recuperative services' means the following items furnished to an inpatient in a skilled nursing facility: (A) skilled nursing care provided by a registered professional nurse or a licensed practical nurse which is prescribed by a physician as required for the recuperative care of the patient; (B) medical and other services required for his treatment in the nursing facility; and (C) bed and board in connection with the furnishing of such skilled nursing care;

"(3) The term 'visiting nurse services' means professional nursing care in a place of residence maintained as an individual's home, prescribed by a physician and provided through a visiting nursing agency;

"(4) The term 'hospital' means an institution which (A) is operated in accordance with the laws of the jurisdiction in which it is located pertaining to hospitals and in accordance with standards established by the authorities responsible for such standards in such jurisdiction; (B) is primarily engaged in providing diagnostic and therapeutic facilities for surgical and medical diagnosis,