[H. Rept. No. 544, 89th Cong., first sess.]

PROPOSED CLOSING OF PUBLIC HEALTH SERVICE

HOSPITALS

Fourteenth Report by the Committee on Government Operations

(Submitted to the Speaker June 23, 1965)

This report deals with a proposed plan announced by the Department of Health, Education, and Welfare on January 19, 1965, for closing seven of the 12 general hospitals operated by the Public Health Service. Under the plan, part of the patient load at the hospitals to be closed would have been transferred to Veterans' Administration or military hospitals. Some of the remaining patients eligible for care at the hospitals were to receive treatment in private hospitals at Federal expense while others would no longer receive hospital care from Federal agencies. In announcing the plan, HEW, claimed it would result in more comprehensive and convenient medical care for patients, while saving more than a million dollars annually in operating costs.

The committee concluded that the decision to close Public Health Service hospitals at Boston, Norfolk, and Galveston had been made without adequate study and consideration. The committee further concluded that the availability, convenience, and quality of medical care provided Public Health Service beneficiaries were likely to be reduced, rather than improved, by the closing plan, and the claim that substantial savings would be realized was extremely questionable. The committee further concluded that two courses of action contemplated by the proposed plan--the establishment of a priority for merchant seamen over some veterans for admission to Veterans' Administration hospitals and the construction of additional facilities by the VA to provide hospital care for merchant seamen-were illegal. The Comptroller General, in an opinion furnished at the committee's request on June 22, 1965, also concluded that the contemplated actions were not authorized by law.

RECOMMENDATIONS

CANCELLATION OF PLANNED ILLEGAL ACTIONS (Recommendation 1):

The committee believes it is the duty of those concerned to immediately take action to insure that, in connection with the closing of PHS hospitals

(a) nonveterans do not receive priority over eligible veterans in Veterans' Administration hospitals;

(b) otherwise unnecessary capital expenditures are not made or facilities constructed under the purported authority of title 31, United States Code, section 686.

Results. The subcommittee was informed by the Veterans' Administration that a directive providing a priority for merchant seamen over veterans for admission to VA hospitals had been rescinded and that VA would not construct facilities for merchant seamen without specific congressional approval.

REEXAMINATION OF PROPOSED CLOSING OF PUBLIC HEALTH SERVICE HOSPITALS (Recommendation 2):

The committee recommends that a careful and comprehensive reexamination of the proposed closing of Public Health Service hospitals be made, with particular attention being given to the situations involving PHS hospitals at Boston, Galveston, and Norfolk.

Such a study should be made with the full participation of all Federal agencies involved and should include a careful examination of the situation involving each individual hospital. The study should include, but not be limited to, consideration of—

(a) the legality of any proposed actions;

(b) the comparative quality and availability of medical care for PHS beneficiaries under each alternative course of action proposed, based on a careful study of the situation at each individual location;

(c) the cost of each feasible alternative course of action; (d) the potential impact of medicare legislation on demand for hospital facilities in the communities involved;

(e) the potential effect on medical training, research and recruitment.

Results. In July 1965, the subcommittee was advised by the Secretary of Health, Education, and Welfare that the decision to close PHS hospitals at Boston, Norfolk, and Galveston had been reversed. In May 1966, the subcommittee was advised that the decision to close PHS hospitals at Detroit and Savannah had also been reversed, and that hospitals would be maintained at those locations.

The subcommittee has been further advised by HEW that a renovation plan has been formulated to bring about improvements in PHS hospitals.

[H. Rept. 1457, 89th Cong., second sess.]

ADVISORY COMMISSION ON

INTERGOVERNMENTAL

RELATIONS: THE FIRST FIVE YEARS

Twenty-seventh Report by the Committee on Government Operations

(Submitted to the Speaker April 28, 1966)

The Advisory Commission on Intergovernmental Relations was established by the 86th Congress as a permanent agency to bring together representatives of all levels of government and the general public for consideration of existing and emerging problems associated with the operation of our federal system. Although the subcommittee has maintained a close and continuous working relationship with the Commission, a formal review was considered desirable and was undertaken in 1965 in order to evaluate the Commission's performance during its first 5 years and to consider its future role.

This report presents the committee's findings and conclusions based upon a detailed review of the Commission's operations. It also contains recommendations for strengthening the Commission's work in

several important areas, including educational activities and professional training, and for the amendment of Public Law 86-380 (the act which established the Commission) to enable the agency to function more effectively.

RECOMMENDATIONS

COMMISSION REPORTS (Recommendation 1):

In selecting subjects for future study [the committee recommends that] the Commission gives increased attention, either through its own research resources or by private organizations and scholars, to the following areas:

(1) Broad, long-range studies of evolving trends in federalism in the light of the changing roles of State government, local governments, and private organizations in the administration of Federal grant programs.

(2) Comprehensive examination of existing methods and the development of new approaches for matching public revenues with service needs at the several levels of government in our federal system.

(3) Study of the use and effectiveness of the planning requirements of Federal aid programs for the development of physical, social, and economic resources in local communities.

Results. In keeping with the Committee's recommendations, the Commission undertook several broad studies resulting in the formal reports Fiscal Balance in the American Federal System and Urban and Rural America: Policies for Future Growth. Another study, State Aid to Local Governments, is now in progress.

EDUCATIONAL ACTIVITIES (Recommendation 2):

[The committee recommends that] the Commission expand its activities to stimulate greater public discussion of major intergovernmental problems in the following ways:

(1) Seek to enlarge its role as a catalytic agent and a coordinating center for intergovernmental research by encouraging qualified organizations and individuals to undertake needed studies.

(2) Hold one meeting a year in metropolitan centers outside of Washington as a means of developing greater awareness of and interest in the Commission's work in all sections. of the country.

(3) Sponsor, in cooperation with interested civic and professional organizations if possible, a national conference on Federal-State-local relations at least once every 5 years. Results. The Commission has worked closely with public and private groups and with individual scholars engaged in studies of our federal system.

In connection with the Committee's recommendation for meetings. outside Washington, the Commission has so far held two such meetings, in Chicago and San Francisco, combined with public hearings.

It is anticipated that the Commission will sponsor a national conference on the American federal system, probably in 1970, as a means of focusing national attention on the changing nature of federalism. During 1969 the Commission plans to encourage and assist interested civic and professional organizations in arranging and conducting conferences that direct attention to the future course of federalism in the United States.

PROFESSIONAL TRAINING (Recommendation 3):

[The committee recommends that] adequate funds be made available to enable the Commission to train approximately four beginning-level professionals each year. The primary purpose of the program would be to further the development of intergovernmental relations specialists who will pursue their careers, after a 1- or 2-year training period, in Federal agencies or in State and local governments.

Results. The Commission has approved the establishment of an intern training program, but this program has not yet commenced due to stringent budget conditions.

AMENDMENT OF PUBLIC LAW 86-380 (Recommendation 4):

The act which established the Advisory Commission on Intergovernmental Relations in 1959 has proved to be a workable and durable statute. Only a few relatively minor amendments to the original act are needed in the light of the Commission's operating experience. [The committee recommends the following:]

(1) Amend section 3 (a) (6) and (7) to accomodate changes in the names of two mentioned organizations made subsequent to passage of the original act. This amendment would substitute "National League of Cities" for "American Municipal Association" and "National Association Counties" for "National Association of County Officials."

of

(2) Amend section 3 (c) to allow a member to serve until his reappointment or until the appointment of a successor, except where the member ceases to serve in the official position from which he was appointed. This would enable the Commission to function more effectively when there is a significant timelag between the expiration of a member's 2-year term and the filling of the vacancy.

(3) Amend section 6(f) to permit the Commission's Executive Director to receive compensation at the rate prescribed for level V of the Federal Executive Salary Schedule established by the Federal Executive Salary Act of 1964.

(4) Amend section 7(b) to make clear that Commission members who are not full-time salaried officers of State and local governments, and are therefore entitled to per diem compensation, are not required to accept such compensation. The elimination of the mandatory language would avoid the possible situation where a State or local official might be

precluded from serving on the Commission because the constitution of the particular State prohibits him from receiving remuneration from the Federal Government.

(5) Add a new section 9 authorizing the Commission to receive funds through grants, contracts, and contributions from State and local governments (or organizations representing such governments) and from private foundations and other nonprofit organizations.

Results. All of the amendments to Public Law 86-380 recommended by the committee were adopted through the enactment of Public Law 89-733, and since this enactment the Commission has begun to receive a portion of its operating funds from State and local government sources. Federal-State-local sharing of the Commission's expenses was contemplated when the agency was established, but was deemed not practical at that time.

[H. Rept. No. 1643, 89th Cong., second sess.]

UNSHACKLING LOCAL GOVERNMENT: A SURVEY OF PROPOSALS BY THE ADVISORY COMMISSION ON INTERGOVERNMENTAL RELATIONS

Thirtieth Report by the Committee on Government Operations

(Submitted to the Speaker June 22, 1966)

Much has been written about the financial, physical, and social problems of our cities and the need for outside help to solve them. While there are indeed many situations where outside assistance is needed, cities and other urban communities are capable of handling many of these problems themselves if given adequate power to act and sufficient encouragement to do so. Since local governments derive their governmental powers from the States under our federal system, the additional authority needed to solve such problems must be provided by the States.

The purpose of this report is to discuss some of the methods by which States might free local governments to handle many of their problems more effectively and expeditiously. It is intended to bring together for easy reference, and in the perspective of history, the recommendations and suggestions made for this purpose by the Advisory Commission on Intergovernmental Relations (ACIR). While the committee is in general agreement with the ACIR's objective of removing restrictions on local governments and believes the Commission's recommendations should receive careful consideration, the report does not endorse particular conclusions and recommendations of the Commission. Moreover, the report contains no recommendations by the committee.

The report was developed to be helpful to the members of the committee, the Congress, and others by providing background information on how local governments can be strengthened to perform a more effective and responsible role in our governmental system.