Summary of anticipated construction of hospitals and other medical facilities (under title VI of the Public Health Service Act) if there were no limitation on Federal assistance, for fiscal years 1965 and 1966-Continued PREPARED STATEMENT OF SENATOR HRUSKA Mr. Chairman, the Hill-Burton program has been very well received in Nebraska as well as the entire Nation. For this reason the Department of Health in Nebraska is very eager to have this program continued. The extension of this program has very wisely foreseen the diversified needs of future medical facilities and promoted construction in needed areas by providing categorical controls. This is a good step to insure responsible use of the funds provided under the program. I am also pleased to see that in both the House bill and the Senate bill certain flexible features are included to allow the States to tailor their construction program to the most urgently needed categories. In anticipation of the extension of this program and in reviewing their future needs, the Department of Health of Nebraska as well as a number of other States have found that they need another kind of flexibility. Assuming that either the House passed bill or the pending Senate bill has sufficient flexibility for transferring allotments between categories there is still a need for allowing States to decide when they should use their funds in each of these categories. As an example, in a State receiving a relatively small allotment under this program, when assisting a large construction project adequate funds may not be available to keep the project moving at its most efficient and expeditious pace. Under either the House-passed bill or the pending Senate bill a State may merely hold its allotment in one category over until the next year and use the 2-year total for a large project, but this would not solve the problem. The need in one category may be very great in 1 year and much less pressing in another category during that year and yet adequate funds for the urgent need would not be available for 2 years. The result would be to give financial assistance while dragging our feet on the actual construction of the project. In the meantime, other funds would be pushing ahead projects in which the need has not fully matured. The purpose of the amendment which I have proposed would be to extend a degree of time flexibility to the States, allowing them to construct their most needed facilities first during the life of this act. Basically, this amendment would allow States to use as much as necessary of the total allotment in an urgently needed category for the overall 5-year life of the act in any one of 2 years of thie life of the act simply by deferring the use of funds from other less needed categories. These less urgent needs could then be provided for in subsequent years. The net effect at the end of 5 years would be unchanged since the average spent in each category would be the same as allowed under the pending provisions. In the meantime the needed facilities would have been in use years earlier. This amendment provides for supervision of these transferred by the Surgeon General to carry through the control features. As a formula which avoids the necessity for some projects to be delayed awaiting adequate assistance it will prevent waste not only in terms of money but also from the standpoint of those needing the required facilities. It is felt that this amendment will help to more closely achieve the purposes o the Hill-Burton program by meeting the needs of the individual States while retaining the control and assistance of the Surgeon General who is responsible to the Congress for the administration of these funds. STATE OF ALASKA Hon. FRANK B. MORRISON, Lincoln, Nebr. DEAR GOVERNOR MORRISON: Thank you for your letter of May 7 concerning the suggestion of Dr. Rogers in regard to merging of Hill-Burton funds. As suggested by you, the proposal was brought to the attention of the Alaska Department of Health and Welfare which felt that it contained such merit that letters have been sent to the Alaska congressional delegation urging support for its adoption. Sincerely, WILLIAM A. EGAN, Governor. STATE OF COLORADO, Hon. FRANK B. MORRISON, State Capitol, Lincoln, Nebr. DEAR GOVERNOR: Your suggestion contained in your letter of May 7 made to your Senators and Representatives in Congress concerning the allocation among the several States of funds appropriated by Congress under the Hill-Burton Act for hospital-type construction is in general conformity with my thinking concerning the earmarking of Federal grants-in-aid and is a good case in point. Your suggestion that the Hill-Burton Act be amended to provide that "any State having a total allocation of less than $2 million a year from all categories may request a merger of these funds and, upon showing a need by the State, the Surgeon General of the Public Health Service shall approve such request," is the minimum that should be requested. I would go a step further and suggest that the first $21⁄2 million of the Hill-Burton Act moneys to any State be permitted to be merged at the option of the State concerned. One of the problems of Federal grants-in-aid to specific categories is that in order for a State to participate they must build the specific type of facility whether or not that is their first priority. Some flexibility should be allowed the States to meet health faciliy construction which is most urgent in their priorities, if Federal grants-in-aid are to be more in accord with what States believe should be done. For example, a State's principal problem may be to obtain mental retardation facilities, but when the Hill-Burton Act provides only a limited amount for such facilities and a much larger sum for say general hospitals, the primary need of the State is not met. The tendency of the Federal Government to earmark grants-in-aid for specific problems to the exclusion of their problems is a most serious criticism that States have of such grants. It is a shifting of decisionmaking from the State capitols to Washington as to what is the most urgent priority need in our States. This is one type of control that accompanies Federal grants-in-aid and which, if it continues, will result in the shifting of decisionmaking in other categories. I believe that our public health director and our State legislature are in a better position to make decisions as to health priority needs in the State of Colorado than is someone far removed from our States. Copies of this letter are being sent to our Senators and Representatives so they, too, may be informed of our general thinking in this regard. Sincerely, JOHN A. LOVE. THE STATE OF NEVADA, Hon. FRANK B. MORRISON, Governor of the State of Nebraska, State Capitol, Lincoln, Nebr. DEAR FRANK: Thank you for your May 7th letter suggesting that I check with my hospital survey and construction authority relative to proposed amendments to the Hill-Burton program. Dr. Daniel J. Hurley, acting State health officer, has recently heard from your Dr. E. A. Rogers and has written to Nevada's Senators and Representative supporting Dr. Rogers' request. I, too, will advise our Senators and Representative of the wishes of my health division regarding the proposed legislation. Kindest regards, Grant, GRANT SAWYER, Governor. STATE OF HAWAII, Honolulu, June 8, 1964. Hon. FRANK B. MORRISON, DEAR GOVERNOR MORRISON: Thank you very much for your letter and proposals relative to the revised public health law title VI (Hill-Burton). We will be in touch with our Congressmen urging the passage of this revised legislation. We agree that certain changes would be desirable to permit a State that is receiving minimum or close to minimum allotments under this legislation, the latitude of arranging these allotments to provide the most suitable resources to the people of the State. With this view in mind, we are urging for greater flexibility on the transfer of funds from the categorical allotment. Sincerely, WILLIAM R. RICHARDSON, Acting Governor of Hawaii. DEPARTMENT OF HEALTH, STATE OF HAWAII, Honolulu, May 22, 1964. E. A. ROGERS, M.D., M.P.H., Director of Health, Department of Health, DEAR DR. ROGERS: Thank you very much for your letter and proposals relative to the revised public health law title VI (Hill-Burton). We will be in touch with our Congressmen urging the passage of this revised legislation. We agree that certain changes would be desirable to permit a State that is receiving minimum or close to minimum allotments under this legislation, the latitude of arranging these allotments to provide the most suitable resources to the people of the State. With this view in mind, we are urging for greater flexibility on the transfer of funds from the categorical allotment. Sincerely yours, DEAR DR. ROGERS: I am pleased to attach herewith a copy of a letter which I have written to our Senators and Congressmen from Rhode Island. As stated in our letter we are in agreement with your views and we hope that our Representatives will give them serious consideration. Sincerely yours, JOSEPH E. CANNON, M.D., M.P.H. MAY 21, 1964. Hon. CLAIBORNE PELL, New Senate Office Building, DEAR SENATOR PELL: In considering the amendment and extension of the HillBurton Act, I am in agreement with the views of the State of Nebraska that the following amendment be inserted in the section providing for allotting the appropriation among the several States and territories: "Provided, That any State having an annual allotment of less than $2% million may request the Surgeon General to merge all categorical funds |