EXHIBIT NO. 2-Continued DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE-COMPARISON OF FISCAL YEAR 1973 OPERATING LEVEL WITH THE 1973 CONTINUING RESOLUTION LEVEL FOR HEALTH PROGRAMS-Continued 1 Included in final line entry-program direction and manpower analysis. 2 Fiscal year 1973 interest subsidy funds ($1,000,000) will be carried over to fiscal year 1974. EXHIBIT NO. 3 U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Hon. CASPAR WEINBERGER, Washington, D.C., May 29, 1973. Secretary, Department of Health, Education, and Welfare, DEAR MR. SECRETARY: We recently discussed funding of the Hill-Burton program during fiscal year 1973, and I would appreciate receiving further information on this subject. Specifically, I would like to know the amounts of money which have been and will be released to the states for purposes of making grants under the Hill-Burton program this fiscal year. How much money does HEW feel has been appropriated for expenditure during this fiscal year under the various parts of the Hill-Burton legislation? How does the Section 601 provision of the Medical Facilities Construction and Modernization Amendments of 1970 apply to expenditures in this area? What general counsel opinions have you obtained relevant to these issues? Thank you for your assistance. Sincerely yours, HARLEY O. STAGGERS, Member of Congress, Chairman. U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D.C., June 8, 1973. Hon. CASPAR WEINBERGER, Secretary, Department of Health, Education, and Welfare, DEAR MR. SECRETARY: In reviewing the FY 1973 appropriations and proposed obligations for the Health Services and Mental Health Administration and the National Institutes of Health, it appears that the Congress has appropriated approximately $1.1 billion which the Department of HEW is not planning to obligate. These amounts include the following: CMHC staffing- Alcoholism programs. Family planning.. National Cancer Institute_ National Heart and Lung Institute. Medical research in total_. Health manpower - - In millions $40 82 195 33 60 42 230. 300 Since the FY '73 Labor-HEW continuing resolution has the full force of law, these amounts are apparently health monies which HEW is proposing to impound. While most legal scholars feel that impoundment is illegal, I do understand that there is some controversy on this point. However, with regard to health monies, there is additional legal authority designed to assure that such monies are expended (section 601 of the Medical Facilities Construction and Modernization Amendments of 1970). Would you provide me with a detailed breakdown of all anticipated differences in health between the FY '73 appropriations and obligations. In addition, I would like to see legal justification for the failure to expend appropriated funds; specifically any opinions from the General Counsel of HEW on this subject including the applicability of section 601. Sincerely yours, HARLEY O. STAGGERS, Member of Congress, * DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. HARLEY O. STAGGERS, Chairman. OFFICE OF THE SECRETARY, Chairman, Committee on Interstate and Foreign Commerce, Washington, D.C. DEAR MR. CHAIRMAN: Thank you for your letters of May 29 and June 8 concerning appropriations for Hill-Burton and other health programs. Since your letters cover similar issues, I am responding to both by this one letter. I have also received your letter of June 13. Enclosed are two tables. The first (enclosure 1) describes the Department's spending for the Hill-Burton program, title VI of the Public Health Service Act. It shows new budget authority available under the Continuing Resolution, the amount of funds carried over from prior years' appropriations, and the Department's FY 1973 operating level. The second table (enclosure 2) [printed as exhibit No. 2, p. 17] provides the data requested in your June 8 letter for all health programs covered by the FY 1973 Continuing Resolution. The meaning of Section 601, about which you enquire, remains unclear and most debatable. To my knowledge, no court has yet attempted to construe section 601 or the companion provision in the education area, section 415 of the General Education Provisions Act. It seems appropriate for the Department of Justice to decide whether to release letters they sent to me some time ago when I occupied a different governmental position. As to the legal justification for impounding funds, I refer you to the February 6, 1973, Senate testimony of Deputy Attorney General Sneed on this subject. His written statement, a copy of which is enclosed for your convenience [not printed], is printed in Joint Hearings before the Ad Hoc Subcommittee on Impoundment of Funds of the Committee on Government Operations and the Subcommittee on Separation of Powers of the Committee on the Judiciary, United States Senate, on S. 373, 93d Congress, 1st Session, beginning at page 364. Sincerely, CASPAR W. WEINBERGER, 1 Includes $2,000,000 allocated for State administration expenses. Carry-over $20,800,000 $30, 012, 000 70, 000, 000 15, 000, 000 41, 400, 000 99, 883, 000 197,200,000 296, 564, 000 Fiscal year 1973 operating level i $17,003,000 30, 215, 000 11,598, 000 26, 426,000 77,864, 000 2 163, 106, 000 2 Includes actual obligations through May 31, 1973, plus an estimate of how June obligations will be distributed among subsections of the law. Determination of need is made in the field and the actual distribution may vary from the estimate. U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERESTATE AND FOREIGN COMMERCE, Hon. CASPAR W. WEINBERGER, DEAR MR. SECRETARY: Thank you for your letter of July 3 concerning health funds which you have impounded. I am dismayed that you have felt it appropriate to impound the billion dollars your letter describes. I am not convinced that this is legal, necessary, or in the best interests of the people of our nation. I would be interested in a detailed, program-by-program, description of why you feel that these programs are inadequate, inappropriate, or unnecessary. They were created to meet specific needs of our population: the need for protection from disease be it infectious, nutritional, or chronic, the need for adequate supplies of health manpower, the need for health services and biomedical research, and the need for improved, or even adequate, health services of many kinds. Unless these needs in fact do not exist, or have been met, or are being met by alternative superior programs, than these impoundments must be considered a sad failure of our government's commitment to serve its people. Yours, ATTACHMENT NO. 2 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. WILBUR D. MILLS, DEAR MR. CHAIRMAN: This is in further response to your letter of February 2 requesting detailed information about the findings set forth in the General Accounting Office report on the program under Title V of the Social Security Act. I appreciate the opportunity to advise you of the steps taken by the Department to assure an orderly transition to the States of the project grant authority in Title V. A detailed response to your questions is provided in the enclosed statement. Planning for the changeover is progressing well. Draft proposed regulations relating to the programs of projects required for State plan approval by sections 505(a) (8), (9), and (10) of the Act have been developed and sent to the State health agencies for comment. Thoughtful responses have been received from 33 States to date. The draft is being revised to take these into account. Guidelines interpreting program concepts are being developed to help States meet the statutory and regulatory requirements. The reporting systems have been simplified to adapt them to State usage. Proposed procedures for completing the transition from direct Federal financing to State financing have been developed and will be issued to State health agencies and other project grantees shortly. Maternal and Child Health Service staff of the Health Services and Mental Health Administration have been working with States and project grantees on problems relating to the changeover since early December, 1972. We will do our best to make the changeover from direct Federal project grants to provision of services by State health agencies with formula and matching funds as smooth as possible. As indicated in the enclosure, reductions in services may occur in some of the States with large urban areas but services not now available will be provided in other States. We think that these programs have carried out their objectives and demonstrated their value and that States will want to continue and expand effective projects. Sincerely, CASPAR W. Weinberger, Secretary. [Enclosures not printed.] ATTACHMENT NO. 3 DEAR U.S. HOUSE OF REPRESENTATIVES, During the executive session of the Ways & Means Committee held on Tuesday, June 5th, the Committee passed over legislation, (H.R. 7114), to extend project-grant funding, under Title V of the Social Security Act, for Maternal and Child Health Care. Failure to extend project-funding for these programs will result in either their acute curtailment or effective demise. There are 139 projects in 38 states and two territories. They provide a complete range of medical services for over 800,000 maternity patients and children. These programs have resulted in dramatic drops in infant mortality rates in areas they cover. Preventive medical and dental care programs have also been extremely effective in raising the percentage of those youngsters and infants declared "healthy on examination". The nation-wide value of these programs is beyond dispute. Should the Committee not provide an extension, total of $28,354,200 will be lost outright to 15 jurisdictions. While it may appear that some states are slated to gain a million or two dollars in overall formula grants, projects, even in those states, will likewise be very seriously affected-some to the point of shutting down all operations. The Secretary of H.E.W. has assured the Chairman and Committee that a smooth transition can be accomplished in terminating project funding. He notes in his letter of April 9, 1973, that only those States most seriously affected by project funding termination may have some difficulty in adjusting. However, it is my understanding, based on direct communications received from the directors of many projects, that an extension of at least another year is urgently needed to secure some alternate funding sources for their programs. While it is hoped that ongoing projects would receive some funding channeled by the States from the new formula grants under Title V, there is no assurance that this will be the case. The Comptroller General has stated there is no way to trace funds to insure they are being used to continue the vital health care being delivered by these projects. As I mentioned above, project directors, even in those states slated to receive slightly more funding under formula grants, have been able to neither secure alternate funding nor receive assurances from their state governments that funds approaching those needed for project continuation will be forthcoming. Such statements have been received from the representative region of every Member of the Ways & Means Committee and from the states of all but two Members whose States either do not have projects, or whose participation is slight. Based on direct statements of project directors and correspondence from the National Association of Maternity and Infant Care Projects, the American Medical Association, and the American Academy of Pediatrics, failure to extend Title V project funding will be a four-fold disaster: First, the extremely important beginning we have made in both perinatal care and parent education will be lost; Second, there is no way for the Congress to assure that the States will provide funds to make up for the 85-90% of project budgets now received under project funding; Third, even if state funding is made available, processing of state assistance applications will cause an hiatus in care; Fourth, the professional and para-medical staffs serving these projects will be dispersed and all voluntary work and assistance to these teams will cease. This matter is clearly of vital and immediate concern to every member of the Committee and of the Congress. It is my hope that the Committee will be given the opportunity to reconsider this legislation, thus providing the time necessary to secure alternate methods of funding; restructure the formula of distribution; seek additional Federal appropriations, so that no state or project is even apparently short-changed in their access to funds; or all three. 3 I have attached a letter from the American Academy of Pediatrics addressed to each member of the Committee, stating the professional judgment of the men most closely associated with these projects and the care being provided over 800,000 mothers or mothers-to-be, and their children. I urge your favorable consideration of both these letters, and concurrence with reconsidering and reporting this urgently needed legislation. Sincerely, HUGH L. CAREY, M.C. ATTACHMENT NO. 4 [Excerpt From the Congressional Record-June 30, 1973] Mr. CAREY of New York. One point, Mr. Chairman: With regard to the State of New York and unemployment compensation insurance benefits and the eligibility factor with regard to our committee's research on this point, again and again I have run into the problem that the geographical area of reporting that covers the statistics is regional, and until we cure that difficulty of the regional reporting, it is very hard to bring New York in under the 41⁄2 percent without heavily increasing the burden across the country in other States that have a level above that level. Mr. MILLS of Arkansas. I agree with the gentleman from New York. Mr. CAREY of New York. I think it is something that is beyond the reach of the conferees. One more thing: I want to commend the chairman for his stamina and steadfasteness in bringing into the conference, I believe, the provisions regarding maternal and child health care. Many States would have lost on these |