MEDICAL CARE FOR SELF-EMPLOYED FISHERMEN-Continued List of U.S. Public Health Service hospitals, outpatient clinics, and outpatient offices-Continued Type of hospital: Drug addiction and mental illness. 3 Address correspondence to MOC, Public Health Service Hospital, Savannah, Ga. Senator BARTLETT. Thank you very much, gentlemen. The next witness is Earl W. Clark, codirector of Labor-Management Maritime Committee. STATEMENT OF EARL W. CLARK, CODIRECTOR, LABOR-MANAGEMENT MARITIME COMMITTEE, WASHINGTON, D.C. Mr. CLARK. Mr. Chairman, if it is agreeable to the Chair, I should like to file a statement which I have here in order to conserve the committee's time, and comment on the document, if I may. Senator BARTLETT. That will be agreeable. (The statement referred to follows:) STATEMENT OF THE LABOR-MANAGEMENT MARITIME COMMITTEE, AFL-CIO MARITIME COMMITTEE, AND AMERICAN MERCHANT MARINE INSTITUTE, ON S. 978 (Submitted by Hoyt S. Haddock, executive secretary, AFL-CIO Martime Committee; Earl W. Clark and Hoyt S. Haddock, codirectors, Labor-Management Maritime Committee; Alvin Shapiro, vice president, American Merchant Marine Institute) The Labor-Management Maritime Committee, representing some of the major American-flag steamship lines and seagoing labor unions, the AFL-CIO Maritime Committee, consisting of the largest segment of maritime unions within the AFL-CIO, and the American Merchant Marine Institute, comprising a broad membership in the maritime industry, desire to jointly support the general intent and purpose of S. 978. We believe that Public Health Service hospital and medical care should be made available to a certain class of seamenfisherman now denied this service because they are owners or part owners of fishing vessels. It should be pointed out that, prior to 1954, this class of persons was receiving such hospital and medical care but was excluded during that year following a legal opinion by the General Council of the Department of Health, Education, and Welfare. We understand the occasion for such ruling arose in 1951 out of claims for medical care by certain parties occupying residential yachts and houseboats. The claims were based on the general language of the law. In the cases in point the attempt was to include even a housewife, who was allegedly engaged in the care or preservation of the vessel under the literal wording of the act. It seems obvious that such persons were not intended to fall under the classification of seamen as set forth in 42 U.S.C. 201 (h). In November of 1953, Public Health Service officials referred the matter to the General Counsel of that agency for review and advice. His opinion resulted in the issuance of regulations which had the broad effect of barring, among certain other beneficiaries, the owners or part owners of small fishing vessels to whom such medical and hospital care had been traditionally extended. The new regulations were first published in the Federal Register on March 24, 1954, revised and republished on May 26, 1954, and became effective June 26, 1954. While no one could quarrel with the necessity for proper interpretation of the law and its appropriate application to the type of cases giving rise to the new regulations, the net effect upon certain of those in the fishing trade was unfortunate. Seamen employed on vessels registered, enrolled, or licensed under the maritime laws of the United States are now entitled to Public Health Service care. This is clearly established in 42 U.S.C. 249(a) (1). The essence of the term "seamen" as defined in the statute is found in the words "care, preservation or navigation" of vessels. Fishermen are not entitled to Public Health Service medical and hospital care by virtue of being fishermen-quite, the contrary. They are not covered under the statute at all unless their activities encompass the care, preservation or navigation of vessels. In such case they qualify because they are, in fact, seamen, and not because they may also engage in fishing. Fishing is incidental to eligibility for medical and hospital care and is not governing. The fact that a person enjoys an ownership or part ownership of a small fishing boat in which he pursues his occupation does not appear to change the complexion of his occupation as a seaman-fisherman. Furthermore, his occupa 142 U.S.C. 201 (h). In tion is for the most part comparable to the many other types of seamen. fact, many of these seamen-fishermen have been readily adjusted to other types of seamen's duties during wartime or in periods of national emergency. Certainly, their normal duties on board a vessel are not changed by virtue of the fact that they have an interest in some fishing boat. We subscribe to modification of the law to the extent that it can be interpreted to reinstate, as recipients of Public Health Service hospital and medical care, owner-operators of fishing boats (documented under the laws of the United States). The wording of S. 978 includes the language "any person employed or selfemployed on board in the care, preservation or navigation of any vessel" (42 U.S.C. 201 (h)). [Italic supplied.] The use of the word "self-employed" is new and would reinstate the owners of fishing boats to Public Health Service medical and hospital care, from which they were excluded on June 26, 1954. Speaking on this point, the Public Health Service in hearings on a former bill before the Committee on Commerce, U.S. Senate (S. 367, 87th Cong.), supported this interpretation and suggested this wording. We quote from the Senate report on S. 367, dated May 2, 1962: "The legislative history of this program suggests that the participation of the Federal Government in providing medical care to merchant seamen rests primarily on a national interest in assuring the effectiveness of the labor force required for an adequate American merchant marine. A self-employed owner who performs duties related to the care, preservation, or navigation of a documented vessel of the United States is in effect fulfilling the same purpose as the employed seamen on board the vessel. Since such persons are in fact applying their maritime skills, they are essentially adding to the maritime labor force. Although statistics are not available on the self-employed seamen who would come within the provisions of the proposed legislation, it is believed that neither the number nor cost would significantly affect the present program. "Public policy, however, would not be served by extending Federal medical care benefits to passengers, guests, and others aboard a documented vessel by reason of some incidential services they may provide in the course of their presence aboard the vessel. It is, therefore, suggested that such persons be excluded from these benefits by revising the amendatory language of S. 367 to substitute 'selfemployed' for the term 'engaged'. "Enactment of this bill would pose no serious difficulties for this Department as a provider of service; however, the fundamental issue of provision of medical care to merchant seamen, as a matter of public policy, is not here in question. The purpose of the bill is to remove an apparent inequity in present practice by amending the act to include a certain class of seamen who formerly enjoyed the privilege of receiving medical care in Public Health Service hospitals, and not to expand the program in any substantial manner." The insertion of the word "self-employed" in section 322 (a)(1) of the Public Health Service Act (U.S.C. 249(a) (1)) is chiefly for the purpose of making this section consonant with 42 U.S.C. 201 (h). We support S. 978 for several reasons: (a) The bill maintains the integrity of the term "seamen" as defined in current statutes. (b) The bill will not floodgate the Public Health Service by unduly increasing the number of recipients otherwise not entitled to its service. (c) The bill reinstates only those who ligitimately should receive medical and hospital care and who were excluded by a legal interpretation based on technicalities of the law, rather than upon the merits. This is appropriate legislation and should be passed by the Congress. Mr. CLARK. This is a statement supported by three organizations— the American Merchant Marine Institute, which widely covers the steamship industry: the AFL-CIO Maritime Committee, which composes a large body of our seagoing labor in this country; and the Labor-Management Maritime Committee, of which I am codirector, which represents both major steamship industries and seagoing labor. May I say, Mr. Chairman, that other associations whose names are not on our submitted statement have not objected to S. 978. The ones that have filed in direct support are those whose functions are more closely related to the problem. Senator BARTLETT. Yes. Mr. CLARK. We testified last year in support of a similar bill. We think the bill as drafted by the committee this year is superior to the one on which we gave favorable testimony last year. This is due principally to the fact that you have simplified the language and merely have added the word "self-employed" with reference to the section of the annotated statute dealing with the definition of "seaman." Now, throughout the history of the program of medical and hospital care to merchant seamen, the terms "care,' "preservation," and "navigation" have been considered key terms. In order to be eligible for care in these public institutions you must actually be engaged in the care, preservation, and navigation of vessels. In 1954 there was a small group of people who were refused this care and who up to that time had received it. Now the loss of this privilege resulted principally from the fact that on some leisure, houseboats, and yachts, there was an attempt on the part of some to get persons into the category of receiving this care who, in fact, were housewives. Now the intent of excluding these people was good, but in the process of doing it, another group was extracted, which we think should be reinstated. These are the owners of these fishing vessels who themselves are engaged in the care and preservation and navigation of the vessels. We feel that a person who is purely a fisherman should not be entitled to medical care unless he is also a seaman. eligible he would get the care because he is a seaman and not because he is a fisherman. If We think that the committee has done a very good job in setting forth the language in S. 978. And now I will turn just to the concluding words of our report. We say: We support S. 978 for the following reasons: (a) The bill maintains the integrity of the term "seamen" as defined in current statutes. (b) The bill will not floodgate the Public Health Service by unduly increasing the number of recipients otherwise not entitled to its service. (c) The bill reinstates only those who legitimately should receive medical and hospital care and who were excluded by a legal interpretation based on technicalities of the law, rather than upon the merits. Now with that statement, Mr. Chairman, the steamship industry, as represented by the groups that I mentioned, gives wholehearted support to this bill, because we think it does justice to the people who were "X'd" out of this program, and we don't think it does damage in any way to the basic integrity of the program as it has been carried out through the years. I must, however, with your permission, turn to another subject related to this problem. It is my understanding that the Bureau of the Budget has taken the position with this committee that in order to reinstate these people, consideration should be given by the committee to the institution of a tonnage tax or a user charge. Or, putting it in a better way, let's say an application of a tonnage tax or a user charge. You will recall that last year the late Congressman Clem Miller, in his testimony before you, raised the question of the tonnage tax. I had long discussions with the Congressman on this and I have the highest regard for him and his ability. I talked with him subsequent to that testimony, however, and pointed out to him that the tonnage tax has nothing to do with this group of people whatsoever. I also testified before you last year to this effect. Because certain figures were needed and were asked for, I did provide them for the committee. But I pointed out to the committee that the tonnage tax has no relationship to these fishing boats, because they normally don't pay a tonnage tax. And to my knowledge they never have paid a tonnage tax. Now if the intent of the Bureau of the Budget is to apply a tonnage tax or user charge to these fishing-boat owners, which will be charged against the whole steamship industry, that would appear to border on the ridiculous. The matter of providing care in these hospitals is of long standing as to policy; it goes back to 1797 when John Adams signed the first law into effect in this country. There was an assumption by the U.S. Government, as expressed by the Congress, that the Government had a responsibility in the care of seamen. Seamen become a part of the fourth arm of defense in case of war. The care of these seamen also avoids the introduction in this country of plagues and all kinds of diseases, and protects the general population. For all these reasons the Congress in its wisdom, since 1797, to the present day, has maintained the position that the Government has a responsibility in this matter. This responsibility is shared. As to ocean transportation you will find that the tonnage tax has been paid over the years both by seamen and the steamship industry. Now I am going to say to this committee that we have had some difficulty with the Bureau of the Budget on this program because they seem to take the position they want to do away with all of the marine hospitals in this country. They are called Public Health Service hospitals, but it is in part the old marine hospital program. And I would hate to see this bill, which we think is a good bill, in any way affected by a position of the Bureau of the Budget, to try to tie into it something that requires a whole Congress policy change to effect. This policy of Government support to these marine hospitals, they would apparently change into something whereby you charge for every one of the services by a tonnage tax or user charge on the industry, and relieve the Government of all responsibility. That presents a bigger issue and must be taken up under different auspices than a little bill like this, which we consider a good bill. And I would dread to see the committee respond favorably to the statement of the Bureau of the Budget that tonnage taxes or user charges should be levied against these people. This is a device to achieve other broader purposes. I should dread to see the committee take that position. I thank you for giving me this time, Mr. Chairman, and I would like to answer any questions you may have. Senator BARTLETT. Well, only this one, Mr. Clark, so far as I now know: It is true that the Bureau of the Budget, in its letter received only this morning, did recommend an increase in the tonnage tax. But the letter went on to say alternatively, and preferably, that there should be an imposition of user charges. |