in Wyoming. Under the current provisions of the act, priorities established in this plan are binding on the State agency. Consequently, the health systems agency can determine State policy without any input from State officials or State agencies. I believe that this situation goes considerably beyond the intent of the law.

In the spring of 1975, I appointed a committee to look into the requirements of this new legislation. The committee was composed of consumers and providers from throughout the State. After much discussion and deliberation, they recommended to me and to the State of Wyoming that it should seek inclusion under section 1536 of the act. which would eliminate the need for a health systems agency. We were told by the Federal officials that this section applied only to Rhode Island and the territories, and that we should not waste their time and ours by pursuing that course of action. In retrospect, I regret not having insisted on the application for a waiver under section 1536.

It is not my intent to malign the good people who have worked diligently as members of the boards governing the health systems agency and the statewide health coordinating council. Under the circumstances, I think, they have done an excellent job in implementing the law in my State.

I do not question the applicability of this legislation to those States having more than one health systems agency, and I cannot speak for them.

The achievement of equal access to quality health care at a reasonable cost is a high priority in the rural States where health resources are so scarce. Thus, my concern is not with the intent of the law.

However, I sincerely believe that the single statewide health systems agency structure inherently contains the seeds of conflict between the State health planning and development agency and the health systems agency staff. My fear is that this discord will overshadow the planning efforts by these two agencies. In the end, it will be the people of Wyoming who will suffer.

My request is that you consider the factors I have presented here today during your deliberations of amendments of the act. Please, if you will, review the appropriateness of the structure and authority currently contained in the law as it is applied to States with a single health systems agency. I would hope that you might conclude that States, such as Wyoming, would be best served by inclusion under section 1536. The intent of the law will remain, but I think the sources of conflict will be resolved.

Thank you very much.

Senator KENNEDY. How do we legislate in this area, Governor? There are 14 other States which have only one HSA?

Governor HERSCHLER. I believe that is correct, sir.

Senator KENNEDY. How do we balance on these factors? Can you give us some insight? You have obviously talked to your colleagues. If they did that with regard to Wyoming, wouldn't maybe Mississippi want it as well? And, do they really have the same kind of a situation that you describe in terms of the uniqueness? And how do we maintain the balance between the local and the input, and the balance that the Governors influence as well?

Governor HERSCHLER. I am not certain that I can answer your question as to what the relationship might be between, for example, Mis

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sissippi and Wyoming. However, I think part of our explanation in making this request to you is a matter of economics.

Wyoming only has a population of about 400,000 people and it has an area of in excess of 100,000 square miles. People on these committees have to travel great distances. The travel expenses are a major consideration. For example, the health systems agency in my State has already spent about $22,000 of their $175,000 budget on travel. If we add additional people to the State health coordinating council, I suppose that would add an additional $10,000 in travel.

Another problem that I have in my State, Senator, is the fact that it is difficult to find people to serve on this type of a committee. We have many consumers and providers who are self-employed and they can't afford to spend 2 days a month in meetings. So, it seems to me that most of the providers who may be relatively financially sound, or the retired, tend to accept the appointments and I think that the remainder of those who get on the boards don't stay very long. So, we are not reaching the people I think that we should.

Senator KENNEDY. How do we do that? How can we do that better? Governor HERSCHLER. I would hope, if we were able to get 1536 status in Wyoming, that our State Health Planning and Development Agency, which is a State agency, could work together with the State health coordinating council.

Senator KENNEDY. As I say, it gets back to the other. Then what do we do? Do you know a Governor who wouldn't like to do that, whether it was New York or Wyoming? Wouldn't they all like to do that effectively? And, again, how do we try and legislate on it?

I think you pointed out a very important dilemma and we obviously we are trying to deal

Governor HERSCHLER. I would say, Senator, that we would be much better off, if you were not willing to expand the 1536 option, to give Governors the option of having two ISA's rather than one. This would probably eliminate some of the conflict because there would be a little different representation on the SHCC.

Senator KENNEDY. That, I think we should do in any event. I would be glad to work with you on the others, but this is part of our dilemma. If there is no reason a particular State ought to bear a burden in terms of national legislation, that is really the question. I think we can do the other part, in any event, on it and we will work with you. Governor HERSCHLER. Wyoming's first choice, of course, would be 1536 status. Our second choice would be to have two HSA's.

Senator SCHWEIKER. Could you draw a logical division for two HSA's in your State, Governor?

Governor HERSCHLER. I think we could, Senator Schweiker.

Senator SCHWEIKER. Were you given that opportunity, or how did the HSA get started in your State?

Governor HERSCHLER. Frankly, I don't know. We have a number of our people who are involved in this, and I am sure you are aware that this is a very complicated act. We were having problems finding out what really was going to happen under the thing and I suppose our first reaction was we could save some money that could eventually go to the people by having one agency. And I think we opted for that.

I think we made a mistake.

Senator SCHWEIKER. Following your point, what would you see as he advantage of having two? You outlined the problem you have with

the one. Suppose you did have two. How would this ease the problem? What advantage to you would there be to have two?

Governor HERSCHLER. One advantage, sir, of course, would be the travel expenses. I think we would have broader representation. We would have two HSA's. What I have done in my State, sir, was to reach an agreement under which I appointed the members of the HSA, and in the interests of economy, from the HSA I appointed the SHCC. Of course, I think I have the authority to appoint 40 percent and then 60 percent comes from the HSA.

As a result, it has created some conflict. We actually have one organization because the executive committee of the HSA sits as SHCC. If we had two HSA's, we would have broader representation on our SHCC and our executive committee.

Senator SCHWEIKER. I think you made a valid point. I am not sure quite what the answer is but it seems to me you do have a unique problem and maybe other States do too. It may be that in single State HSA's we ought to have some different procedures and relationship between the State agency and the HSA. It would eliminate some of the problems you are talking about.

I know it gets a little detailed and maybe your health commissioner, or equivalent, might want to give some consideration to that. I can see when you have a single HSA it gets to be a rather unique situation that could be unproductive. Maybe you could give us some suggestions as to how to define an HSA in a single State role differently.

Governor HERSCHLER. This might be helpful, Senator. I am sorry that I can't give you any ready answers to that.

Senator SCHWEIKER. I know it is a complex problem. I recognize that. And maybe there isn't one, but if you could have your health commissioner look at the problem and make some recommendations. I am receptive to the idea that maybe a State ought to have two IISA's, or at least if it doesn't, we ought to mandate the relationship between HSA's and the State in a different way than we do for the multi-States. Governor HERSCHLER. I think this is one of our problems because in one particular area we are getting along very well, and that is in the mental health area, where there has been a great deal of cooperation and coordination between our State agency and the HSA. But, in other areas we don't have that and I think there has been some conflict between the State agency and the ISA. If there were amendments that would create a balance, this could be helpful, Senator.

Senator SCHWEIKER, I would be glad to look at any suggestions you folks have.

Governor HERSCHLER. I am sure I could probably send you something that might be helpful to you.

Senator KENNEDY, Governor, in the drafting I believe that we would have the possibility for the two IISA's. We will review those, as a minimum, and we will take a look at any other suggestions you have.

I want to thank you very much. I want to, in the record, point out that the Governor wrote to us about 21% months ago about the planning bill generally, and it is a very thoughtful, very helpful letter. It had many, many good suggestions and we studied that and reviewed it and profited from it, Governor.

Governor HERSCHLER. Thank you very much.

Senator KENNEDY. We want to thank you for taking the time. It is the kind of valuable input that can be very, very useful to us. We profit from it and want to thank you for taking the time.

Governor HERSCHLER. Thank you, sir, and I apologize again for being late.

Senator KENNEDY. It was a good cause. Did you see Senator Schweiker down there. He was down at that prayer breakfast.

Senator SCHWEIKER. We were all praying for Jimmy Carter. The Democrats were up here. [Laughter.]

Governor HERSCHLER. I think we were all praying for each other. Thank you very much.

Senator KENNEDY. Our final witnesses this morning are a Consumer Coalition for Health panel: Herb Semmel, who is the director of the Consumer Coalition for Health (Mr. Steve Suitts, southern regional council in Atlanta, and Willie Mitchell, National Health Law program, Newnan, Ga.

Mr. Semmel, we welcome you all. Would you like to introduce everyone and then we will get started in whatever order you would like. STATEMENT OF HERBERT SEMMEL, DIRECTOR, CONSUMER COALITION FOR HEALTH, WASHINGTON, D.C., STEVE SUITTS, EXECUTIVE DIRECTOR, SOUTHERN REGIONAL COUNCIL, ATLANTA, GA., AND WILLIE MITCHELL, NATIONAL HEALTH LAW PROGRAM, NEWNAN, GA., A PANEL

Mr. SEMMEL. Thank you, Senator Kennedy and Senator Schweiker. I would like to introduce the two other persons who are with me. On my left is Mr. Willie Mitchell, who is here on behalf of the national health law program. Mr. Mitchell is a low-income, disabled resident of Coweta County, Ga., who has been a long-time activist in community affairs in Coweta County, was an elected alternate delegate to the Democratic National Convention. He is going to testify

Senator KENNEDY. We are not going to hold that against him.
Mr. SEMMEL. I hope not. [Laughter.]

Mr. Mitchell will testify about the frustrations that he has experienced in attempting to establish low-income representation on the North Central Georgia HSA, as a result of which he finally became a plaintiff in a lawsuit trying to establish that representation through the courts. He is also going to speak on the effect the lack of representation has had on perpetuating the pattern of denial of access to needed health services to low-income people and minorities.

On my right is Mr. Steve Suitts, who is the executive director of the Southern Regional Council. He will talk about a broader survey that the council made of health systems agencies in the South.

Upon completion of their statements, if there is any time left, I hope I will have an opportunity to make some suggestions as to how these problems can be handled through legislation.

Mr. Mitchell?

Mr. MITCHELL. Mr. Chairman, and members of the committee, my name is Willie P. Mitchell. I was born in Coweta County, Newnan, Ga. I am 57 years old.

I am interested in health care because I am myself a diabetic. I have a heart condition. I also have deterioration of the hips. My wife ad a stroke a year ago. She has high blood, suffers with hypertension. So, we know someting about high health costs.

I am also involved with the welfare department in Newnan, Ga., as a volunteer working in helping getting people back and forth to the doctor which, in my city, we have a clinic which hires many doctors. They do not take medicaid so, therefore, of low-income people, the poor people, some who receive $141 a month to live on-four in a family-they have to travel in the surrounding counties, Fulton, Troup, and maybe Fayette, to get medical attention. hospital

attention.

So often, I have seen in my going and carrying these poor people trying to seek medicaid, I have seen some turned away from doctors' offices. I have seen some turned away from hospitals. This became to me a great concern.

When the HSA first started organizing in the State of Georgia it sent me a letter to come to a meeting, in a letter. On that very first meeting that I went to I stood up, trying to get to ask a question, and I was refused to speak. They refused me to speak.

Later on they had two meetings in Newnan, in my home town and we had poor people there. I got some poor people together, some people that was consumer medical care. I carried them down to the meeting. And in that meeting we were to ask questions. Sometimes we was turned off so cold. It seems that they didn't want to listen.

Mr. Chairman, I am here today to tell you first-hand that I think this is one of serious bills that Congress ever come up with and as a medical poor person, I do not want to see this Congress not put some teeth in this bill that would insure poor people a say so to represent themselves in the decisionmaking process. I hope this won't happen. Also, I want to point out something else to you that HSA did. We have two hospitals in Newnan, Ga. One is Collier Young Hospital, which serves all the total community, black and white. Another one is Newnan Hospital, which only serves white people.

Newnan Hospital put in a request for renovation forms to expand. It was about $2 million-something that they applied for. Collier Young put in a request for $900,000. The HSA passed both hospitals. They passed both hospitals. Now, Mr. Chairman, if I had been sitting on that board and some more people like me, that board never would have passed that because I would have fought it to the last, for Newnan Hospital.

Senator KENNEDY. Maybe that is why you are not on it.
Mr. MITCHELL. Yes; I think so.

We go on. A representative from HEW was sitting in on the committee meeting and he said that the Newnan Hospital admits certain members of the community by tradition, when he very well knows that Newnan Hospital only admits whites. On the other hand, HEW is dragging its feet.

Mr. Chairman, I said to you today I could go into a long story about how I've been involved, how many States. I worked all across the Southeastern States in every State, small city and town. I could say a lot, but I'm not here to say that to you today. I'm here to ask this committee to don't be bought in by paperwork, to listen to what people like me who come from communities tell you because we live there, sir. We are involved every day with our problems.

When the HSA in the State of Georgia, north central, it hasn't lived up-if there's guidelines for it to go by it hasn't lived up to