Is the Governing Body self-perpetuating? No The Utah HSA is a public regional planning body created by state statute. It has a Governing Board which is appointed by the Governor and confirmed by the State Senate. The Governing Board, which is composed of a majority of elected officials, appoints the governing body (Health Planning Council). Senator KENNEDY. It has been very, very interesting and very constructive. I am a firm believer, if we are able to get these HSA's the way they should be in terms of the consumer, what that can mean in terms of the whole range of health care issues, health insurance and all the rest, are really going to be built upon these kinds of successes, and if we get off on the wrong foot on this we are going to be right back where we are, so this is terribly important. I think it is absolutely essential, so we will work with you. We have got to deal with it. It is one of the very, very important parts of the whole program. I thank you all for your testimony. We look forward. Our doors are open and we keep counting on them. We look forward to a responsible response. Thank you very much. The subcommittee stands in recess till 9:30 tomorrow. [Whereupon, at 12:52 a.m. the subcommittee recessed, to reconvene at 9:30 a.m., Friday, February 3, 1978.] HEALTH PLANNING AMENDMENTS OF 1978 FRIDAY, FEBRUARY 3, 1978 U.S. SENATE, SUBCOMMITTEE ON HEALTH AND SCIENTIFIC RESEARCH Washington, D.C. The subcommittee met at 9 a.m., in room 1318, Dirksen Senate Office Building, Senator Richard S. Schweiker presiding pro tempore. Present: Senator Schweiker. Also present: Stuart Shapiro, M.D., professional staff member, Robert Wenger, J.D. counsel, David Winston, professional staff member, Polly Gault, professional staff member. Senator SCHWEIKER. The Senate Subcommittee on Health and Scientific Research will please come to order. Today marks the second day of hearings by the Health Subcommittee on S. 2410, the Health Planning Amendments of 1978. Yesterday we heard from a number of interesting witnesses, and our schedule today is also full with groups representing many different points of view. I have the pleasure of chairing today's hearings as Senator Kennedy has been unavoidably called elsewhere. I look forward to exploring with all of the witnesses their proposals as to how we can make the National Health Planning and Resources Development Act more effective in national planning, and more successful in accomplishing the dual goals of cost containment and accessibility of quality health care. I would like to make one observation before we begin. Yesterday's witnesses spent most of their time discussing possible amendments of Public Law 93-641. S. 2410, the legislation Senators Kennedy, Javits. Williams, Chafee and I introduced as amendments to the National Health Planning and Resources Development Act, has not, as yet. been discussed in any detail. The members of this subcommittee devoted a great deal of time and effort to develop this legislation, and we would appreciate some detailed reaction to it. This is particularly critical in light of the fact that S. 2410 will be the legislation which comes before this subcommittee and the full Human Resources Committee for consideration. Of course, all of the testimony we have received so far will be helpful. However, it would be beneficial to everyone's interests if, in preparing testimony, some reaction to S. 2410 were included. We would like to begin by calling our first witness today, the Honorable Terrance L. Pitts, supervisor, Milwaukee County, Wis., for the National Association of Counties. Mr. Pitts, would you please come forward? STATEMENT OF HON. TERRANCE PITTS, SUPERVISOR, MILWAUKEE COUNTY, WIS., ON BEHALF OF THE NATIONAL ASSOCIATION OF COUNTIES, ACCOMPANIED BY MIKE GEMMELL, NACO ASSOCIATE DIRECTOR FOR HEALTH AND EDUCATION Mr. PITTS. My name is Terrance Pitts. I am a supervisor for Milwaukee County, Wis. I am also chairman of its health and education policy steering committee, and I am also a member of the National Association of Counties. With me is Mike Gemmell, the associate director for health and education for the National Association of Counties. In the interest of time, Mr. Chairman, we are submitting for the record a detailed statement of our proposed amendments to the National Health Planning and Resources Development Act. I shall confine my remarks to our major concerns. The National Association of Counties is strongly in support of a truly local health planning system. These agencies, we believe, should play a key role in the containment of costs and the implementation of a national health financing system. They must also provide the stimulus for providing services in underserved areas and encourage the kind of public health and prevention activities which offer the greatest potential for long-term improvement in health status. However, planning in general and health planning in particular are intensely political activities. It is the process by which scarce resources are allocated-the classic definition of politics. As such, the process of planning is far more than the mere development of technically competent plans, reports and analyses. Of at least equal importance is the development of a broad based community support for the process and for the specific policies which are embodied in the health systems plan and annual implementation plan. Without broad public support, neither public nor private HSA's can withstand the political pressure which inevitably will result from policies aimed at making the health care system more efficient and effective. There is clearly no large constituency now in existence for restricting the health care system. The some 50,000 responses to the recently issued national guidelines for health planning make this absence abundantly clear. If this constituency is to evolve, it must be developed at the local level-and the HSA's are critically important participants. These local agencies must be credible and have the understanding and, hopefully, the support of all segments of the community which have an interest in improving the efficiency and effectiveness of the health care system. Our concern is that elected officials and other major groups are alienated from the health planning process. Their alienation is caused by the structure and processes of many HSAs which are established to avoid the significant and meaningful involvement of the local official and other major consumer and provider groups. Yet, their involvement and political support are critical for the successful implementation of the plans and policies of the HSA. The amendments we are pronosing are based, in part, on intensive on-site studies of some 12 HSAs around the country. They focus on assuring that elected officials and other major consumer and provider groups have a meaningful-as opposed to token-participation in the health planning process. While these changes will not assure community support, they will remove one of the major factors disintegrating such support. First, we believe that the public regional planning body, joint powers agency or unit of local government which is an HSA should have the authority to approve the major policy documents of the agency, as well as the budget. It should have the authority to set the rules and regulations of the agency and appoint the governing body for health planning. Presently, after the governing body is appointed, the HSA governing board has nothing to do-yet, it is responsible for the policies which are incorporated in the HSP and AIP. S. 2410 gives the governing board of the HSA the power to appoint the governing body for health planning and approve the agency's budget. Budget control, we think, is critical, and we fully support the inclusion of this provision. However, if the governing board is to be truly accountable, and if the public agency is to play a truly meaningful role, then it must have the power to approve the HSP and AIP, the criteria for project, institutional and appropriateness review, set the operating rules and regulations for the agency, and act as an appeal board for decisions made by the governing body for health planning. A second major concern relates to the closed, often self-perpetuating nature of many HSA's. The present law allows a subcommittee of the existing governing body to choose new members of the body. In addition, it allows virtually any member of a group to represent that group. Therefore, any minority member can be deemed to represent minorities, any elderly person can represent elderly, and so on. The problem of elected officials is particularly difficult. A public health nurse, a faculty member from a public community college in health sciences, or even the coroner can be considered a public official representing the city or county. A study of the first 136 HSA's showed that only 9 percent were local elected officials. An additional problem, relatively unique to elected officials, relates to the need to clarify all governing body members as consumers or providers. Many elected officials are classified as providers solely because the county board also serves as the county health board, board of trustees of the county home or hospital, or sponsors of funds programs providing county alcohol, drug abuse or mental health services. However, elected officials are not providers as the act contemplated. They are public officials who represent the public-both consumers and providers. While S. 2410 prohibits the selection of new members of the governing body by the existing governing body or a subcommittee of it, we believe that the bill should go further. Because of their significant role in the provision of health care, their role in paying for health care, particularly medicaid, and because they can show a direct constituency relationship to all segments of the community, we believe that one-third of the seats on an HSA governing body should be reserved for local elected officials or their designees from units of local government with substantial health interests. We believe that elected officials should be identified as a separate category from consumers or providers. |