services. In other words, meet the criteria, the financial criteria and other criteria that is established. Mr. ABERNETHY. Let's say an ambulance picks up a person that has been hit by an automobile, and they brought him in to Sibley Hospital. Dr. GRANT. Sibley Hospital is one of the hospitals with which we do not have a contractural arrangement. Mr. ABERNETHY. What about Doctors Hospital? Do you have one at Doctors? Dr. GRANT. No, sir. Mr. ABERNETHY. Georgetown? Dr. GRANT. Yes, sir. Mr. ABERNETHY. All right. The ambulance picks up a person hit by an automobile. They carry him in to Doctors. What do they do then? Dr. GRANT. At Doctors? Mr. ABERNETHY. Yes, sir. Dr. GRANT. I assume, Mr. Abernethy Mr. ABERNETHY. He gets attention if he pays the bill. Dr. GRANT. I assume so, Mr. Abernethy. I assume so; or what they may do, if it is a public case Mr. ABERNETHY. I am not knocking Doctors, particularly, I am just trying to find out how this thing operates. Dr. GRANT. If it is a public case, they may turn around and transfer him. Mr. ABERNETHY. How do they know it is a public case? Dr. GRANT. I am not sure they do. Mr. ABERNETHY. The patient is unable to speak. He is hurt. He is dying, maybe. Dr. GRANT. There may be someone with him that can supply that information. Mr. ABERNETHY. Suppose they go to Georgetown. Dr. GRANT. Yes, sir. In Georgetown Mr. ABERNETHY. They take him right on in; treat him, then send you the bill? Dr. GRANT. That is correct. That is exactly correct. Mr. ABERNETHY. Well, do they make any effort to collect themselves, first, or do they just treat every case that comes in as an emergency and bill the Public Health Service? Dr. GRANT. No, sir. They would make an effort to collect themselves. We would only receive the bill if they were not able to collect the payment themselves. Mr. ABERNETHY. I see. What percentage of these cases go to D.C. Dr. GRANT. I don't know the exact percentage, Mr. Abernethy. Dr. GRANT. It is a very large number. Let me just think for a moment. It is very difficult to give you the percentage, Mr. Chairman. Mr. ABERNETHY. Would you say as many go to D.C. General as go to all the others combined? Dr. GRANT. I would guess so, Mr. Abernethy. Certainly the public cases, yes. Mr. ABERNETHY. What does this public medicine cost the District annually? 1 Dr. GRANT. At the present time, it is around $40 million. Mr. ABERNETHY. And you are administering to how many people? Dr. GRANT. 260,000 people. Mr. ABERNETHY. I cannot figure that fast. How much is that per capita? Per patient? I believe it is on this chart, isn't it? Mr. DowDY. It is on the chart at 33 million. It would be $205 a patient but if it is $40 some million, it would be more. Mr. ABERNETHY. That is $205 for public medicine per patient, is that right? Dr. GRANT. Per year, yes, sir. Mr. ABERNETHY. Per year. That is 260,000 people, is that right? Dr. GRANT. Yes, sir. Mr. ABERNETHY. This is about a third-That is better than a third of the District of Columbia. Dr. GRANT. Yes, sir. Approximately. Mr. ABERNETHY. There are an awful lot of poor folks in this rich town. Dr. GRANT. Yes, sir. Mr. ABERNETHY. I think you are administering to too many. I really do. I just don't see how it could be possible. Did you make any effort to cut this down? Do you think it could be cut down, this quantity of free medicine? Dr. GRANT. I don't know how to do it, Mr. Abernethy. These are individuals who meet the financial criteria that have been established and we have to follow the criteria that have been established. Mr. ABERNETHY. And is that the criteria-that everyone who earns less than $3,360 a year Dr. GRANT. For a family of four. Mr. ABERNETHY. For a family of four, except the emergency cases? Dr. GRANT. That is correct. There are some other criteria, too. Mr. ABERNETHY. 100,000 of those annually. Dr. GRANT. There are 160,000 of those. Mr. ABERNETHY. 160,000? Dr. GRANT. Yes, sir. Let me clarify that. I am sorry, Mr. Abernethy. There are 160,000 Mr. ABERNETHY. Who meet the criteria? Dr. GRANT. Yes, sir; and, in addition, 100,000 emergency, yes, sir. Mr. ABERNETHY. I tell you, I don't see how you can get along with just 67 more doctors that you are calling for here. they need 167. You need more, don't you? Dr. GRANT. Yes sir. It seems to me Mr. DOWDY. In reading some of the estimates here, I note you mention that there are 160,000 eligible people that you care for the year round in medical health care cases. Dr. GRANT. Yes, sir. Mr. DOWDY. There is another 100,000 who are not eligible but you pay the bills anyway. Dr. GRANT. Only if they come to us in emergency. Mr. Dowdy. Well, there are 100,000 of them. Dr. GRANT. Yes, sir. Mr. DowDY. Now, that is 260,000. There is a note here that the D.C. Commissioners, on the 22nd day of May of last year, estimated that there were 330,000. That is 70 additional thousand who are eligible to receive medical care and services, if we enact this Bill. Dr. GRANT. Yes, sir, Mr. Chairman. Mr. DOWDY. So, in other words, you are trying to dig up some more clients that have not even asked for it, is that it? Dr. GRANT. Mr. Chairman, those estimates of 334,000 were the early estimates that we made which we have since revised and the 260,000. figure we believe to be much more accurate. Mr. Dowdy. I notice in this information I have here, estimates regarding the District of Columbia qualifying under Title XVIII and XIX Social Security benefits. That is just four years from now. It is the purpose and intent to raise the income level to $4,780.00. Anybody making less than that is eligible for free health service. Dr. GRANT. Yes, sir. Mr. DOWDY. And that you will then have approximately 260,000 persons eligible. How many of these additional "emergency cases" would you expect? Would you expect 100,000? Dr. GRANT. No. What would happen Mr. DOWDY. Is that going to be increased, too? Dr. GRANT. No, sir. What would happen, if you raise the eligibility level for a family of four to the $4,700 figure, it would take care, on a routine basis, of all of these 260,000 people we have been talking about. Mr. ABERNETHY. Will the Chairman yield? Mr. DOWDY. Yes. Mr. ABERNETHY. The Chairman has a reference here which says: "The D.C. Commissioners in 1966 estimated that 330,000 persons or 40 percent of the District population are eligible to receive medical care under the 1965 Act if this legislation is enacted." Now, that means that 60 percent of the people of the District of Columbia would be taking care of 40 percent, those eligible under the Medical Care Bill. Mr. DOWDY. That refers to the Commissioners recommendation for identical legislation, made to the Speaker under date of May 27, 1966, which will be made a part of the record at this point. (The letter referred to follows:) GOVERNMENT OF THE DISTRICT OF COLUMBIA, The Honorable THE SPEAKER, EXECUTIVE OFFICE, Washington, May 27, 1966. MY DEAR MR. SPEAKER: The Commissioners of the District of Columbia have the honor to submit herewith a bill "To enable the District of Columbia to participate in the health and medical assistance benefits made available by the Social Security Amendments of 1965, and for other purposes." The purpose of the bill is to authorize the Commissioners to take such action and to promulgate such regulations as may be necessary or required to permit District of Columbia hospitals and other medical facilities to provide health and medical care and services to eligible aged individuals under the hospital insurance benefits program and the supplementary medical insurance benefits program established by title XVIII of the Social Security Act, and to furnish medical assistance to eligible residents of the District of Columbia under the program established by title XIX of such Act, as added by the Social Security Amendments of 1965 (79 Stat. 286; Public Law 89-97). The Social Security Amendments of 1935 contain health legislation which has a very significant impact on the District of Columbia government and particu- larly upon its Department of Public Health. The statute makes it possible to greatly broaden the scope and to improve the quality of the health and medical services which are available to individuals in the District, particularly to those persons whose ability to obtain adequate medical care is impeded by the inadequacy of their finances. Depending upon the scope and content of the programs which the District might be able to establish pursuant to provisions of the Act, it is estimated that 40 percent of the District's population, or more than 330,000 persons, stand to receive care and services thereby. Under the proposed legislation, the District of Columbia could receive during the first full year of operation an estimated $4,000,000 in Federal reimbursements, in addition to approximately $2,000,000 currently being received under the existing Old Age Medical Care and Medical Assistance to the Aged programs (Federal participation in which will terminate with respect to any period after December 31, 1969). With the enactment of the bill, the District's program under title XIX would absorb these ongoing OAMC-MAA programs, and their benefits would thus be continuted after December 31, 1969. The District Government will use reimbursements received under title XIX to further improve District health and medical services. Present indications are that the implementation of titles XVIII and XIX in the District of Columbia will not require any supplemental appropriation in Fiscal Year 1967. The Commissioners believe it highly advantageous to the District government and its citizens that they realize the liberalized benefits of the expanded health and medical programs provided by titles XVIII and XIX of the Social Security Act, and they strongly recommend the enactment of this legislation during this session of the Congress. The Commissioners have been advised by the Bureau of the Budget that, from the standpoint of the Administration's program, there is no objection to the submission of this legislation to the Congress. Sincerely yours, (Attachment.) /s/ WALTER N. TOBRINER, President, Board of Commissioners, D.C. A BILL To enable the District of Columbia to participate in the health and medical assistance benefits made available by the Social Security Amendments of 1965, and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the Board of Commissioners of the District of Columbia is hereby authorized, within available appropriations and allotted funds, to take such action and to promulgate such rules and regulations as may be necessary to permit District of Columbia participation in, and to secure for the District of Columbia the health and medical assistance benefits made available by, titles XVIII and XIX of the Social Security Act, as amended, notwithstanding any other provision of law establishing (1) a durational residency requirement, (2) a means test, (3) per diem or other periodic rates for the inpatient or outpatient care or treatment of the medically needy (by which term is meant those whose income and resources are insufficient to meet the cost of necessary medical services), or (4) the financial responsibility of relatives of the medically needy, for persons provided health and medical care and treatment by or at the expense of the District of Columbia. Commissioner DUNCAN. Mr. Abernethy, the Commissioner's report that the Chairman incorporated in the record, dated March 10, 1967, contains the figure of 217,000. This is the document to which I referred and the figure upon which I relied. It may well be that the Health Department officials can explain the difference between the figure we used a year ago and the figure today. I believe that they are saying, in effect, they are in a better position to give an estimate of the actual number at this date than they were last year about this time. Dr. GRANT. That is correct, Mr. Abernethy. Mr. ABERNETHY. I don't know what is correct. I thought he said you were giving the explanation. Commissioner DUNCAN. Might I say this also, Mr. Abernethy. My effort was to encourage Dr. Grant to go through the further data which he has in a formal statement which he hopes to present here this morning. I think that conceivably, some of your questions may be answered by his statement if he would read that statement to the Committee. Mr. DOWDY. All right. You may proceed, Dr. Grant. STATEMENT OF DR. MURRAY GRANT, DIRECTOR, DEPARTMENT OF PUBLIC HEALTH, DISTRICT OF COLUMBIA; ACCOMPANIED BY DR. REINALDO FERRER, ASSOCIATE DIRECTOR, AND GEORGE HALSTEAD, ASSISTANT Dr. GRANT. Mr. Chairman, I would like to introduce the other two gentlemen with me. Dr. Reinaldo Ferrer, Associate Director, and Mr. George Halstead, who is his Assistant. Mr. Chairman, the medical assistance program as operated by the Department of Public Health for the people of the District of Columbia has long left much to be desired in both the efficacy and economy of its operation. Public recognition of some of the deficiencies of this program was given in my testimony before the Subcommittees of the Committees on Appropriations [Hearings, United States SenateVol. III, pp 2593-2596-and in the House of Representatives, pp 532535]-during the hearings on the District of Columbia Appropriations for 1964. Subsequent to the making of this statement, we have continued to study this problem. The results of these studies and of our more recent deliberations regarding the potential effects of P.L. 89-97-the Medicare Law-have been conclusively substantiated by previously stated opinions. In summary, we have found that although some 160,000 persons in the District of Columbia are eligible for medical care at public expense under our existing programs, a target population equivalent to nearly 260,000 is actually receiving care, with 100,000 of these being treated only as "Medical emergencies." These "Medical emergencies" at best have only marginal ability to finance their own medical expense. However, because of the fact that their illnesses were not treated until they became emergencies, their hospital stays were longer and more expensive than the average and many of these persons found their way to the Welfare rolls either during or after their illness. These facts, coupled with other shortcomings, such as an ineffective and cumbersome eligibility determination program and the difficulties we have had in fully capturing partial payments which may have been available to pay for the medical care being provided to persons by the Department of Public Health, have led us to the conclusion that extensive changes should be made. Furthermore, it was deduced that a substantial portion of the needed changes could be accomplished with no additional over-all cost to the District of Columbia. As a result of these conclusions, recommendations were evolved to provide a methodology for effecting the needed changes in the medical assistance program. The formulation of these recommendations happened to coincide, in time, with the enactment of P.L. 89-97. Re view of this new law revealed that our recommendations had the result of producing a program closely paralleling the requirements of Title XIX of that law. Even more importantly, Title XIX provides a source of funding capable of financing needed improvements in the program which the District of Columbia would be otherwise hard put to accomplish. |