To give the committee some idea as to just how liberal the requirements are for eligibility in Louisiana's medical care program under old-age assistance and medical assistance, we submit the following table of eligibility prepared by the Public Affairs Research Council.

TABLE 1.-Eligibility requirements for medical care under OAA and MAA,

age 65 or over

OAA

Residence: Must have been a resident of the State for at least 5 years during the last 9 years immediately preceding application. The last year must be on a continuous basis and must immediately precede application.

Institutional status:

1. Inmates of public institutions are not eligible.

2. Patients in TB or mental hospitals or patients in other hospitals as a result of TB or mental conditions are not eligible.

Allowable assets of client and spouse:

1. House assessed at not more than $5,000.

2. Car valued at not more than $1,250.

3. Cash or cash equivalent of $500 if single, $1,000 if married.

4. Real property (other than home property) valued at not more than $1,500 if single, $2,000 if married.

5. Business assets of not more than $1,500 whether single or married. 6. Gross income not exceeding $5,000 whether single or married if specific records are not available on which the determination of net income can be based.

7. Insurance with cash or loan value of $1,000 if single, $1,500 if married. A person is not eligible if the combined value of his resources specified in 2, 3, 4, and 5 exceed $1,500 if single or $2,500 if married.

Income: Not eligible if his income is sufficient to meet his needs. Welfare department determines if his income is sufficient.

MAA

Residence: Must be a bona fide resident of the State. A person is considered a bona fide resident if he is in the State other than on a temporary basis. Institutional status:

1. Inmates of public institutions are not eligible.

2. Patients in TB or mental hospitals or patients in other hospitals as a result of TB or mental conditions are not eligible.

Allowable assets of client and spouse:

1. One home regardless of value.

2. One car regardless of value.

3. Cash or cash equivalent of $1,000 if single, $1,500 if married.

4. Income producing property (other than a home) with an assessed value of $5,000.

5. Farm or business assets which produce income.

6. Insurance with a cash or loan value of $1,500 if single, $2,000 if married. Income for hospitalization:

1. The maximum amount allowed is $250 per month if single, $325 per month if married.

2. If a person has no cash or cash equivalent and his income is less than $90 if he is single or $140 if he is married, then he is not required to make any payment toward his hospital bill.

3. If a person has hospitalization insurance, then his allowable income increases by $15 per month if he is single, or $25 per month if he is married and both he and his wife are covered by hospitalization.

4. The maximum allowable income increases by $30 for each dependent who is under 21 years of age, unmarried and is not self-supporting. Also increases by the same amount for any person over 21, other than a spouse, who is disabled.

Income for physicians' services: '

1. Monthly income cannot exceed $125 for a single person, $175 per month for a couple.

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2. If a person has hospitalization insurance, the monthly allowable increases by $15 if single or $25 if married, provided both are covered.

3. Allowable increases by $30 per month for each dependent.

4. After the deductions, the income cannot exceed that outlined in number 1. A study of this table shows that a person can have an income, own a home, have cash in the bank, insurance, other assets and still qualify for assistance. He does not have to be a pauper, as the proponents of H.R. 3920 would have you believe.

The care provided under Louisiana's old-age assistance and medical assistance for the aged programs is comprehensive. In addition to hospitalization, the program provides for physicians' services, drugs, and home nursing care. The following public affairs research table shows in detail the extent of these services. TABLE 2.-Medical care provided under OAA and MAA

Hospitalization..--

Drugs..

ОАА

(a) Maximum of 30 days per calendar year.
Will not pay for blood, special nurse,
telephone, meals for members of the pa-
tient's family, etc.

(b) Will pay the hospital for the actual cost
not to exceed the per capita and per diem
rate agreed on by the hospital and the
welfare department of $35 per day,
whichever is less.

(c) When payment on a per diem basis does
not cover the actual cost of the patient's
stay, the hospital may arrange with a
member of the patient's family to pay
the difference.

(a) Will pay according to an established sched-
ule for eligible clients with an approved
medical plan; or for clients who receive
nursing care in their own home or in a
licensed nursing home. Will also pay
for drugs used as part of hospital care.

Physicians' services... (a) Will pay the costs of consultations and

Nursing home care....

surgery in a hospital according to a fixed
schedule.

(b) Will pay up to a maximum of 2 office or
house calls per month for eligible clients
with an approved medical plan, or who
receive nursing care in their home or in a
licensed nursing facility.

MAA

(a) Same.

(b) Same.

(c) Same.

(a) Will not pay for drugs except in nursing home cases or when used in conjunction with hospital care.

(a) Same.

(b) Same for eligible clients with an approved medical plan, or who receive care in a licensed nursing home.

(c) Will pay up to a maximum of 6 hospital (c) Same.

visits for each hospital adminission for
nonsurgical cases, not to exceed 30 hospi-
tal visits in each calendar year.

(d) Will pay for outpatient surgery, diagnostic (d) Same for eligible clients

tests and consultation for eligible clients
with an approved medical plan or who
receive nursing care in their own home
or in a licensed nursing facility.

(a) Will pay for nursing care for eligible pa-
tients in a nursing home that is licensed
and classified by the state department of
hospitals. Will pay at an established
rate provided the nursing home fee for
the welfare client does not exceed the
maximum participation rate established
for the home's classification.

with an approved medical care plan or who receive care in a licensed nursing home.

(a) Same, provided the indi

vidual meets the OAA requirements for nursing home care except for residence.

The care and services presently provided for those over 65 who need assistance is considerably more extensive and comprehensive than that proposed in H.R. 3920. The big difference in these two programs is that we are now helping those who need help, not rich and poor alike.

Louisiana has a good plan for helping the needy over 65, and those who need help are getting it. In the State's 1961-62 fiscal year, 49,728 different persons (20.9 percent of the over-65 population) received Kerr-Mills assistance under OAA and an additional 1,465 persons received Kerr-Mills assistance under MAA.

Because the Louisiana State Medical Society feels so strongly about helping the medically needy, it has given its full support to the Kerr-Mills program. The society, through its medical advisory committee to the Louisiana Department of Public Welfare (the State agency responsible for the administration of the Kerr-Mills law), has made many contributions to the successful implementation of this law in Louisiana.

The Louisiana State Medical Society approves and supports the Kerr-Mills law because it can do the job it was designed to do, and in all phases of this program freedom of choice has been maintained. The patient at all times has the right to choose the physician of his choice. The doctor has the choice of accepting a patient for treatment as well as the choice of participating in the program. Equally important, the program is conducted with a minimum of outside interference and redtape because it is administered locally.

In addition to the Kerr-Mills program, Louisiana has one of the finest and most extensive systems of public hospital systems in the United States. The State hospital budget exceeds $52 million and provides for over 14,000 free beds. Almost 5,000 of the States' 14,000 beds are devoted to general hospital care and services in 9 strategically located hospitals (see following map). The other 9,000 beds are devoted to specialized care, for example, mental, tuberculosis, and so forth. A 10th State general hospital of 200 beds will be constructed in the near future in Baton Rouge. There is hardly a person in Louisiana who lives more than 75 miles from a State general hospital and ambulance and bus services to these hospitals are provided to patients without charge.

One of the most important services provided by Louisiana's free general hospitals is extensive outpatient care. Over 950,000 outpatient services were performed by these 9 hospitals in the fiscal year July 1, 1961, to June 30, 1962. In the same period, these hospitals admitted as bed patients 112,183 persons (excluding newborns). The services provided by these hospitals are available to all citizens, including those 65 and over, meeting certain qualifications. It is estimated that approximately 10 percent of all services and admissions rendered by these hospitals were for those 65 and over.

Qualifications for admission to the State hospitals are also liberal. To qualify for admission, a person must (1) be a resident of Louisiana; (2) have a net worth not in excess of $5,000 excluding a home; (3) an income not in excess of $140 if single and $160 per month if married (approximately $20 is added to this figure for each dependent); (4) need medical care. A person may also be admitted to a State hospital if in the preceding 12 months he has spent 20 percent or more of his income for medical care and is unable to pay for private hospital services.

Besides the extensive system of State general hospitals, Louisiana operates a program in conjunction with 41 private hospitals at an annual cost of $468,000. These private hospitals provide care for acutely ill OAA and MAA patients who are too sick to be transported to State hospitals.

Many private hospitals and nursing homes are also providing low-cost care for persons over 65. In the majority of cases these patients in private institutions have a large portion of their costs (up to $165 per month) underwritten by various programs of the State welfare department.

The construction of new nursing homes for the care of the aged in Louisiana has progressed at a rapid rate since 1958. The following figures, obtained from the Louisiana Department of Hospitals, clearly show how quickly facilities of this type are being added.

Besides these facilities, the Louisiana Department of Hospitals presently has under review plans for 47 more nursing homes with a total of approximately 3,000 additional beds.

Mr. Winborn E. Davis, director of the Louisiana State Department of Hospitals, estimates that Louisiana has a need for 9,864 nursing home beds and that this need will be met within 3 years if the present rate of construction continues.

We feel it is significant that the need for nursing home facilities in Louisiana is being met and that this need is being met by private enterprise. Of the 43 nursing homes constructed since 1958, only 2 have been built with State funds. In recent years the number of people 65 and over covered by some form of private health insurance has shown a tremendous increase. According to the latest available figures, 85.6 percent1 of the Louisiana population 65 and over not covered under the Kerr-Mills law have some form of private health and/or hospitalization insurance.

Aged population, 243,000; institutionalized, 4,547; Kerr-Mills eligible, 126,000; privately insured,' 94,344.

Besides private health insurance policies, many persons 65 and over are covered by the nonprofit Blue Cross plans. The two Blue Cross plans operating in Louisiana presently cover 24,162 (14,678 by the Hospital Service Association of New Orleans and 9,484 by the Louisiana Hospital Service of Baton Rouge).

We believe a complete study of all information available on the financial health resources of those 65 and over will show :

1. The majority of those 65 and over are able to meet the cost of their health

care.

2. More and more in this age bracket are buying, and should be encouraged to buy, private insurance protection.

3. The Kerr-Mills law provides the means of helping those who do not have insurance or the means to meet their needs.

The Louisiana State Medical Society has carefully studied the contents of H.R. 3920. In the opinion of our members it is not legislation which would be in the interest of the public.

1 Health Insurance Council estimates of Dec. 31, 1961.