94th Congress, 1st Session Senate Docoinent No. 94 92

VETOING S. 66, PUBLIC HEALTH SERVICES ACT

MESSAGE

FROM

THE PRESIDENT OF THE UNITED STATES RETURNING

WITHOUT MY APPROVAL, S. 66, A BILL TO AMEND THE

PUBLIC HEALTH SERVICE ACT TO PROVIDE SUPPORT FOR

HEALTH SERVICES, NURSE TRAINING, AND THE NATIONAL

HEALTH SERVICE CORPS PROGRAM

JULY 26 (legislative day, JULY 21), 1975.-Read and ordered to be printed

57-0110

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON ! 1975

94th Congress, 1st Session Senate Document No. 94-92
To the Senate of the United States:

I am today returning, without my approval, S. 66, a bill to amend

the Public Health Service Act to provide support for health services, nurse training, and the National Health Service Corps program.

This bill is very similar to two separate bills which I disapproved

during the last session of the 93rd Congress, H.R. 14214 and H.R.

17085. In my memorandums of disapproval, dated December 23, 1974,

and January 3, 1975, respectively, I cited a number of reasons why 1

could not approve those bills. Those objections remain valid for the

measure before me today.

As in last year's bills S. 66 would authorize excessive appropriation levels. I realize that in considering the bill this year, the 94th

Congress made some reductions in the total cost of the measure. However, the levels authorized are still far in excess of the amounts we can afford for these programs. The bill would authorize almost

$550 million above my fiscal year 1976 budget request for the programs

involved, and it exceeds fiscal year 1977 levels by approximately the same amount resulting in a total increase of $1.1 billion. At a time

when the overall Federal deficit is estimated at $60 billion, proposed

authorization levels such as these cannot be tolerated.

When I signed the Tax Reduction Act of 1975, I pledged to do

everything in my power to keep this year's deficit from exceeding $60

billion and to restrain the longer-run growth in Federal spending. I

stated that I would resist every attempt by the Congress to add to that deficit. Bills currently being considered by the Congress would

add $25 billion to the fiscal year 1976 deficit and $45 billion to next year's deficit. If they were to become law, they would lock us into a permanent policy of excessive spending and make the Federal budget a primary cause of inflation for years to come. To avoid this, I have no choice but to veto these bills if the Congress insists upon sending

them to me. Apart from its excessive authorization level, S. 66 is unsound from a program standpoint. In the area of health services, for example, the

bill proposes extension and expansion of Community Mental Health

Centers projects which have been adequately demonstrated and should now be absorbed by the regular health services delivery system. S. 66

also would continue and expand such separate categorical programs as Community Health Centers and Migrant Health Centers. In addition, it would authorize several new narrow categorical, and potentially costly programs which duplicate existing authorities, including

$30 million for the treatment of hypertension, $17 million for rape

prevention and control, $10 million for home health service demonstration agencies, and $16 million for hemophilia treatment and blood

separation centers. Three new national commissions on specific diseases

also would be established. The expansion of the Federal role in health

services delivery through such narrow categorical programs is not consistent with development of an integrated, flexible health service

delivery system.

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The Administration repeatedly and vigorously has opposed measures such as S. 66 and urged passage of a more effective and more equitable approach to Federal assistance for health services. H.R. 4819

and S. 1203, which reflect our proposals, would consolidate various

separate programs into the flexible project grant authority of the

Public Health Service Act to allow funding of a wide variety of health

services projects based on State and local needs. Moreover, such programs would be for demonstration purposes. Once a new service

model has been adequately tested, its adoption into the delivery of

services can-and should-be the primary responsibility of the private sector and State and local governments.

The Federal role in overcoming barriers to needed health care should emphasize health care financing programs-such as Medicare

and Medicaid for which spending is estimated at $22 billion this year. These programs establish specified eligibility and benefits standards

and provide assistance generally available to those most in need, such as the poor and the aged, S. 66, on the other hand, would have the

Federal Government select individual communities and groups for

special funding assistance. In my view, this is clearly an inequitable approach to health problems and an unwise attempt to substitute judg- ments made in Washington for those of responsible persons in State

and local governments and the private sector. In extending the registered nurse training authorities, S. 66 inap- propriately proposes continuation of large amounts of capitation and

construction support. These support mechanisms have outlived their

usefulness. They were introduced to stimulate nursing schools to educate more general-duty nurses because of an overall shortage. The

schools responded, with enrollments in baccalaureate and associate

degree programs rising by more than 90 percent during the period 1070-74. As a result, with no further Federal stimulation, we can expect the supply of active registered nurses to increase by more than

50 percent during this decade.

With these increases, the employment market for general duty nurses already is tightening in some areas. As early as January, 1973, the American Nurses' Association stated that ". . . it appears that the

shortage of staff nurses is disappearing." Our failure to limit growth now could result in our training an excess number of nurses, creating the same kind of oversupply that has left thousands of elementary and secondary school teachers disillusioned with the lack of teaching

opportunities.

The general nursing student assistance provisions contained in this

bill are largely duplicative of existing undergraduate student aid

programs offered by the Office of Education, and represent just one more unnecessary categorical program. The bill also fails to shift emphasis in any meaningful way from

problems of aggregate supply shortages to the problem of geographic maldistribution, which is reflected in very substantial intra- and

inter-State differentials in nurse-to-population ratios.

S. 66 continues to treat nurse training separately from the other

health professions. The Congress is now considering various measures for Federal support for education in other health professions. Nurse

training should be considered as part of that debate to interrelate

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health manpower education programs rather than to perpetuate a

fragmented Federal health professions policy.

Finally, S. 66 provides for a one-year extension of the National

Health Service Corps. I support this fine program, and the Administration has submitted legislation to the Congress for its extension. I

believe, however, that the authorization level proposed in S. 66 of $30

million for fiscal year 1976 is excessive.

Good health care and the availability of health personnel to administer that care are obviously of great importance. I share with

the Congress the desire to improve the Nation's health care. I am

convinced that legislation can be devised to accomplish our common objectives which does not adversely affect our efforts to restrain the

budget or inappropriately structure our health care system. I urge

the Congress to pass such legislation, using the bills I have endorsed

as the starting point in such deliberations.

GxALD R. FORD.

Tar WHrrE HOUSE, July 26, 1975.

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