« PrécédentContinuer »
Social Welfare, and I know what both sides of the means-test areboth the people coming in and how you apply it, and it is a tough job.
If you go down this means-test road, you are going to have to ask every older person what their income is. You are not going to automatically be able to exempt and tell a person coming into a senior center program or a nutrition program that you are below the poverty line, or 185 percent below the poverty line, or 200 percent. You are going to have to ask that person, and once you go down that road, you are going to evolve very quickly into a full-blown means-tested program. It will happen very quickly, Mr. Martinez, if you make that decision, if the Congress makes that decision.
Chairman MARTINEZ. Thank you, Mr. Bechill. I agree with you. Chairman ROYBAL. Mr. Fawell. Mr. FAWELL. Thank you, Mr. Chairman. I very much respect your views, Mr. Bechill. When you refer to cost-sharing, and for purposes of my comments I am limiting it to in-home care, I think you are absolutely correct in some respects. I think you will find most of the 36 states that are involved in cost sharing are doing so in the area of long-term care. I agree with you too that there is pressure there, and we all, as members of Congress, recognize the plight that we face.
Both my mother and my mother-in-law are now in nursing homes and over 90 each, and it is because everybody is living longer. It is a whole new world. A baby born at the turn of the last century had a longevity of 47 years. At the turn of the next century, which is just a few years away, they say it is going to be 91; so it is a growing problem, and I think this probably does explain why the states are bolting from the Older Americans Act, and I would tend to think it is probably going to continue whether we like it or not.
But I don't have quite as strong a feeling as you have in reference to this being a welfare program. I have seen it work in Illinois, and it is accepted by everyone, and there is no evidence at all that people think of it that way, nor that there are any problems in regard to a lesser percentage of low-income minorities being served. In fact, what data they have, and I respect too your views that there isn't much data suggesting that there is a greater percentage of low-income minorities and so they are accomplishing the basic purposes.
But unlike a welfare program, nobody is turned down because of lack of funds, and everyone can gain those services too which is not true in the ordinary welfare program. You must combine that with the fact that we are already using Federal funds under Title XX and wherever we can get them and 36 states are seemingly comfortable using cost-sharing, and that includes, I gather, California too, there is a state program, and it is operated by voluntary disclosures. If they are doing their job well, they know who is eligible because they have got to advise people on, “Are you eligible for Medicaid? Are you eligible for food stamps?"--all of the low-income programs so they must make some kind of hopefully, non-invasive questioning.
And so combining all of that together with the realistic knowledge that this year as we look at that budget, I tend to support an
increased authorization. I am not so sure that our counterparts in appropriations will be able to match that, and I don't like to see the senior programs going all which ways not under the Older Americans Act.
I personally would favor the idea of cost-sharing being limited strictly to the in-home care. If it had to come, would you agree that that would be the area that would at least in your view bring about the least amount of damage?
Mr. BECHILL. Congressman Fawell, I respect you very much.
Mr. FAWELL. —even though everybody can, I mean, a millionaire can get the services,
Mr. BECHILL. Fine.
Mr. BECHILL. Voluntary contributions I have always respected. We have always encouraged. I don't object to millionaires participating in the Older Americans Act program. This is a universal program.
Mr. FAWELL. Uh-huh. I thank you. I just wanted to—I am sorry, my time is up so—but I appreciate all of the testimony, and the testimony on the data is,
Mr. ROYBAL. All right. Mr. Barrett.
Mr. BARRETT. Thank you, Mr. Chairman. Mr. Bechill, I too respect your many, many years of experience, and you have probably answered my question. I was going to-you and I perhaps have a different idea regarding the concept of cost-sharing. Did you or did you not say that you would support voluntary cost-sharing?
Mr. BECHILL. I have done that on occasion. We have it in the Act at the moment insofar as the nutrition program is concerned.
Mr. BARRETT. Okay. But you are adamantly opposed-
Mr. BECHILL. —on the mandatory-administration of a mandatory program-let me pose a hypothetical situation to you. What if someone came into a senior center and had—wasn't a millionaire but had, say, the income that was twice or three times what the standard had been set, and that person looked the senior center director in the eye and said, “I don't want to pay,” are we going to in this program, I mean, that is what you get into in a mandatory program because if you don't pay, you will not be permitted to participate.
It is that kind of—those kinds of decisions. They look absurd at first, but they are not. You are going to be making judgment calls, and you won't be able to exempt any person from that kind of consideration.
ment insofar. But you mandatory, e
* 995 SESSIBËŽE ESTE ESE
Now, in a voluntary program I think it is handled quite differently. It is made clear that it is voluntary. It is interpreted to the person that it is voluntary, and let me tell you even with voluntary types of contributions you can get into a situation where you can get people walking away from the program.
I wish you could invite a former director of a very large senior center in the City of Baltimore, the Waxter Multipurpose Senior Center, well-known, nationally recognized. When they introduced even a voluntary monthly due program, they lost some membership, not so much on the basis perhaps of stigma but just on the basis of, "I can't afford to put in another $5 or $10 a month," and there are all sorts of things that happen once you go-administratively, once you go down this road of mandating cost-sharing.
I realize where the pressures are coming from. I don't think this is the way to resolve those pressures.
Mr. BARRETT. Then it is safe to say those who want to pay should be allowed to pay? Mr. BECHILL. Yes.
Mr. BARRETT. Thank you. Mr. Mangano, may I go back to the question or two that I asked Dr. Berry? If you would elaborate perhaps on the study mentioned in your testimony on the eight states where some form of cost-sharing is allowed and where you found that nearly 90 percent of the recipients interviewed said it was fair to pay something. In fact, over 90 percent said that the services they received are worth what they paid for them. I asked Dr. Berry if anyone complained about paying too much or even too little in your report?
Mr. MANGANO. No. Quite to the contrary, most of the seniors said the process that they went through to even determine what they would pay they felt was very fair because it was based on selfdeclaration from the individual, and the use of sliding fee scales. The seniors as well as staff persons there told us that there were some instances where people, even though they fit the sliding fee scale and should have been paying something, did not feel they could, and there were considerations made that even went beyond economic into the social area.
Mr. BARRETT. But I asked Dr. Berry about sliding fee scales, and I think your testimony speaks to that as well. What about the question I asked about more Title III programs, specifically nutrition? Would this encourage or discourage, in your opinion, from the study that was made?
Mr. MANGANO. We did ask them if it should be extended into other areas. Three of the areas that they did mention were transportation, in-home meals, and legal services as being good candidates for other services that could have cost-sharing.
Mr. BARRETT. But nothing about nutrition specifically? Mr. MANGANO. In-home mealsMr. BARRETT, Okay. Mr. MANGANO. --but not-the community meals was not, the service centers was not mentioned. Mr. BARRETT. Thank you, sir. Thank you, Mr. Chairman. Chairman ROYBAL. Thank you. Mr. Martinez. Chairman MARTINEZ. Thank you, Mr. Chairman. I have one last question that I wanted to ask, but before I ask that question, I feel
I have got to comment on some of the statements that were made here previous.
In the first place, you know, a millionaire is not going to go to one of these programs only unless they do it on a lark, and if a millionaire goes to one of these programs and he would say, “I don't want to pay,” in all probability when he saw what was going on there, if he were any kind of a person or human being he would probably contribute a lot of money to it more than just what the average person would contribute, and I am likened to the situation with Eddie Cantor. When Eddie Cantor said when they asked him why he went for Social Security, he said, “Because I paid in. It was a contract made between me and the government,” and that is a whole different situation, and even there he was entitled. It is entitlement.
I would ask the people that feel there should be cost-sharing, then you want to make this entitlement, and I guarantee you you will say, no, you don't want to make it an entitlement so, you know, we are back to the idea that people who are saying things when they are being interviewed, people that are saying things when they are being interviewed are not always completely honest, and let me tell you something.
If you are asking me about my personal life, do you think I am going to make you-looks less to you than I want to look in your eyes? And I am not going to admit the things with especially somebody that I feel is a government official or somebody that is trying to compile information that might make me look bad and say, “Do you want to pay at all?" and I say, “No, I don't want to pay at all.” They will say, “Sure, I want to pay." I don't know of anybody that doesn't want to have a little dignity and pride, and that is the whole idea of the program. It is to provide that dignity and pride for people, but you start asking questions about their personal income, and they are not going to be completely honest with you and a lot of times not because they have more than they should but a lot of times because they have less than they should. They just don't want to be that downtrodden, here-with-my-hand-out kind of person, and that is very true.
And I think that when we start looking at exaggerations of situations like a millionaire coming to this program, that is a complete exaggeration, and it isn't going to happen except and unless there was a very, very cheap millionaire, and I imagine there might be one or two around that would, you know, go and take advantage of something that was really designed for someone else just simply because they wanted to take advantage, and, you know, I am sorry that is human nature with some people, and there isn't much you can do about it, but would you damn the whole program for the few individuals like that? I don't think so.
But more importantly than that, you know, because we are talking about cost-sharing and the validity of the studies that have been done before, I would like to ask the GAO: can you comment on the quality of the previous studies on cost-sharing? Are they scientifically valid in showing impact on minorities?
Mr. YORK. Mr. Chairman, we have just begun the work for both of your committees on cost-sharing, but to date we have not found
any study that we would consider a real adequate study of costsharing in terms of the impacts on minority participation.
This IG study that is being discussed today is one of the few that looks at the actual observations from participants rather than just opinions, but that study suffers from the fact that its respondents were people who have paid, who have, in effect, invested into the program. The program services are satisfactory to them, and they think they are worthwhile. You don't know who may have been discouraged. They weren't part of the study.
Chairman MARTINEZ. Exactly. Thank you. Thank you, Mr. Chairman,
Chairman ROYBAL. Mr. Mangano, I would like to go over with you just your study and your report. I am sorry I did not read it before this meeting took place, but what little I have read leaves some questions in my mind, and that is with regard to some of your findings. You conclude in one of your findings that extending cost-sharing to Title III has strong support. Most of it is strong support from the states that are short of money. Therefore, they want more income. Is that not correct?
Mr. MANGANO. Yes. It came from the states as well as from the recipients themselves.
Chairman ROYBAL. How many recipients were interviewed?
Chairman ROYBAL. So 160 recipients out of how many thousands coming into the program?
Mr. MANGANO. Well, of course, there are thousands and thousands.
Chairman ROYBAL. Well, then what I am getting at is that a real study to make that determination was not made because if 160 were only interviewed out of 26,000, that is not a good
Mr. MANGANO. Well, I would add though that the persons that we interviewed at the individual sites within the states were randomly selected off the list of people who participate
Chairman ROYBAL. Sure. And another thing, two-thirds of the state and local officials from all eight states say they maintain services to recipients while they try to resolve payment issues. Did you find out in this study how much it cost to resolve payment issues in view of the fact that there are high-salaried officials conducting these investigations? How much did it cost to do that? Did you find that out?
Mr. MANGANO. No, we didn't. We can't answer that specifically, but what I can say generally is that the system they used is a very cost-efficient one in that it is based on self-declaration, sliding fee scales, and they do not ask the recipients to bring in any economic
Chairman ROYBAL. But that is not the point. The point is that the two-thirds of the state and local officials say that they maintain services. They don't stop the services. They maintain the services while they try to resolve payment issues. That is bothersome because how much does it cost to resolve payment issues? We don't know, do we? Mr. MANGANO. I can't answer that.
Chairman ROYBAL. This is one of the things we should know before we go into this thing. There is something else that bothers