Speech #890284406

Chairman. I now want to discuss a part of this bill which is vitally important to the district which I represent. I refer to the appropriation of $51 million to finance the Cuban refugee program. This figurc reflects an increase of $8.4 million over the amounts appropriated last year to carry on the program of assistance to Cuban refugees in the United States. This increase in appropriations is necessitated. of course. by the increased influx of Cuban refugees under the airlift that was commenced in response to the declaration President Johnson made when signing last years immigration bill that "those who seek refuge here in America will find it." An average of around 1.000 refugees have been admitted each week since the airlift was initiated on December 1. 1965. Along with the airlift a policy of increased emphasis on resettlement of Cubans outside of the Miami area was adopted. I am pleased that this policy has been so successfully applied. For every four Cuban refugees admitted by the airlift. three have been resettled in areas throughout the country. This is a remarkable record. for which many people are to be congratulated. Among them are the personnel of the U.S. Cuban refugee program in the Department of Health. Education. and Welfare. the voluntary agencies that have offered their assistance in arranging for the actual resettlement of refugee families. and the people of America who have responded so generously to the call to welcome these strangers into their midst. The Cuban refugee program is not a dole. It is. rather. a wellcoordinated program designed to offer a temporary helping hand to the refugee in his effort to achieve selfsufficiency as well as freedom from tyranny. In addition to the sum of $51 million to finance the Cuban refugee program this fiscal year. the bill before us also provides specifically that the sum of $1.032.997 of unobligated balances be used to reimburse the government of Dade County for medical services rendered In past years to Cuban refugees. I should like to describe the justification for this item of the bill. The Dade County Department of Hospitals has provided extensive medical care. both inpatient and outpatient. to the exile community since it first began arriving. Although the very earliest of the refugees were from the middle and upper socioeconomic strata of the Cuban population. considered medically average or above average by Cuban physicians practicing in Miami. this has not been true of the refugee population post1961. This latter group has been characterized as a medically highrisk group. with a "higher than average percentage of elderly. chronically ill. children. and individuals who. in the judgment of the Cuban Government. could not make a contribution to its welfare." Consequently. and as might be expected. the medical care which this group has required has been substantial. The refugee center itself is equipped to handle such procedures as screening. immunization and vaccination. and medical care for ambulatory patients. Refugees requiring further medical care are. referred to local hospitals. Because Jackson Memorial Hospital is the largest teaching hospital in Dade County and offers a comprehensive program of medical services. the vast majority of Cuban refugees were referred to it. Between 1961 and September 1965 approximately 69.000 Cubans were treated at Jackson as either inpatients or outpatients. The peak was reached in 196263. but the more stable current patient load is nevertheless considerable. During the period from October 1960. to September 30. 1965. close to $3.8 million was spent on the medical treatment of the Cuban refugees. Jackson Memorial Hospital has experienced difficulty in obtaining full reimbursement for this care provided the exiles despite the fact that. in establishing the original program. the Federal Government recognized that medical care of Cuban refugees was a national rather than a local problem. The Federal Government currently administers its assistance to the county hospitals through the Florida State Welfare Department. The hospital has been paid a per diem rate in accordance with the current State reimbursable per diem cost formula. for the first 30 days of care per admission. Initially no payments were made for more than 30 days a year. but later the Cuban refugee program agreed to pay the hospital $22 a day for additional hospitalization. These figures become especially meaningful. however. when the inequity inherent in the State cost formula is brought to light. This formula does not include interest on capital indebtedness. it is not based on current operating costs but on costs of a period perhaps 2 years prior. Moreover. the average Cuban admitted has required more medical and nursing services than the average nonCuban admission. All of these factors. as well as some which I have not mentioned. mean that Jackson Memorial Hospital has provided services to the Cuban refugees at a cost much higher than that reflected by the per diem reimbursement rate. As of January 1. 1966. the per diem reimbursement rate for inpatient admissions has been paid at the increased rate of $40 for the first 30 days and $24.80 for the 30th through the 90th days. Payment for outpatient clinic visits was raised from $10 to $12.50. This is considered an Interim arrangement pending the introduction of assistance formulas provided for under title 18 and 19 of the Social Security Amendments of 1965. Public Law 8997. Therefore. there is reason to hope that the annual deficit which Jackson Memorial Hospital has incurred as a result of treating Cuban refugees will be greatly reduced if not eliminated in the future. The problem which remains. however. is that whatever agreement is reached in the future under Public Law 8997 will not take care of the sizable lossa net loss of $1.032.997 between October 1. 1960. and September 30. 1965which has already been borne by Dade County residents. The item contained in the bill will reimburse the taxpayers of Dade County for the expenses they have borne in discharging an obligation which is national rather than local in character. I should like to express my appreciation to the Commiittee on Appropriations and to each member of the Subcommittee on Foreign Operations for the understanding consideration they nave given to the problem of financing the Cuban refugee program. Also I particularly want to express my deep thanks to the chairman of the Subcommittee on Foreign Operations. the distinguished gentlemen from Louisiana [Mr. PASSMANI. for his courtesy. but more than that for his willingness to face the difficult responsibility of his task and his leadership in carrying it out.