of policy changes in 1947, while in accessions for this reason increased assistance program to another and 1948 Mississippi accounted for about steadily each year, from 12 in 1947 those that formerly received private 75 percent of the acceptances for to 20 in 1949. The highest percentage aid, as well as those in which the this reason. In Mississippi, revision (28.4) for the 3-year period was re- applicant had deferred his request for in State policy as well as additional ported by Utah in 1948, when many assistance. funds permitted large numbers of aged blind persons who had been re- The proportion of cases opened for eligible persons on waiting lists to be ceiving old-age assistance transferred these reasons is higher for the aid to approved for assistance. In 1947 to the program for the blind rather the blind program than for any other several Stat,es, including Mississippi, than sign the newly imposed lien on program, and it has become ,larger that had formerly made joint pay- property required of all old-age assist- each year, increasing from 10.2 in ments to two eligible spouses pro- ance recipients in that State. 1947 to 14.3 percent in 1949. In many vided for separate payments. This In aid to dependent children, only States, aged blind persons are often change in agency policy accounted for 2.1 percent of all cases were accepted transferred from old-age assistance to many of the openings in that year. for this reason in 1947 and less than aid to the blind (and from the latter In the aid to the blind program, 4.1 1 percent in 1949. Additions to the program to old-age assistance) for and 4.4 percent of all new cases in general assistance rolls were even reasons unconnected with agency pol- 1947 and 1948 were taken on because more negligible-less than 1 percent icy or practice. The effect of these of changes in legislation or agency in each year. transfers on the small program of aid policy. The proportion was less than All other reasons.-Included in to the blind is likely to be greater than 1 percent in 1949. It is noteworthy cases opened for unspecified reasons in the case of transfers from aid to that the number of States with no are cases transferred from one public the blind to old-age assistance.

life insurance programs were excluded because they are managed in the same Note3 and Brief Reports way as private insurance; decisions Expenditures for Civilian governments. The table is not con- on such matters as participation and Social Security and fined to the programs of the Social the amount of protection are made Security Administration but at- by the individual participants, not by Related Public Programs tempts to present a comprehensive law or government agencies. Expenditures for social security picture of public expenditures for so- Since the purpose of the table is and related public programs, as de- cial security and related purposes. to indicate the magnitude of expendi- fined and used in the accompanying Social security and related public tures directly related to the social table, have become an important programs are considered here to in- security programs, the table also ex- item in the budgets of the Federal, clude all social insurance programs; cludes expenditures for education, State, and local governments. Dur- veterans’ disability and survivor bene- public housing, crime control and ing the fiscal year 1948-49, public ex- fits, readjustment allowances, medical correction, and similar social pur- penditures by civilian governmental care, and welfare programs; public poses. The largest of these exclusions agencies for social security and re- assistance; health and medical care; is education. During the fiscal year lated public programs were about and certain welfare services. Al- 1947-48, the States and localities $11.6 billion, a $1.6 billion increase though the armed forces and the spent about $4.3 billion for elementary over expenditures in the fiscal year Atomic Energy Commission spent sig- and secondary schools, some part of 1947-48. On the Federal level these nificant amounts for direct medical which was devoted to school health expenditures represented about 15 services and for medical research, services. Besides expending these percent of Federal expenditures from these are primarily military or defense amounts, both the States and the general funds and from social insur- expenditures and have not been in- Federal Government are supporting ance trust funds; State and local cluded in the table. Some other agen- college and professional education, in- expenditures for these purposes rep- cies, in carrying out their programs, cluding the training of nurses, resented more than 25 percent of all make relatively small expenditures for physicians, and other medical person- State and local outlays. medical research or services; among nel. The veterans’ education pro- The increasing magnitude of ex- those agencies are the Department of gram alone amounted to more than penditures for social security and the Agriculture, the Tennessee Valley Au- $2.7 billion in 1948-49. Housing and increasing interest in such programs thority, the Civil Aeronautics Admin- community development expenditures emphasize the need for information istration, the Fish and Wildlife Service by the Federal Government, which on the scope of current expenditures of the Department of the Interior, and totaled nearly $300 million in 1948-49 made at the various levels of gov- others-none of whose expenditures and might reach $1.0 billion in 1949- ernment. The accompanying table is included here. 50, are also excluded. indicates the approximate outlays for The outlays from the veterans’ na- The table differs in a few important each of the social security and re- tional service life insurance and Gov- respects from earlier tables, which lated programs for 3 fiscal years and ernment life insurance trust funds are were carried in the SOCIAL SECURITY shows these expenditures separately not (and have not been in previous YEARBOOKS. Several categories of for Federal and for State and local years) included in this table. These expenditure have been included for

Bulletin, July 1950 1.5 the first time, principally the private veterans and professional medical Expenditures under some programs expenditures required under the training, which had been included have been transferred from one cate- State temporary disability (cash sick- previously, are now excluded. In gory to another. Hospital and medi- ness) insurance programs and the addition, all international health ob- cal care now includes several medical sanitation expenditures of State and ligations and military and atomic programs-those for merchant sea- local governments now included un- medical research, both of which had men, Indians, and Pederal prisoners- der community and related health previously been included in part, are that were formerly considered to be services. Education expenditures for excluded. “other” health programs (the miscel-

Expenditures for civilian social security and related public programs, by source of funds and by program, fiscal years 1946-47, 1947-48, and 1948-49 1 [In millions; data corrected to May 22,1950]

194&49 194748 194647 - Program 3tate and 3tate and ‘ State and Total Federal local Total Federal local Total Federal local .- Total..~.___._-----______-~-~~~ -I- $11,591.8 $6,370.4 $5, 221.5 $10,024.9 $5, 920.0 $4, 105. fl $9,817.1 $6. 233. 6 $3, 583.4 Social insurance and related pr”grsms-----~-~-~~~~ - 6, 175. 0 4,118.Q 2, 056. 2 5, 571.5 4, 022. 2 1, 549.4 6, 106. 2 4, 567.8 1,538.3 Old-age and survivors insurence~~~~~~~------660.5 660.5 _. 559.1 559.1 466.4 466.4 -_ Railroad retirement . . . .._. ._...... _._ -_---___- 282.5 282.5 -..------... 227.3 227.3 177.6 177.6 -. Public employee retirement systems 2--..._----- 632.5 352.0 2x0.5 550.7 294. 2 2.56. 5 492.7 256.0 236.7 Employment security ~-~.....~----~------~---~~ 1, 382.2 184.3 1,198.0 901.2 141.5 759.7 986.0 148.8 837.2 Railroad unemployment insurance-.------50. 5 50. 5 -. 35.9 35.9 51.2 51.2 -. Railroad temporary disability insurance 4.-----_ 32.0 32. 0 -. 28. 6 28.6 -. State temporary disability insurance programs I- 51.7 51.7 34.3 34.3 1.5. 3 15.3 Veterans’ program n...... ___._....._..__ ---_--- 2, 541.6 2,541. 6 -. 2,720.6 2, 720.6 3,451.l 3,451. 1 -. Workmen’s compensation ~~.~-~------~--- ____.. 541.5 15. 5 8 526.0 513.8 15.0 6 498.9 465.9 16.7 8 449.1

Publicsid-. _...... __ ___...... _._ -_---_---_--- 2,086.4 939.5 1, 146.9 1,699. 9 722.5 97i. 4 1, 440. 1 615.9 824.2 Special types of public assistance Q~~~-~------.. 1,820.2 939.5 880.7 1,487. 5 722.5 76R. 0 1, 271.9 615.9 656.0 Generalassistance~~~~~~-.....~~~~-~~--~---~--~~. 266.2 266.2 212.4 212.4 168.2 168.2 Health and medical services K--_- ____.__...... 2,607.O 828.5 1,778.5 2. OR2 0 717.2 1,344.8 1,717.1 678.4 1,038.7 Hospital and medical care II---_-_- _____...... 1,589. 1 603.1 986.0 1,324.6 547.2 777.4 1,076.O 530.9 545.1 New hospital construction 18. . .._ --~ __.._...... 294.4 94.4 200.0 123.1 55. 1 RR.0 84. 8 28.8 56.0 Community and related health services 13------649.7 75. 4 5i4.3 551.5 67. 1 484.4 488.7 63. 7 425.0 Maternal and child health care 14_____.__...... __ 30.8 20.5 10.3 34.1 25. 1 9.0 51.9 43. 7 8.2 Medical rehabilitation ~J~----~------~~-- __.._... 6. 2 3. 1 3. 1 5. 2 2. 6 2. 6 3. 5 1.8 1.7 Medical and public health research 18__..___..... 31.3 29.3 2. 0 19.8 17. 8 2. 0 10.1 8.1 2.0 Health manpower training ~~.-~------___.__.... 5.5 2.7 2. 8 3. 7 2. 3 1.4 2. 1 1.4 .7 Other welfare services-...... ___.______------~ 723.4 483.5 239.9 601.5 458.1 233.4 553.7 371.5 182.2 Vocational rehabilitation 18__....__.____ -_------19.6 15. 1 4.5 19. 4 15. 1 4. 3 15.8 12.4 3.4 Veterans’ program 19______-_------_--- _...... 366.9 366.9 _.____------353. 3 353.3 ___---.--- 263.8 263.8 -. Institutional and other care ~~~._----_--- __...... 223.0 23.0 200.0 217. 0 17.0 200.0 173.5 15.4 1.58.2 Schoollunch pr”gram~~-..~~~~~------~~--~~~..~ 110.1 2’ 35.4 98. 3 69.2 2129.1 98.5 77. 8 2’ 20.6 Child welfare _____--_-_- _.______-----_--- _____. 3.8 ‘i:i (9 3. 5 3.5 w 2. 1 2. 1 (22) - - * Preliminary: not comparable with data in Social Security Yearbooks (before 13 Federal expenditures represent those made by the U. S. Public Health Serv- the 1948 issue) because of changes in inclusions and classification. Data repre- ice (exceDt for international health activities. the National Institutes of Health. sent expenditures from public funds (general and special) and trust accounts. medical &nd hospital care and hospital construction. and professional education and other expenditures under public law; exclude transfers to such accounts and training) and by the Food and Drug Administration; State and local expendi- and loans; include administrative expenditures unless otherwise noted. Fiscal tures represent all community health and sanitation expenditures by public years ended June 30 for Federal Government, most States, and some localities; agencies except those in connection with schools and public welfare and those for other States and localities, fiscal years cover various 12.month periods ended classified elsewhere as health and medical services. with the specified year. 14 Federal expenditures are for the maternal and child health program, the pro- 2 Excludes rofunds of employee contributions to employees leaving service. gram for crippled childron, and the wartime emergency maternity and infant 3 Represents State unemployment insurance and employment service pro- care program; State and local expenditures represent required matching of Fed- grams, the reconversion unemployment benefit program for seamen, and sdmin- eral grants under the maternal and child health program and under the program istratwe expenditures of the Bureau of Employment Security. for crippled children. 4 Benefits first payable July 1, 1947. 16Expenditures for medical oaro and services under the Vocational Rehnbilita- 0 Benefits first payable in California in December 1946 and in New Jersey in tion Act. January 1949; includes benefits paid by private plans under State law in Cali- 16 Represents all expenditures (except for education and training) of the Na- fornia and New Jersey. tional Institutes of Health. U. S. Public Health Service, and estimated amounts 0 Represents pensions, annuities, burial awards, and readjustment allowances appropriated by State and local governments for medical research. and estimated administrative expenditures in connection with these payments; 1’ Represents in-service training of the National Institutes of Health and other excludes expenditures from Government life insurance fund. units of the U. S. Public Health Service and of the Children’s Bureau. Excludes 7 Includes expenditures for medical services-approximately $150 million in professional education and training of nurses, physicians, and other medical 194647, $165 million in 1947-48, and $175 million in 194849. Includes payments personnel and expenditures in State-supported medical schools. by employers and private insurance carriers of benefits payable under public law. 18Expenditures under the Vocational Rehabilitation Act other than those for 8 Excludes administrative expenditures. medical services. 9 Old-age assistance: aid to the blind, and aid to dependent children. IQVeterans Administration programs for vocational rehabilitation, automobiles 10Excludes all medwnl expenditures (both health services and rescsrcb) of the and other conveyances for disabled vetorans, and housing for paraplegic veterans. Military Establishment and the Atomic Energy Commission; health services 20 Federal ovpenditures are for the American Printing House for the Blind, provided in connection with primary and secondary public education; medical the Columbia Institute for the Deaf, the U. S. Soldiers’ Home, and the U. S. services included under the public aid programs above (about $150 million in Naval Home. and for domiciliary care of veterans; State and local expenditures 1947); medical care included under workmen’s compensation above; international in institutions for chronic care, for the handicapped,, and for the aged. health activities; proIessiona1 education and training of nurses, physicians, and 21 Funds are also available from private organizetwns and payments from par- other medical personnel: and expenditures for medical services and research ents: in 194647 these nongovernmental funds amounted to $130 million, in 1947- subordinate to the performance of other functions, such as those of the Depart- 48 to $161 million, and in 194849 to $182 million. ment of Agricultux and the Civil Aeronautics Authority. 2%Rough estimates, based on a 1947 study. indicate that State and local govern- 11Includes hospital and out-patient care in public institutions and expendi- ments are spending about $40-50 million for care of children in foster homes: tures for maintenance and improvement of existing facilities. Excludes expendi- because of the tentative nature of this estimate, the amount is not included here. tures for domiciliary care by the Veterans Administration and institutions for Source: Data taken or estimated from Federal budgets and available reports chronic care (other than mental and tuberculous) included under institutional of Federal, State, and local administrative agencies. and other care helow. 12Federal expenditures include cost 01 hospital planning and surveys; State and local expenditures include new construction only.

16 Social Security laneous grauping used in the earlier tures in the preceding fiscal year; dis- including the introduction of a new tables); Food and Drug Administra- bursements during 1948-49 were 30 winter supplementary benefit pro- tion outlays have been transferred percent higher than in 1947-48. gram-by chapter 1 of the Statutes from “other” health programs to com- An increasing proportion of the of 1950, which received the Royal As- munity and related health services; total outlays for social security and sent on March 1.’ domiciliary care of veterans and care related purposes is being devoted to Coverage.-The amendments do of the chronically ill in State and local health and medical services. Where- not, with the partial exception to be institutions have been included under as in 1946-47 health and medical noted, affect the types of work that institutional and other care. services comprised 17.5 percent of all are covered, so that agricultural, do- Several changes have also been social security and related outlays, mestic, and permanent public em- made in the methods used to estimate in 194748 they accounted for 20.6 ployment remain among the excluded expenditures, so that even when the Percent, and in 1948-49, for 22.5 per- employments. However, the upper inclusions under a heading are un- cent. All health programs (with the earnings limit for insurability has changed, the results may be some- exception of wartime emergency ma- been raised from $3,120 to $4,800 a what different. The changes in esti- ternity and infant care, liquidation of year, and in this way an estimated mating procedure were significant for which began in July 1947) have 90,000 additional persons will be the Federal employment security pro- shown significant increases. This is added to the 2.5 million already gram, for State and local community particularly true of the nonservice covered. Contribution and benefit and related health services, and for programs, such as medical research levels remain unchanged for earnings hospital and medical care, new hos- and health manpower training, both in excess of $2,496 a year. pital construction, and institutional of which increased more than 160 Workers in lumbering, logging, and other care. percent between 1946-47 and 1948- and stevedoring are also covered by Identical changes in expenditure 49. Under the stimulus of the Hos- the amendments of 1950. The effect classifications and inclusions have pital Survey and Construction Act is to confirm coverage already been made for each of the three fiscal and the Veterans Administration achieved or initiated by orders in years to permit com.parison of the hospital program, and because of the council issued in 1946 (covering data (table). Total expenditures for backlog of construction and repair logging and lumbering in British the social security and related pro- work piled up during the war years, Columbia ) , 1948 (for stevedoring), grams in 1948-49 showed a 15.6-per- public hospital construction expen- and 1950 (logging and lumbering cent increase over those in 1947-48 ditures have increased from $85 mil- elsewhere than in British Columbia). and an 18.1-percent increase over lion in 1946-47 to $123 million in The latter order, by action taken 19464’7. Expenditures for the insur- 1947-48 and $294 million in 1948-49. February 23, brought an estimated ance programs alone increased from Expenditures in 1948-49 for medical 75,000 persons into the system on $5,572million in 1947-48 to $6,175mil- services to individuals were about 20 April 1. lion in 1948-49. Veterans’ benefits- percent greater than the amount Supplementary benefits.-The most principally readjustment allow- spent in 194748. important change is the addition of ances-declined by about $180 million, The increase in State and local a supplementary benefit program but this decrease was more than offset government outlays for social se- providing insurance payments to cer- by increases in other programs. The curity and related purposes during tain classes of unemployed workers- largest increase occurred in outlays the 3 years has been more marked estimated at about 100,000 persons- for employment security; unemploy- than the increase in Federal expendi- who are not eligible for regular ben- ment benefit payments by the States tures for the same purposes. In efit. The supplementary benefits are were 58 percent more than in the pre- 1946-47 the States and localities payable only from January l-March ceding year. This large increase re- spent $3.6 billion, or 36.5 percent of 31 of each year--that is, at the time flects the rise in the monthly average the total, but in 1948-49 their share of greatest seasonal unemployment of unemployment from 3.4 percent of had increased to 45.0 percent of total (for the first year, the benefit period the civilian labor force in the fiscal social security expenditures and rep- lasted until April 15, 1950). The year 194748 to 4.1 percent in 1948-49. resented outlays of $5.2 billion. This supplementary benefit amounts to 80 The outlays of the State temporary relative increase in State and local percent of the regular rate; it is pay- disability insurance programs went up expenditures is partly explained by able to the following groups: (1) 51 percent; the beginning of benefit the drop in expenditures in some of Persons who have exhausted their payments under the New Jersey law the Federal programs for veterans, benefit rights during the fiscal year was in part responsible for this in- but it also reflects increasing State (between March 31 and the date of crease. activity in the broad field of social claim) ; (2) persons with 90 daily The public aid programs and wel- security. contributions in the fiscal year but fare services all showed some in- fewer than the 180 contributions crease. Within these two categories, Canadian Unemployment expenditures under the Federal public 1 Canada, House of Commons, Bill 8, Insurance Amendments passed February 24, 1950; and U. S. De- assistance programs showed the larg- prt,meilt of State, Despatch from Lau- est dollar increase and one of the larg- Unemployment insurance in Can- rence A. Steinhardt, Embassy, Ottawa, est percentage increases over expendi- ada was amended in several respects- March 1. 1950.

Bulletin, July 1950 17