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Federal Grants-In-Aid Earmarked for State Dental Public Activities
N A TIO N A L DENTAL HEALTH C O N FER EN C E . . . VOLUME 62, APRIL 1961 • 23/38T
FEDERAL G RAN TS-IN-AID EARM ARKED FO R STATE DEN TAL PUBLIC A C T IV IT IE S B ern ard J. C on w a y,* L L .B ., C h ica go
The federal grants-in-aid system for get ting the job done has had a peculiar his tory. Innovations created by the federal government at the time grants-in-aid originated usually met severe challenges in the federal courts. There was a time, actually, when federal enactments that had any state or local effect had about a fifty-fifty chance of being declared un
aid plan for state highway construction was enacted. Because the states were so pleased to receive this federal money, there was no hint of a lawsuit to inter rupt the largesse from the nation’ s capi tal. Perhaps the Supreme Court recog nized that an invalid Maternity Act grants-in-aid system might stain the sys
constitutional. Y et, the federal grants-inaid system has escaped serious challenge even though the system was started at a time when the United States Supreme Court was most sympathetic to states’ rights. T h e Constitution of the United States (Article 1, Section 8, Paragraph 1) per mits Congress to “Lay and Collect taxes . . . for the general Welfare of the United States.” T h e power to collect revenue has, in effect, been interpreted to mean “ to tax and to appropriate those tax funds for the general welfare.” This is the rationale for the federal O A S I taxes being collected and spent for general wel
tem as such and threaten the highway program. In any event, the Supreme
fare. T h e same holds true for the federal unemployment tax with its accompany ing grants. Whether a federal appropriation for general welfare not accompanied by a specific tax for that purpose is constitu tional is the question which might have been argued at the time the Maternity A ct grants-in-aid were threatened by lawsuits in 1923. This was only about three years after the federal grantSTin-
Court dismissed two lawsuits on the same day in 1923; both attacked the constitu tionality of the federal grants-in-aid sys tem authorized by the Maternity Act. O ne suit was brought by the state of Massachusetts, the other by a resident of the District of Columbia. T h e Supreme Court never got around to the merits of such arguments as: “ The federal Con gress has now converted state adminis trative organizations into mere agencies for carrying out federal policy.” T h e Court held that neither the state of M as sachusetts nor the private citizen could show any appreciable injury or loss; therefore, they were not proper parties to an action complaining about the va lidity of federal grants-in-aid. Let us hope that a federal grants-inaid program for state dental public health activities does not set the stage for the long-delayed test of the constitu tionality of federal grants-in-aid pro grams which are not linked to dedicated tax funds.
24/382 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA T IO N
BACKGROUND OF POLICY ON FEDERAL G R A N TS-IN -A ID
In 1952, the House of Delegates of the American Dental Association approved a policy statement in support of earmarked federal grant-in-aid funds for state den tal public health activities.1 In 1953 and 1954 the then new Eisenhower Admin istration urged the Congress to eliminate all special disease grant-in-aid categories, such as the mental, venereal disease and tuberculosis provisions of the Public Health Service Act, and substitute a general grant-in-aid category to be made available to states for whatever public health purpose the state desired. The Association’s Council on Legislation de cided that it would be inopportune to press for an additional category in the face of the Administration’s opposition to the entire categorical scheme. The Council, then, testified in 1953 in favor of the elimination of the categorical sys tem on the ground that state dental divi sions would have some chance to get fed eral funds from a general grant source; there was no opportunity to get Public Health Service funds for dentistry under the categorical scheme. W ith the beginning of President Eisen hower’s second term, there was no express recommendation on eliminating categorical grants-in-aid for state public health purposes. Later in 1956, three state dental societies submitted resolu tions to the Association urging the A .D .A . to renew action on earmarked federal funds for state dental programs. In 1957, Rudolph H . Friedrich, then secretary of the Council on Dental Health, and I visited Senator H ill and requested his support for a dental grantin-aid category. Senator H ill stated that he might support the Association’s ob jective on the condition that a full justi fication for the program be developed and that the public health dentists as well as the dentists in private practice back it enthusiastically.
Early in 1958, the Council on Dental Health distributed a comprehensive questionnaire to all state dental health directors requesting complete informa tion on their present activities, the activ ities which they could not carry on be cause of lack of funds and the funds needed for expansion. In April of 1958, there was an extended discussion of the dental division survey at the National 'Dental Health Conference. Both the state directors and the state society offi cials were, on the whole, enthusiastically participating in the survey. Late in 1959, the Council on Legisla tion staff, with the assistance of the legis lative technical staff of the United States Senate, drafted a plan for dental health grants-in-aid into bill form. However, at the request of the chief staff representa tive of Senator H ill’s Committee on Labor and Public Welfare, the Council did not press to have the bill introduced by Senator Hill. It was explained to the Council on Legislation staff that the Administration would almost certainly oppose the dental health category and would, in all likeli hood, seize upon the Association’ s plan as a basis for reasserting the case for eliminating all categorical programs. Although Senator H ill and his staff are confident that the present categorical programs will be preserved, they do not relish a partisan political battle on Public Health Service programs in this election year. There is a strong belief that with a new Administration in 1961, Repub lican or Democratic, the dental health categorical plan can be put forward with bipartisan support. During M arch of 1960, Senator Hill received several communications from dentists in his home state of A la bama urging his support of earmarked funds for state dental health activities. A t the request of the Senator, represent atives of the Association met with him and it was again agreed to withhold ef forts on the project until 1961 for the
n a t io n a l d e n t a l h e a l t h c o n f e r e n c e
reasons previously stated. A letter was sent to the Alabam a dental officials in forming them of the decision to hold up action until 1961 but also telling them of Senator H ill’ s consent to introduce the Association’ s bill just prior to adjourn ment of this Congress— about the end of M ay.2 T h e legislative draft of the Associa tion’s plan takes a rather complicated form because it must be adapted to sev eral paragraphs of Section 314 of the Public Health Service A ct (42 U .S .C . 2 4 6 ). In substance, though, the plan sim ply makes available federal grants-in-aid to states to support public health pro grams designed for the prevention and control of dental diseases. The matching of funds would be on a fifty-fifty basis and, presumably, the federal funds would be available only for new or expanded programs and could not be used as a substitute for existing state financial sup port of dental programs.3
sta te
a c t io n
s t il l
n eed ed
There are, of course, some very impor tant steps that should precede action at the federal level. It would be desirable, for example, to have each state society go on record favoring federal funds for state dental health activities. Addition ally, the state dental societies should adopt resolutions specifying the new pro grams that are needed or the existing programs that require expansion. This is an essential preliminary step to action at both the state government and federal government levels. I emphasized this during the 1958 Dental Health Confer ence in a presentation on this subject. Perhaps the most important step in the procedure for the coming year is to have
. . VO LUM E 62, APRIL 1961 • 25/383
the state dental societies urge the state legislatures to appropriate funds for the programs which the dental association supports in the amounts needed to carry out those programs effectively. This legis lative activity will have the proper ori entation if the society has previously adopted a firm policy on both the pro grams to be supported and the amount of financing needed. Hopefully, the state dental directors will be in a position to record their support of the society’s rec ommendations in testimony before the legislatures. I have renewed my emphasis on the need for building the record at the state agency and legislative levels before go ing to the federal Congress. One of the questions that is certain to be asked of Association witnesses is: H ow much ef fort was put forth to gain support from the state health departments, state gov ernors and the state legislatures? The chances for success will hinge just as much upon the answer to this question, in my opinion, as on the merits of the programs to be supported. It must be kept in mind that dentistry has always espoused the principle of sub sidiarity. This means that efforts to obtain support state programs should be fore appealing for federal
all reasonable of local and exhausted be support.
Presented before the Eleventh National Dental Health Conference, American Dental Association, Chicago, April 25-27, I960. •Assistant secretary Legal Affairs, American Dental Association. 1. American Dental Association Transactions 1952, p. 35. 182.
2. S. 3780 was introduced by Senator Hill on June 29, I960. 3. S. 917 was introduced on Feb. 13, 1961.
FEDERAL G RAN TS-IN-AID EARM ARKED FO R STATE DEN TAL PUBLIC A C T IV IT IE S B ern ard J. C on w a y,* L L .B ., C h ica go
The federal grants-in-aid system for get ting the job done has had a peculiar his tory. Innovations created by the federal government at the time grants-in-aid originated usually met severe challenges in the federal courts. There was a time, actually, when federal enactments that had any state or local effect had about a fifty-fifty chance of being declared un
aid plan for state highway construction was enacted. Because the states were so pleased to receive this federal money, there was no hint of a lawsuit to inter rupt the largesse from the nation’ s capi tal. Perhaps the Supreme Court recog nized that an invalid Maternity Act grants-in-aid system might stain the sys
constitutional. Y et, the federal grants-inaid system has escaped serious challenge even though the system was started at a time when the United States Supreme Court was most sympathetic to states’ rights. T h e Constitution of the United States (Article 1, Section 8, Paragraph 1) per mits Congress to “Lay and Collect taxes . . . for the general Welfare of the United States.” T h e power to collect revenue has, in effect, been interpreted to mean “ to tax and to appropriate those tax funds for the general welfare.” This is the rationale for the federal O A S I taxes being collected and spent for general wel
tem as such and threaten the highway program. In any event, the Supreme
fare. T h e same holds true for the federal unemployment tax with its accompany ing grants. Whether a federal appropriation for general welfare not accompanied by a specific tax for that purpose is constitu tional is the question which might have been argued at the time the Maternity A ct grants-in-aid were threatened by lawsuits in 1923. This was only about three years after the federal grantSTin-
Court dismissed two lawsuits on the same day in 1923; both attacked the constitu tionality of the federal grants-in-aid sys tem authorized by the Maternity Act. O ne suit was brought by the state of Massachusetts, the other by a resident of the District of Columbia. T h e Supreme Court never got around to the merits of such arguments as: “ The federal Con gress has now converted state adminis trative organizations into mere agencies for carrying out federal policy.” T h e Court held that neither the state of M as sachusetts nor the private citizen could show any appreciable injury or loss; therefore, they were not proper parties to an action complaining about the va lidity of federal grants-in-aid. Let us hope that a federal grants-inaid program for state dental public health activities does not set the stage for the long-delayed test of the constitu tionality of federal grants-in-aid pro grams which are not linked to dedicated tax funds.
24/382 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA T IO N
BACKGROUND OF POLICY ON FEDERAL G R A N TS-IN -A ID
In 1952, the House of Delegates of the American Dental Association approved a policy statement in support of earmarked federal grant-in-aid funds for state den tal public health activities.1 In 1953 and 1954 the then new Eisenhower Admin istration urged the Congress to eliminate all special disease grant-in-aid categories, such as the mental, venereal disease and tuberculosis provisions of the Public Health Service Act, and substitute a general grant-in-aid category to be made available to states for whatever public health purpose the state desired. The Association’s Council on Legislation de cided that it would be inopportune to press for an additional category in the face of the Administration’s opposition to the entire categorical scheme. The Council, then, testified in 1953 in favor of the elimination of the categorical sys tem on the ground that state dental divi sions would have some chance to get fed eral funds from a general grant source; there was no opportunity to get Public Health Service funds for dentistry under the categorical scheme. W ith the beginning of President Eisen hower’s second term, there was no express recommendation on eliminating categorical grants-in-aid for state public health purposes. Later in 1956, three state dental societies submitted resolu tions to the Association urging the A .D .A . to renew action on earmarked federal funds for state dental programs. In 1957, Rudolph H . Friedrich, then secretary of the Council on Dental Health, and I visited Senator H ill and requested his support for a dental grantin-aid category. Senator H ill stated that he might support the Association’s ob jective on the condition that a full justi fication for the program be developed and that the public health dentists as well as the dentists in private practice back it enthusiastically.
Early in 1958, the Council on Dental Health distributed a comprehensive questionnaire to all state dental health directors requesting complete informa tion on their present activities, the activ ities which they could not carry on be cause of lack of funds and the funds needed for expansion. In April of 1958, there was an extended discussion of the dental division survey at the National 'Dental Health Conference. Both the state directors and the state society offi cials were, on the whole, enthusiastically participating in the survey. Late in 1959, the Council on Legisla tion staff, with the assistance of the legis lative technical staff of the United States Senate, drafted a plan for dental health grants-in-aid into bill form. However, at the request of the chief staff representa tive of Senator H ill’s Committee on Labor and Public Welfare, the Council did not press to have the bill introduced by Senator Hill. It was explained to the Council on Legislation staff that the Administration would almost certainly oppose the dental health category and would, in all likeli hood, seize upon the Association’ s plan as a basis for reasserting the case for eliminating all categorical programs. Although Senator H ill and his staff are confident that the present categorical programs will be preserved, they do not relish a partisan political battle on Public Health Service programs in this election year. There is a strong belief that with a new Administration in 1961, Repub lican or Democratic, the dental health categorical plan can be put forward with bipartisan support. During M arch of 1960, Senator Hill received several communications from dentists in his home state of A la bama urging his support of earmarked funds for state dental health activities. A t the request of the Senator, represent atives of the Association met with him and it was again agreed to withhold ef forts on the project until 1961 for the
n a t io n a l d e n t a l h e a l t h c o n f e r e n c e
reasons previously stated. A letter was sent to the Alabam a dental officials in forming them of the decision to hold up action until 1961 but also telling them of Senator H ill’ s consent to introduce the Association’ s bill just prior to adjourn ment of this Congress— about the end of M ay.2 T h e legislative draft of the Associa tion’s plan takes a rather complicated form because it must be adapted to sev eral paragraphs of Section 314 of the Public Health Service A ct (42 U .S .C . 2 4 6 ). In substance, though, the plan sim ply makes available federal grants-in-aid to states to support public health pro grams designed for the prevention and control of dental diseases. The matching of funds would be on a fifty-fifty basis and, presumably, the federal funds would be available only for new or expanded programs and could not be used as a substitute for existing state financial sup port of dental programs.3
sta te
a c t io n
s t il l
n eed ed
There are, of course, some very impor tant steps that should precede action at the federal level. It would be desirable, for example, to have each state society go on record favoring federal funds for state dental health activities. Addition ally, the state dental societies should adopt resolutions specifying the new pro grams that are needed or the existing programs that require expansion. This is an essential preliminary step to action at both the state government and federal government levels. I emphasized this during the 1958 Dental Health Confer ence in a presentation on this subject. Perhaps the most important step in the procedure for the coming year is to have
. . VO LUM E 62, APRIL 1961 • 25/383
the state dental societies urge the state legislatures to appropriate funds for the programs which the dental association supports in the amounts needed to carry out those programs effectively. This legis lative activity will have the proper ori entation if the society has previously adopted a firm policy on both the pro grams to be supported and the amount of financing needed. Hopefully, the state dental directors will be in a position to record their support of the society’s rec ommendations in testimony before the legislatures. I have renewed my emphasis on the need for building the record at the state agency and legislative levels before go ing to the federal Congress. One of the questions that is certain to be asked of Association witnesses is: H ow much ef fort was put forth to gain support from the state health departments, state gov ernors and the state legislatures? The chances for success will hinge just as much upon the answer to this question, in my opinion, as on the merits of the programs to be supported. It must be kept in mind that dentistry has always espoused the principle of sub sidiarity. This means that efforts to obtain support state programs should be fore appealing for federal
all reasonable of local and exhausted be support.
Presented before the Eleventh National Dental Health Conference, American Dental Association, Chicago, April 25-27, I960. •Assistant secretary Legal Affairs, American Dental Association. 1. American Dental Association Transactions 1952, p. 35. 182.
2. S. 3780 was introduced by Senator Hill on June 29, I960. 3. S. 917 was introduced on Feb. 13, 1961.