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The Special Supplemental Food Program for Women, infants, and Children John R. Nelson, Jr INTRODUCTION By any measure, the Special Supplemental Food Program for Women, Infants, and Children (WIC) makes an intriguing study of the policy-making process. Enacted by Congress in 1972, it was a $20-million pilot program designed to provide specified food supplements to a few thousand pregnant women, lactating mothers, infants, and preschool children determined by health clinics to be nutritionally "at risk." Plagued over its 7-year history by litigation, impoundments, a presidential veto, controversial evalua- tions, and fiscal austerity, WIC nonetheless reached 2.5 million people at an annual cost of $750 million by the close of fiscal 1980. It is touted by administrators at the U.S. Department of Agriculture (USDA), congressional supporters, and public advocates as the most successful health or welfare program in the federal government. Congress has reenacted it three times with near unanimity. It represents one of the very few major programs greatly expanded under the Carter administration. This chapter traces the evolution of federal policy toward pregnant women, infants, and children in the areas of health care and nutrition. It pursues the historical strands that led to the creation of WIC, from the New Deal to the Great Society programs of the 1960s. This chapter then focuses on WIC's direct antecedent, the Commodity Supplemental Food Program, which was initiated in 1968. In sequential sections, WIC's origins in Congress, its difficulties with the USDA and the Office of Management and Budget (OMB), its days in federal court, and the evaluations of its efficacy are examined. Throughout the case study, particular attention is accorded to the role of research and evaluation in policy making. 85

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86 CHILD NUTRITION: THE NEW DEAL TO THE GREAT SOCIETY Direct federal financial support for feeding children began with a conversation between Harry Hopkins, admini- strator for the Federal Emergency Relief Administration, and Frederick I. Daniels, director of New York's Emergency Relief Administration. The first 100 days of the Roose velt administration had just ended. Hopkins had been made czar of the federal relief and employment programs. Daniels had asked him if some of the $200 million appro- priated for relief could subsidize New York's financially strapped school lunch program. Hopkins agreed to match every two state dollars with one federal dollar. Concom itantly, the Reconstruction Finance Corporation agreed to loan money to support lunch programs in Mississippi. The Work Projects Administration (WPA) subsequently supported local lunch programs with their personnel. The crucial metamorphosis, however, which carried the nascent programs beyond the demise of these New Deal agencies into the 1960s, came with the linkage of school lunches to the disposal of farm surpluses.) Section 32 of the Agricultural Adjustment Act of 1935 provided a compensatory fund from tariff revenues to increase farm incomes. The theory was that industrial tariffs compelled farmers to spend more money on their equipment than they would have to in a situation of free international trade. The law instructed the USDA to spend these revenues to increase the price levels of farm commodities by encouraging "the domestic consumption of such commodities." Backed by Section 32 funds, the number of schools serving lunches grew to over 3,800, serving 342,000 children in 1937.2 The Surplus Marketing Corporation provided not only lunches but also food for relief agencies, institutions, and, in 1939, a food stamp program. Piloted in Rochester, New York, food stamps spread quickly throughout the country, reaching 4 million people by 1941. The USDA also began to provide lunch milk to school children for a penny or free of charge in mid-1940 and expanded their distribution to 417,000 children in 18 months.3 The great expansion of federally supported school lunches did not occur until late 1940. In August of that year, the WPA and the Surplus Marketing Administration of the USDA issued a directive to all regional, state, and local personnel involved in federal food programs. It began rather succinctly: "Recent violent disruptions in world distribution of American farm products and the

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87 prospects of added losses of markets make imperative the development of new outlets for American surplus food- stuffs." The directive specified three areas of expan- sion: food stamps, direct distribution of commodities, and school lunch programs. They sought to increase the coverage of the lunch program n to not less than six million children during the 1940-41 school term"--fully half of the school population.4 It was a goal that they came within 800,000 children of achieving. By fiscal 1943 the USDA was spending over $18 million annually on school lunches and the commodities that local distribution centers received. (For funding, participation, and legis- lative data, see Appendixes B and C.) Well before the USDA distributed food for lunches, or for any other purposes, it had published numerous pamph- lets on nutrition and diet, e.g., Food for Children (1931), Milk for the Family (1933), and Meals and Recipes for Lunches (1936). . When it entered the food distribution business, the stream of booklets became a torrent. The Bureau of Home Economics (later the Bureau of Human Nutrition and Home Economics) published over 50 pamphlets in the 1940s dealing specifically with school lunches. The USDA also provided nutrition and production data to the military for diet planning during the World War II. In 1933 the Programs Planning Division of the USDA began coordinating crop production with human nutritional requirements. The onset of World War II brought the first serious and extensive application of nutritional needs to crop production: If crops were planted according to their nutritional value, then any potential tension between what was distributed as surplus and what was nutritious would dissipate .5 World War II stimulated a flurry of nutrition-related activities. At President Roosevelt's request, the National Research Council established the Food and Nutrition Board in May 1941. The board drew together existing research, previous standards, and USDA data to develop recommended dietary allowances (RDA) for persons by age, sex, and level of activity. The original RDA covered calories, protein, calcium, iron, and some vitamins; it specified, in a preliminary manner, the nutritional needs of pregnant women, infants, and lactating mothers. Subsequent reports described the "staggering n extent of malnutrition in antebellum America "It is obvious," one report concluded, "that an appalling proportion of families were receiving what might with considerable understatement be called an unsatisfactory

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88 diet." Guided by these recommendations, the USDA launched a nationwide campaign to improve the diets of Americans. To abet this effort, it expanded the Bureau of Home Economics into the Bureau of Human Nutrition and Home Economics, and created a Nutrition and Food Conservation Branch of the Food Distribution Administration to incorporate all food-related activities in the federal government. Internationally, USDA officials organized the United Nation's Interim Commission on Food and Agriculture, which issued, among other things, worldwide standards for human nutrition .6 The lunch program in particular, and the feeding of children in general, did not come under congressional scrutiny until 1943, when the USDA requested a $50- million appropriation for the program's continuance. The war had absorbed the agricultural surplus and rendered direct commodity distribution impossible. Only commercial purchases could maintain the program. Secretary of Agriculture Claude Wichard proposed legislation to the White House through the Bureau of the Budget to create a permanent lunch program. He stressed the necessity of adequate food distribution to children in the face of wartime rationing/and working mothers. He suggested the President convene a national committee on child nutrition. Other USDA officials contacted the Bureau of the Budget to support Wichard. War Food Administrator Marvin Jones explained that the lunch program ensured "proper distribu- tion of the civilian food supply during the war" and "expanded markets for agricultural products and . farm surplus during peacetime." A USDA memorandum stressed malnutrition as evidenced by the high rates of draft rejections. In sum, Wichard and the USDA had, by 1943, not only presented all the arguments that would be offered subsequently to support the program but had also identified in their choice of a child nutrition committee all the important elements of what came to be the political coalition for feeding children.7 The complex preparation for maintaining a lunch program developed out of a postwar planning commission on agricul- ture that met in July 1943. The commission anticipated strong economic growth after the war and made four assump- tions about agricultural policy: first, that large postwar incomes could maintain a strong market for farm products and adequate diets for Americans; second, that farmers should anticipate expanding their output of commodities to meet this demand; third, the food stamp and school lunch programs would compensate for any slack ~

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89 in normal market outlets; and fourth, as a result of these factors, little production restriction would be necessary. Though by no means the principal instrument of farm policy, agricultural policy makers considered the lunch program an integral tool of price stabilization.6 While the administration prepared permanent legisla- tion, the congressional agriculture committees permitted a temporary appropriation to continue the program. Congress approved of the appropriation as a wartime exigency to ensure food distribution to children. Congressional concerns about funding the program beyond the end of the war resulted in the House rejection of an appropriation to extend it pending hearings on formal legislation. A peacetime program awaited the full legislative process and consideration of the whole issue of agricultural stabilization and the feeding of children.9 Within the administration a disagreement erupted between the War Food Administration (representing the USDA) and the Federal Security Agency (representing the Office of Education) over administrative jurisdiction of the proposed School Lunch Program (SLP). The Federal Security Agency argued that as a program functioning within the school system for an educational purpose, the SLP should come under the Office of Education. War Food Administrator Marvin Jones disagreed. "I cannot too strongly emphasize," he wrote, "that, although the educational aspects of this are very significant, the operational meaning of the program is that it is providing food. It is a food program in wartime providing proper distribution of food, and in peacetime expanding markets for agricultural products and providing orderly removal of farm surplus."~ That the USDA prevailed indicates to some degree that the administration assigned a higher priority to the farm disposal aspect of the program than to the educational aspect. With regard to nutrition- related activities, however, the USDA was the logical choice: It was by far the preeminent federal agency involved in nutritional research and information dissemination. Inertia and the relative clout of the executive and congressional entities involved in the SLP also contributed to the USDA's victory. With the onset of congressional hearings in late 1944 through 1945, a nascent children's feeding coalition became evident. Various farm organizations and their representatives served as the bulwark of continued federal funds for lunches. School lunches, the National Farmers

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Do Union argued, were "a big market farmers cannot afford to lose. . . ." USDA officials also stressed the need to maintain outlets for surplus farm products, which were again becoming a problem in May 1945. Indeed, the program, as Senator Richard Russell noted, "grew up out of the disposition of surplus agricultural commodities, and no one had ever seriously discussed any bill providing for a federal school-lunch program prior to that time." In a brief House Agriculture Committee exchange the "main objective" of the program could not be clarified. Repre- sentative Harold Cooley believed that the primary objective was the disposal of surplus agricultural commodities and feeding school children was "just collateral." The majority, however, stressed it as a "two point" program: surplus disposal and children's feeding. 2 The dual stress enabled program promoters to draw a broad range of support outside agriculture. The children's feeding coalition encompassed nonfarm groups that included school administrators, who had a direct financial stake in continued federal funding, organized labor, PTAs, social organizations, professional nutritionists, and medical experts. - . . .. In their testimony before the House Agriculture Committee, many nutritionists pleaded for a flat national commitment to children's nutrition regardless of agricultural surpluses. The surgeon general made an extraordinary plea, in terms of need, for a national policy to combat malnutrition when he described Americans as "poorly fed." Another official of the U.S. Public Health Service noted that pregnant women and infants would be an excellent target population for . . nutritional aid. The committee ignored his comment ana all other suggestions to modify or expand federal aid based on nutritional need beyond the lunch program. Such innovations from the depression era as food stamps and the school milk program were not revitalized. The ideologi- cally conservative Congress of 1946 authorized only a limited federal role in nutritional welfare." 3 Support for the program, particularly among southern members of Congress, stemmed from several factors other than farm incomes. The primary basis was the enormous popularity of the lunch Program among constituents throughout the nation. ~ was an inherently appealing activity. Even those few members of Congress opposed to federal support praised school lunches as an eminent state or local endeavor. In addition, there was the problem, conceived in terms of national security rather than social welfare, of Second. feeding school children

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91 malnutrition in America, demonstrated by selective service rejection. General Lewis Hershey, the Selective Service director, testified that 40 to 60 percent of those rejected for military service had defects related to nutritional deficiencies. Overall, this meant that roughly 1 of every 10 draft-age males was sufficiently malnourished to preclude induction. Nutrition-related rejections were concentrated in poor southern states and were much higher among blacks, though this revelation evoked little congres- sional comment. The South, too, faced the problem of newly consolidated rural schools that required busing children, making it impossible for them to return home for lunch. Regardless of the school's distance from home, the absence from home of working mothers during the war made a home lunch difficult in all parts of the nation.) 4 The School Lunch Act of 1946 set the basic terms under which the lunch program operated into the early 1960s. Funding for the first decade remained around $80 million per year. In light of the explosion of the school popula- tion and inflation, this constant funding level represented a continuous decline in federal participation. Federal funds were paid as matching grants in a ration declining from 1:1 to 1:4 over a 5-year period. This ratio was adjusted according to the extent to which a state's per capita income varied from the national average--an advan- tage to the South. Finally, the legislation provided for nutritional standards, nondiscriminating discounts or free meals to poor children, nonprofit programs, and priority Purchases of commodities in surplus. The preamble of the act "declared [it] to be the policy of Congress, as a measure of national security, to safeguard the health and well-being of the nation's children and to encourage the domestic consumption of nutritious agricultural commod- ities. . . ." The policy statement struck a balance between the two major interests of the children's feeding coalition.~5 In 1946 the USDA issued detailed nutritional require- ments for school lunches. They divided the lunches into three types and provided a declining scale of reimburse- ment dependent on the lunch's nutritional adequacy. Type A supplied one third to one half of the daily nutrient needs of a child. Type B supplied roughly one third of a child's daily needs. Type C was one half a pint of milk. A more complete lunch yielded a higher federal subsidy. The local school or district chose the exact composition of the meal with an eye to what commodities were in surplus. Although this practice often precipitated a

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92 . jejune diet, the nutritional regulations did limit abuse of the mandate that required the use of commodities in surplus. 6 Prior to the 1960s, Congress enacted only one other federal program related to feeding children: the Special Milk Program (SMP). As the Korean War ended, the USDA's Commodity Credit Corporation found itself accumulating milk at an increasing rate. In 1954 its price support operations absorbed 10 percent of the total milk supply-- more than triple its acquisitions of the year before. Milk prices declined, and national farm incomes suffered from this weakness of its largest single component. Not only production increases wrought from mechanization, but also a decade-long decline in per capita milk consumption had created a crisis for the dairy industry. Their organi- zations turned to Congress and the USDA. The result was a revival of the depression era school milk program, renamed the Special Milk Program, a $50-million "domestic disposal program" to ease dairy surplus by providing subsidized milk to school children in addition to lunch milk. When the SMP came up for a supplementary appropriation and renewal in January 1956, the USDA proposed a 20 percent increase in the appropriation and an expansion of the program into nonschool areas devoted to children. As in the initial legislation, the burden of congressional testimony came from USDA officials and dairy organizations. The passage of the new law increased SMP funding by 20 percent in fiscal 1956 and by 25 percent more in fiscal 1957. More significantly, the new law extended the SMP to nursery schools, day care centers, summer camps, settlement houses, and "similar non-profit institutions devoted to the care and training of under-privileged children on a public welfare or charitable basis." 7 By 1959, gross federal spending exceeded $210 million on the lunch and milk programs operating in a wide variety of settings. Although both programs were administration initiatives, their maintenance and expansion became the hobbyhorse of Congress. In the final two years of the Eisenhower admini- stration, the huge surplus of the Commodity Credit Corporation, which had directly stimulated the SMP, began to ease. Coupled with a general fiscal conservatism, these circumstances led the administration, through the USDA, to oppose any increases in the SLP and seek a retrenchment of the SMP. The issue involved more than a change in farm surplus or fiscal policy. An important reason for the stagnation of nutrition programs for children in the 1950s was the decision to use that surplus

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93 abroad as an instrument of foreign policy (P.L. 480 and the Food for Peace Program). This decision reflected the exigencies of international relations and the impact domestic disposal was purported to have on prices. "The commodities contemplated to be set aside," Agriculture Secretary Benson explained, "are so large that it is not anticipated any substantial portion can be disposed of through domestic channels without disrupting markets and our future price support programs. The only solution to the problem," he concluded, "lies in recourse to distri- bution abroad." The nature of the agricultural market and foreign policy combined to prevent the expansion of the programs. Indeed, had it not been for Congress, the programs would have been curtailed. Against the administration's proposed cuts assembled the now familiar agricultural lobbies, school admini strators, PTAs, and newly formed food service organ~za- tions. At their prompting, citizens inundated Congress with protest letters over the cuts. Farmers did not want subsidized markets reduced nor did parents, educators, or service workers want reduced federal aid or increased costs. The SMP alone accounted for 2 percent of the aggregate fluid milk consumption and probably much more in terms of establishing the habit of drinking milk among children. One of every two school children drank SUP milk. The lunch program purchased $750 million in agricultural products. One of every three school children ate SLP lunches. Overall, approximately one third of the lunch costs were born by the federal government. When the administration attempted to retrench and restrain appro- priations for these programs on the grounds of the improved farm situation, it was overwhelmingly defeated in Congress. There was simply no support for the cuts and a phalanx opposed to them.~9 The administration's challenge did lead supporters of these programs to begin to rethink their heavy reliance on the farm surplus situation for justification. The surplus tended to have an amorphous quality, given form only in terms of the relationship of price to parity. The separa- tion of children's feeding programs from the "surplus" could well mean even higher prices for farmers without the usual criticisms of price support programs. To the various agricultural interests and their representatives, stressing nutritional need in these programs or allowing more input to educators and health specialists would not hamper the programs in their role as a market. Indeed, if need and nutrition were given sway, perhaps the programs might

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94 . expand beyond the constraints of surplus and parity. No farmer would turn down a price higher than parity. More- over, the support of members of Congress from nonfarm states would come more easily for food assistance than for price support. As long as it was not used to curtail any price support programs, nutritional need was a method of disposing of surplus agricultural products that was accept- able to the agricultural interests. The reorientation of federal feeding from surplus disposal toward nutritional need occurred slowly during the 1960s. The farm interests receded in preeminence and the educators, nutritionists, physicians, social workers, and service organizations moved into the forefront of federal policy for feeding children. Although federal policy leaned more toward nutrition than agriculture, the programs still drew political strength from their impact as a subsidy to American agriculture. For this reason they received a great deal of congressional support that would otherwise have been hostile to social welfare measures. On the other hand, a great deal of support that otherwise would have opposed farm subsidies found no objec- tion to feeding needy children and adults. In public opinion polls, food stamp programs (and by inference other feeding programs) enjoyed much greater popular approbation than either cash subsidies for the poor or price supports for farmers (see Appendix A). The Eisenhower administration was the last to argue for alterations in children's feeding programs based exclu- sively on changes in farm prices. When Kennedy assumed office, the USDA ceased its opposition to extension of the SMP and expansion of the SLP. Instead, the USDA became an advocate of reform and larger appropriations. Expansionist fiscal policies and an effort to restructure program allocations to reflect better participation rates and nutritional needs led the administration to propose increasing the funding of the SLP and changing the 1946 allocation formula. The old formula used per capita income and the school-age population as the bases for apportionment of federal funds, regardless of the actual participation rate. States therefore found it more financially advantageous to keep participation rates down. Congress revised this formula to reflect participation rates and followed an administration initiative to include a specific appropriation for needy children and schools. By 1962 the SLP and the SMP had been expanded to over $260 million and directed more toward need. This subtle shift in emphasis alienated no one, for funding was adjusted

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95 upward based on need. No middle-class children were dropped. Aggregate program expenditures on farm products rose. An expanding economic pie would bring the "other America" into the affluent society. 2 o Under the auspices of the Johnson administration, political recognition of America's poor people reached a level unattained since the prewar depression. The new administration's stress on need coupled with the burgeoning financial drain of the war in Vietnam spawned a White House drive to reorder the priorities in children's feeding programs and cut back the SMP by 80 percent in fiscal 1967. The drive commenced with Bureau of the Budget's directives to the USDA to withhold $3 million of the SMP appropriation for fiscal 1966. The reaction from the dairy and education interests was swift and predictable. Bureau of the Budget Director Charles Schultze wrote to outraged representatives and senators of "the increased Vietnam defense requirements" and the subsequent decision to hold SMP expenditures down to $100 million in fiscal 1966. Schultze felt compelled to inform the President of the vehement opposition to this S1' get cut and the ~nev~- able outcry against the $79 million cut proposed for fiscal 1967. In defense of this cut he added, "Why subsidize milk for wealthy Montgomery County school children"' He sought to restrict the SMP to needy children and schools without any lunch program. Aside from the losses to the dairy industry, the only problem the Bureau of the Budget foresaw was that schools with few needy children might drop the SMP if federal reimbursement were available only for the needy. The net savings of $65 million and the war demands on the budget outweighed these concerns. Whatever the merits of the arguments, Congress was not impressed. The thrust of the argument before Congress was that "the dairy situation is greatly improved now from what it was in 1954 . . . [and] the diversion of milk to avoid adding to surplus inventories is no longer a compelling oD~ecc~ve.-- The only remaining justification for a milk subsidy was financial need. The remaining $21 million provided adequately for needy children in the program. 2 2 Congress parried with the argument that need, though significant, could not be used to curtail a subsidy program. "This is," Representative Sisk told Agriculture Secretary Freeman, "no way to cure the ills of our dairy industry. . . ." SMP defenders added that middle-class children could be malnourished as well as poor ones. Finally, to the administration's exigencies-of-war plea, ~a

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140 8/61 Increase community voice in relief regulations: 55% Continue federal control as is: 29% No opinion: 16% 8/61 Physically able must work somewhere in public park, etc. for relief. Favor oppose No opinion 85% 9% 6% August 1961 November 1964 82% 12% 6% 1/69 Equalize welfare payments across the nation. Good idea: 77% Poor idea: 15% No opinion: 8% 6/71 Compel large firms to hire welfare recipients and pay three fourths of the salary with federal funds. YES NO NO OPINION 67% 27% 6%

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141 II. Food Stamps/Child Health Month/Year 8/37 Should federal government help state/local governments aid mother at childbirth with medical care? YES 81% NO 19% 10/39 Food stamps for relievers. Approve: 62% Disapprove: 26% No opinion: 12% Food stamps for families earning $20 per week or less? Approve: 57% Disapprove: 43% 3/69 Food stamps free to families making les than $20 per week? Favor: 68% Oppose: 25% No opinion: 7% s 3/69 Food stamps for families earning $20-60 per week at reduced cost. Favor: 60% Oppose: 31% No opinion: 9%

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142 III. Farm Aid Month/Year 9/49 Federal purchase of eggs/potatoes to support prices. Eggs Approve Disapprove Neutral 25% 61% 4% No opinion 10% Potatoes 30% 58% 4% 8% Federal guarantee of price for farmers Approve: 49% Disapprove: 45% No opinion: 6% 7/53 7/53 Federal government should continue to buy and store farm products to keep farm income up? Should: 72% Should not: 20% No opinion: 8% Should the President be allowed to send surplus food to famine nations? Should Should not: No opinion: 72% 20% 8% 8/55 What should federal government do with surplus food it has? Give it away: 76% Sell it: 14% Destroy it: 2% Give it to what country? U.S.: Needy country: Specific country (India, Korea, etc.): 50% 14% 36% 8/55 Give some to USSR as goodwill gesture? Good idea: 30% Poor idea: 60% Unsure: 6%

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143 Sell at reduced price to USSR? Good idea: 46% Poor idea: 44% Unsure: 10% 12/55 Idea of "soil bank," paying farmer not to grow? Good idea: 29% Poor idea: 47% Unsure: 24% Farmers only asked. Good idea: 49% Poor idea: 32% Unsure: 19% 8/61 Reliefer must take any job offered at going wage. August 1961 November 1964 Favor 84% 85% Oppose 10% 7% No opinion 6% 8% 8/61 Persons coming to new area must prove they are not doing so to obtain relief before it is granted. August 1961 November 1964 Favor 74% 69% Oppose 16% 22% No opinion 10% 9% 8/61 Force mother to name illegitimate child's father in court. August 1961 November 1964 Favor 73% 64% Oppose 16% 24% No opinion 11% 12% 11/64 Overall feelings on welfare. Favorable: 43% Mixed: 45% Abolish it: 6% No opinion: 6%

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144 11/64 Amount of money spent in your area on welfare. Too much: Not enough: About right: No opinion: 20% 18% 33% 29% Guaranteed annual incom 9/65 5/6812/68 Favor 19% 36%32% Oppose 67% 58%62% No opinion 14% 6%6% Guaranteed work to each family wage earner of certain income. Favor 78% Oppose 18% No opinion 4% May 1968 December 1968 79% 16% 5%

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