Title VI and Health Care Discrimination

The 1964 Civil Rights Act created a broad remedial structure to end discrimination across sectors of American society. Title VI of the Act—which prohibits discrimination on the basis of race, color, or national origin by recipients of federal financial assistance—has dominated legal analysis of race and health because of the enormous reach of federal funding in the health care system. However, Title VI is not without its limits: It does not reach purely private conduct; physicians whose sole source of federal funding comes from Medicare Part B are exempt from Title VI's prohibitions; the federal office responsible for enforcing Title VI in a health context is under-resourced and operationally distinct from federal health care financing; and the U.S. Supreme Court, in Alexander v. Sandoval, dramatically undercut the ability of private individuals to enforce their rights under Title VI (Sandoval prevents individuals from enforcing what are known as Title VI's “disproportionate adverse impact” regulations, even though the legislative history of Title VI reveals that both deliberate acts and conduct that unintentionally results in harm to racial minorities were a driving force behind the law's enactment). In addition to the aforementioned concerns, this presentation will consider how federal agencies in the areas of environmental protection, housing, and education carry out their Title VI enforcement responsibilities relative to the U.S. Department of Health and Human Services, and how to strengthen the role of Title VI in health care moving forward.