155478 Title VI and Health Care Discrimination

Monday, November 5, 2007: 12:30 PM

Joel B. Teitelbaum, JD, LLM , Department of Health Policy, George Washington University, Washington, DC
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.

Learning Objectives:
1. Describe the scope of Title VI of the 1964 Civil Rights Act, including its link to health care financing 2. Describe Title VI's limitations in the context of health. 3. Describe how the Supreme Court's decision in the case of Alexander v. Sandoval undercut the Title VI enforcement scheme. 4. Recognize how various federal agencies in non-health contexts have attempted to fulfill their Title VI enforcement responsibilities. 5. Assess ways in which Title VI enforcement in health care can be made stronder going forward.

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.