“I'm from the federal government, and I'm here to help you…desegregate your hospital”: Medicare and hospital desegregation

The desegregation of American hospitals in preparation for Medicare's rollout was characterized by commitment at the top and passion all around. The implementation of Medicare dramatically improved access to health care for millions of elderly Americans by minimizing the burden of medical expenses. However, Medicare not only revolutionized healthcare access by reducing economic barriers, but also by rooting out racial discrimination in hospital care. President Johnson demanded that before any hospital could receive Medicare funds, it would have to demonstrate compliance with the nondiscrimination standards of Title VI of the Civil Rights Act of 1964. In response to President Johnson's requirement, HEW recruited hundreds of volunteers from the federal bureaucracy who, with critical assistance from civil rights activists, inspected 1000s of hospitals to get them into compliance with the Act. In April 1966 less than half of hospitals nationally and only 25% in the South were in compliance. Through a combination of personal acts of courage, remarkable on-the-ground data gathering, and a fierce bureaucratic commitment to achieving equity, more than 1000 hospitals were desegregated in 4 months. By demanding that hospitals receiving Medicare funds provide equal access and care without regard to race, Johnson revolutionized the rights of citizenship for African Americans (and other people of color). But at the same time, at a critical point in the maturation of medical science and growth of hospitals as fundamental community resources, Johnson's insistence on nondiscriminatory healthcare as a pillar of the expanded social safety net recognized healthcare as a civil right for all Americans. The history of this brief period is exciting, compelling, and has many lessons about what it takes to move a social change agenda and the impact of federal policy and action on assuring equality in health care. This is particularly relevant today as we embark on a new phase of health care reform. This presentation will include video of interviews with principal participants in the desegregation process including both civil rights activists, health professionals and federal employees. Video will include visual evidence of living and health conditions and provision of health care in the 1960s.