Online Program

Oral

That the passage and implementation of Medicare meant the biggest single expansion of access to health care that the US had ever experienced is well known, but the fact that it expanded health care to African Americans and other people of color by requiring hospitals to desegregate is little known even to health and civil rights activists. Fifty years ago the nation faced a seemingly insurmountable challenge: How to implement the Medicare Act of 1965 and comply with Title VI of the Civil Rights Act of 1964 that prohibited the allocation of funds to institutions that practiced racial discrimination. By December 1965 civil rights groups had submitted more than 300 Title VI complaints against hospitals and were demanding strict enforcement as a condition of receiving Medicare funds. Less than half of U.S. hospitals served African Americans equally. In the South, only 25% did, and many refused to serve African Americans at all. The Department of Health Education and Welfare (HEW) faced a huge dilemma. The Under Secretary of Health was ambivalent about refusing funds to segregated hospitals. HEW had to implement the massive Medicare program in just a few months on July 1, 1966. It had no funds to staff a Title VI enforcement effort nor any prospects of getting them from Congress. Nevertheless, in March 1966 the federal government entered into the highest stakes gamble in domestic program history, organizing a massive hospital inspection effort to ensure that no hospital practicing racial discrimination would receive Medicare funding. Chased by the Klan and followed by the police, the federal employees who volunteered to inspect hospitals, drove down dirt roads seeking out patients and hospital workers in the Black community to collect information. They met with hospital administrators, some polite and cooperative; some belligerent and resistant. With crucial help from the civil rights movement they were successful. By the implementation of Medicare on July 1st, more than 90 percent of the nation’s hospitals were certified to be in compliance with the Civil Rights Act. Much to the surprise of both the advocates and critics of this policy, the nation’s hospitals were desegregated, largely in secret and almost overnight. Disparities in health care use by race and income largely disappeared and disparities in health narrowed. The panel and filmed excerpts of a new documentary with actual participants will discuss how hospitals were transformed from the most racially and economically segregated private institutions in the nation to our most integrated and the lessons it offers to current struggles in addressing disparities in access and health.

Session Objectives: Explain how Medicare was used to desegregate thousands of hospitals in a few months. Identify and analyze the forces and people who supported, opposed and were ambivalent about using Medicare to desegregate hospitals. Compare the role of the federal government in the struggle for health equity now and in 1966.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)