Medicare and hospital desegregation

In 1959, 83 percent of general hospitals in the North cared for patients on an integrated basis. In the South the figure was 6 percent. Black patients there were turned away or put on a separate ward, sometimes in the basement. The 1963 Simkins decision struck down the separate-facilities clause of the Hill-Burton Act, and it helped secure Title VI of the Civil Rights Act of 1964, which barred federal money from any program that discriminated by race.

Through 1965 Title VI did little to change segregated care in hospitals built with Hill-Burton money. According to David Barton Smith, who has studied the campaign, its implications were never mentioned while Congress debated Medicare in 1965. Medicare, due to start on 1 July 1966, changed that: a hospital had to be certified as complying with Title VI before it could be paid. Nearly 7,500 hospitals had to be certified for safety standards and Title VI, while 19 million older Americans were enrolled. The office set up in March 1966 to do the civil rights certification had a staff of five.

John Gardner, Secretary of Health, Education, and Welfare, recast his department as a civil rights agency in a memo at the end of December 1965. Almost 1,000 civil servants volunteered for temporary duty as hospital inspectors, among them Public Health Service officers, laboratory scientists and local Social Security staff, and about 60 medical students joined them for the summer. Physicians and members of the Medical Committee for Human Rights, the National Medical Association and the NAACP Legal Defense Fund helped train them. The guidelines were specific, and no hospital was to be certified without full compliance. Local activists were urged to file complaints where they knew of violations.

More than 1,000 hospitals integrated their medical staffs, waiting rooms and floors in less than four months. When Medicare began, 97 percent of the country's acute hospital beds were in hospitals that complied with Title VI and took part in the program. The effort stopped at the hospital door. No one inspected nursing homes for compliance, and physicians were specifically exempted from Title VI.