The ability to access quality health care services for the majority of the black population has been largely due to federal government policies and initiatives designed to address long-standing, systemic barriers to medical care for African Americans. As part of the White House’s Black History Month panel co-hosted by the Association for the Study for African American Life and History (ASALH) this past Wednesday, I had an opportunity to elaborate on this history by discussing the significance of the Affordable Care Act and rejection of the Medicaid expansion by southern states within the context of the ongoing struggle for health equity in the U.S.
While my research examines the interaction of racial politics with efforts to pass large-scale health reform from the New Deal to the ongoing opposition to the ACA, focusing on this year’s 50th anniversary of the passage of Medicare and Medicaid offered an opportunity to shine light on how important these programs have been in reducing the discrimination and institutional racism that were once hallmarks of American health care.
For a good part of the 20th century American health care was segregated and national health care policy like the Hill-Burton Hospital Construction Act was structured by powerful Southern legislators who used states’ rights as the guiding principle for incrementally expanding federal involvement in health care while maintaining “separate but equal” facilities throughout the South. The deeply entrenched Jim Crow system of segregated hospitals in the South often relegated blacks to substandard care and denial of admission to white hospitals even as black patients experienced life-threatening emergencies right outside their doors. Moreover, African American health care providers were excluded from membership in professional associations such as the American Medical Association that were crucially important for credentialing purposes and hospital admission privileges.
When Medicare went into effect in 1966, the Johnson administration used the Civil Rights Act as the basis for requiring hospitals to desegregate as a condition for receiving Medicare funds. By pulling this important policy lever, the Johnson administration ushered a relatively swift end to the Jim Crow hospital system in the South.
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