Hill-Burton Act

Signed into law in 1946 by President Harry S. Truman, the Hill-Burton Act represented the most significant expansion of federal regulation of the healthcare industry since the United States conception.  The act provided federal funding for healthcare facility modernization and construction.  These facilities were required to treat patients with demonstrated low income or financial inability for a free or reduced cost.  Created as a response to the significant need for affordable healthcare options post World War 2, its passage drew significant criticism from the American Medical Association who saw a foray into socialized medicine occurring (Almond, 2011).  In order to qualify for this program, patients cannot simultaneously be receiving insurance coverage from any other provider, and, through this act, U.S. residents, including non-citizens who have lived in the U.S. for at least three months, can access free/low-cost health insurance. One caveat of the program is that there is a threshold of free care that a medical facility is required to meet, once that is met however they can stop offering free or reduced care (Brinker, 1962).  This program stopped its funding of hospitals for the purpose of modernization in 1997, but in the 51 years that the program has bene running, uninsured patients have received benefits amounting over $6 billion in healthcare services (“Hill-Burton Free and Reduced-Cost Health Care”).

By the year 1975, this Act was the reason for one-third of hospital construction, and 40% of these new facilities were located in counties that could not boast a single hospital prior to the act. These 6,800 facilities (hospitals, rehabilitation and long-term care clinics) spread across 4000 communities in the United States, and while they had originally been funded by the government, they were soon able to sustain themselves – thus accomplishing Truman’s mission to create a sustainable solution to improve national health (Schumann, 2016). On an individual level, each facility, on average, spent $221,100 on charity care (in the name of the act), but the vast majority of this money was spent on maternity care – which only represented 9% of the total population applying for this kind of care (“Hill-Burton Free and Reduced-Cost Health Care”).  Despite these statistics, it is important to note that care at Hill-Burton established medical centers are not automatically free.  In order for an individual to receive subsidized care, they must apply at the facility and be found eligible to receive reduced-cost care.  While you can apply at any process of your treatment (before, during, or even after), only the costs of the medical facility are covered.  Your interactions with private doctors are not.

Since this charity care began to resonate with the overall American identity, the United States set a precedent of caring for the uninsured. Thus, to this day, Hill-Burton and non-profit hospitals are still obligated to provide free/subsidized care to qualified patients in order to remain tax-exempt. Additionally, as a result of Hill-Burton, the concept of matching federal subsidies with money from state governments was created – which is the process in which Medicaid is financed (Almond, 2011).

Truman’s act was viewed as, “an example, warts and all, of how a bipartisan Congress can forge compromises to bolster American infrastructure and boost the well-being of our people” (Schumann, 2016). Following World War II, Truman outlined his plan to improve national healthcare in a 5-pronged approach. The first, and least controversial, issue addressed the need to construct new hospitals and clinics to serve an ever-growing population. The second prong took note of the need to improve maternal health services. With regard to the third issue, Truman yearned to increase the amount of money invested in medical research and education.  The fourth and fifth prongs, the most controversial, sought to address the high cost of medical care that burdens low income individuals (Markel, 2014). These prongs were very controversial because they would put into place a requirement for healthcare facilities to treat those that were not citizens (“Hill-Burton Free and Reduced-Cost Health Care”).

While many of the effects of Hill-Burton have been displayed in a positive light, in order to have this act passed by both republicans and democrats alike, Republican Senator Harold Burton and Democratic Senator Lister Hill based their legislation on the concept of “separate but equal” institutions – leading to institutionalized racism at the level of the federal government (“Hill-Burton ‘Separate But Equal’ Provision Unconstitutional”, 1961). This compromise allowed for the act to get enough support from both sides in order to pass and appeased those who were concerned about the act being too liberal for serving the needs of non-citizens. In 1963, this aspect of the law was called into question and, consequently, overturned, and since this overturning, “Hill-Burton went on to become a major driver of hospital desegregation” (Schumann, 2016). By legally setting this precedent, government agents were able to specifically target segregation in hospitals and refuse to continue funding those facilities which reinforced segregation. This is directly related to the politics of health because of its correlation with historical trauma (Mohatt, 2014). Since the United States’ government agencies have a history of discriminating against African Americans, this institutionalized segregation that was deemed necessary in order to pass the bill exacerbates racial tensions and compounds the amount of historical trauma this minority group must face. Moreover, this segregation in the healthcare sector, in particular, perpetuates poor health in African Americans because they are consistently marginalized and without equal access to healthcare services, they will continue to be at a disadvantage.  Furthermore, the Hill-Burton Act interestingly intersects with the concept of therapeutic citizenship, or the biomedical form of government that objectifies and classifies citizens based on their biological condition.  In this situation, an individual is only able to receive care if they are resource poor, and have access to a facility.  Because of this, the Hill-Burton act is marginalizing populations and classifying citizens.

Works Cited

Almond, Douglas, Janet Currie, and Emilia Simeonova. “Public vs. private provision of charity 12342care? Evidence from the expiration of Hill–Burton requirements in Florida.” Journal of 12342health economics. January 2011. Accessed February 16, 2017. 12345https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809144/.

Brinker, Paul A., and Burley Walker. “The Hill-Burton Act: 1948-1954.” The Review of 12345Economics and Statistics 44, no. 2 (1962): 208-12. doi:10.2307/1928204.

“Hill-Burton Free and Reduced-Cost Health Care.” Hill-Burton Free and Reduced-Cost Health 12345Care. Accessed February 16, 2017. 12345https://www.hrsa.gov/gethealthcare/affordable/hillburton/.

“Hill-Burton ‘Separate But Equal’ Provision Unconstitutional.” Journal of the National Medical 12345Association. November 1961. Accessed April 03, 2017. 12345https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642060/.

Markel, Dr. Howard. “69 years ago, a president pitches his idea for national health care.” PBS. 12345Accessed April 02, 2017. http://www.pbs.org/newshour/updates/november-19-1945-harry-12345truman-calls-national-health-insurance-program/.

Mohatt, Nathaniel Vincent et al. 2014. Historical Trauma as Public Narrative: A Conceptual 12345Review of how history impacts present-day health. Social Science & Medicine 106:128-12345136.

Schumann, John Henning. “A Bygone Era: When Bipartisanship Led To Health Care 12345Transformation.” NPR. October 02, 2016. Accessed February 16, 2017. 12345http://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-12345bipartisanship-led-to-health-care-transformation.