The Historical Trajectory of Civil Rights Enforcement in Health Care

Journal of Policy History

Volumn 18, Issue 3, 2006, Pages 362-386

  Bonastia, Christopher ^a  

^a CITY UNIVERSITY OF NEW YORK   (United States)

Author keywords

[No Author keywords available]

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EID: 77958593352     PISSN: 08980306     EISSN: 15284190     Source Type: Journal    
DOI: 10.1353/jph.2006.0006     Document Type: Article

References (86)

1. See Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (Washington, D.C. 2002).
2. Kaiser Family Foundation, “Trends and Indicators in the Changing Health Care Marketplace,” accessed on 19 September 2005 at http://www.kff.org/insurance/ 7031/ index.cfm.
3. See also Cynthia Smith et al. “Health Spending Growth Slows in 2003,” Health Affairs (January-February 2005).
4. See Rufus E. Miles, The Department of Health, Education, and Welfare (New York, 1974)
5. David Barton Smith, Health Care Divided: Race and Healing a Nation (Ann Arbor, 1999)
6. Jill S. Quadagno, “Promoting Civil Rights Through the Welfare State: How Medicare Integrated Southern Hospitals,” Social Problems 47 (February 2000): 68-89;
7. U.S. Commission on Civil Rights, Federal Title VI Enforcement to Ensure Nondiscrimination in Federally Assisted Programs (Washington, D.C. 1996).
8. Ruth T. Perot and Mara Youdelman, “Racial, Ethnic, and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices” (2001). Commonwealth Fund (www.cmwf.org).
9. Thomas Perez, “The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status,” in Institute of Medicine, Unequal Treatment.
10. Sara Rosenbaum, Anne Markus, and Julie Darnell, “U.S. Civil Rights Policy and Access to Health Care by Minority Americans: Implications for a Changing Health Care System,” Medical Care Research and Review 57, supplement 1 (2000): 241.
11. Medical Care Research and Review;
12. Marian Gornick, Vulnerable Populations and Medicare Services: Why Do Disparities Exist? (New York, 2000).
13. See also Bryan v. Koch (1980). A 1990 Circuit Court decision, Women's Equity Action League v. Cavazoz, concluded that the procedures used by HHS to enforce the law are the agency's exclusive discretion and are not reviewable by the courts (Smith, Health Care Divided).
14. Rosenbaum et al. “U.S. Civil Rights Policy and Access to Health Care by Minority Americans.”
15. Smith, Health Care Divided, 162.
16. David Barton Smith, “Racial and Ethnic Health Disparities and the Unfinished Civil Rights Agenda,” Health Affairs, March-April 2005. Smith contends that one major consequence of this exemption was the federal failure to collect data on discriminatory medical treatment, despite the regulatory authority to do so.
17. Sara Rosenbaum and Joel Teitelbaum, “Civil Rights Enforcement in the Modern Healthcare System: Reinvigorating the Role of the Federal Government in the Aftermath of Alexander v. Sandoval,” Yale Journal of Health Policy, Law and, Ethics 3 (Summer, 2003), 215.
18. Smith et al. “Health Spending Growth Slows in 2003.”
19. The agreement took shape before the EEOC got its enforcement powers. See Karen E. DeWitt, “Labor Report/Strengthened EEOC Accelerates Action Against Business, Labor Employee Discrimination,” National Journal, 23 June 1973, 913–21;
20. Equal Employment Opportunity Commission, “Milestones in the History of the U.S. Equal Employment Opportunity Commission,” http://www.eeoc.gov/abouteeoc/35th/milestones.
21. DeWitt, “Labor Report,” 913.
22. Labor Report 920.
23. See Smith, Health Care Divided; Miles, The Department of Health, Education, and Welfare; and Quadagno, “Promoting Civil Rights Through the Welfare State.”
24. Quoted in “The Civil Rights Enforcement Program in the Health and Social Service Programs of the U.S. Department of Health, Education, and Welfare: Policy Paper for a New Direction and Approach,” box I:143, Folder: Health Task Force, p. 9, LCCR, LoC.
25. House Judiciary/Civil Rights and Constitutional Rights Subcommittee, “Title VI Enforcement in Medicare and Medicaid Programs,” 12, 17, 24 September and 1 October 1973 (hereafter HJC 1973), 24.
26. Testimony of Robert E. Iffert Jr. HJC 1973, p. 23. See also Kenneth Wing, “Title VI and Health Facilities: Forms without Substance,” Hastings Law Journal 30 (1978): 137-90.
27. U.S. Commission on Civil Rights, HEW and Title VI (Washington, D.C. 1970).
28. For earlier data, see Wing, “Title VI and Health Facilities.” For data from the 1980s and 1990s, see U.S. Commission on Civil Rights, Federal Title VI Enforcement to Ensure Nondiscrimination in Federally Assisted Programs.
29. Smith, “Racial and Ethnic Health Disparities and the Unfinished Civil Rights Agenda.”
30. Wing, “Title VI and Health Facilities,” 144.
31. Smith, Health Care Divided, 102. For historical background on this case
32. Health Care Divided
33. Smith, Health Care Divided
34. Preston P. Reynolds, “Hospitals and Civil Rights, 1945-1963: The Case of Simkins v. Moses H. Cone Memorial Hospital,” Annals of Internal Medicine 126 (1997): 898-906.
35. Wing, “Title VI and Health Facilities,” 146.
36. “OCR Historical Records, Title VI Implementation,” Reel 1, part 2, chap. 3, p. 47
37. Department of Health Education and Welfare (1963-1969): Official History and Documents (microfilm) (Frederick, Md.: 1983). Hereafter HEW.
38. Miles, The Department of Health, Education, and Welfare, 252.
39. See also U.S. Commission on Civil Rights, Title VI. One Year After: A Survey of Desegregation of Health and Welfare Services in the South (Washington, D.C. 1966).
40. With this new arrangement, direct Title VI appropriations were made by Congress. Under the prior approach, no separate Title VI funds were allocated to the various agencies within HEW. See “OCR Title VI Report,” Reel 2, part 1, chap. 5, p. 2, HEW.
41. See Hugh Davis Graham, “The Politics of Clientele Capture: Civil Rights Policy and the Reagan Administration,” 103–19, in Redefining Equality, ed. Neal Devins and Davison M. Douglas (New York, 1998).
42. U.S. Commission on Civil Rights, HEW and Title VI, vi.
43. “The Department of Health, Education, and Welfare During the Administration of President Lyndon B. Johnson,” Reel 1, part 1, pp. 1–2, HEW.
44. Miles, The Department of Health, Education, and Welfare, 247.
45. General Accounting Office, “Compliance with Antidiscrimination Provision of Civil Rights Act by Hospitals and Other Facilities Under Medicare and Medicaid” (Washington, D.C. 1973), 14.
46. HJC 1973, 166.
47. Leadership Conference on Civil Rights Task Force, “The Civil Rights Enforcement Program in the Health and Social Services Programs of the U.S. Dept. of Health, Education, and Welfare: Policy Paper for a New Direction and Approach,” circa 1977, box I:143, Folder: Health Task Force, LCCR, LoC.
48. Letter, Law Offices of Rauh, Silard and Lichtman to Patricia Roberts Harris, 10 August 1979, Box 53, Folder: OCR 1979, Patricia Roberts Harris Papers, LoC.
49. “OCR Review,” box 298, Folder: OCR Review 5/16/80, Harris Papers.
50. Graham, “Civil Rights Policy in the Carter Presidency.”
51. “OCR Review,” box 298, Folder: OCR Review 5/16/80, p. I-1, Harris Papers.
52. Harrison Donnelly, “Equality for the Handicapped: Can the Nation Afford It?” Congressional Quarterly (31 May 1980): 1505-9.
53. “Memorandum for the Heads of Executive Departments and Agencies,” 20 July 1977, box 4, Civil Rights Act of 1964 Title VI, Martha (Bunny) Mitchell Papers, CPM. The memo also notes that “administrative proceedings leading to fund terminations are the preferred method of enforcing Title VI, and this sanction must be utilized in appropriate cases. The effective use of the sanctions provided by Title VI is an essential element of this Administration's effort to guarantee that Federal funds do not flow to discriminatory programs.”
54. “Department of Education: What's It All About-Some Questions and Answers (May 1979),” box 285, Folder: Education, Department of Proposal 8/22/79, Harris Papers.
55. “OCR Review,” Folder: OCR Review 5/16/80, p. II-2, Harris Papers.
56. See, for example, Pierson, Dismantling the Welfare State? (New York, 1994)
57. Steven A. Shull, The President and Civil Rights Policy: Leadership and Change (New York, 1989).
58. See, for example, Pierson, Dismantling the Welfare State?; Skocpol, Protecting Soldiers and Mothers (Cambridge, Mass. 1992)
59. and Margaret Weir, Politics and Jobs (Princeton, 1992).
60. For an overview of historical institutionalism, see Kathleen Thelen and Sven Steinmo, “Historical Institutionalism in Comparative Politics,” in Structuring Politics: Historical Institutionalism in Comparative Analysis, ed. Sven Steinmo, Kathleen Thelen, and Frank Longstreth (New York, 1992), 1-32.
61. On civil rights policies, see, for example, John D. Skrentny, The Minority Rights Revolution (Cambridge, Mass. 2002), and
62. Christopher Bonastia, Knocking on the Door: The Federal Government's Attempt to Desegregate the Suburbs (Princeton, 2006).
63. On policy legacies, see Theda Skocpol, Protecting Soldiers and Mothers;
64. Pierson, Dismantling the Welfare State? and Weir, Politics and Jobs.
65. Rochelle L. Stanfield, “Reagan Courting Women, Minorities, But It May Be Too Late to Win Them,” National Journal, 28 May 1983), 1118–23.
66. House Government Operations/Intergovernmental Relations and Human Resources Subcommittee, “Oversight of the Office for Civil Rights at the Department of Health and Human Services” (6 and 7 August 1978), 84.
67. Nancy DeLew and Robin M. Weinick, “An Overview: Eliminating Racial, Ethnic, and SES Disparities in Health Care,” Health Care Financing Review 21, no. 4.
68. HHS, “Healthy People 2010: Understanding and Improving Health,” (Washington, D.C. 2003).
69. HHS Title VI Regulation, 45 CFR 80.6.
70. Perez, “The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status,” 651.
71. Perot and Youdelman, “Racial, Ethnic, and Primary Language Data Collection in the Health Care System,” 25.
72. Michelle van Ryn and Jane Burke, “The Effect of Patient Race and Socio- Economic Status on Physicians' Perceptions of Patients,” Social Science and Medicine 50 (2000): 813–28.
73. See Harold Luft, “Why Are Physicians So Upset about Managed Care?” Journal of Health Politics, Policy and Law 24, no. 5: (1999) 957–66
74. Jill S. Quadagno, “Why the United States Has No National Health Insurance: Stakeholder Mobilization Against the Welfare State, 1945-1996,” Journal of Health and Social Behavior 45: (2004) 25–44. On the public-sector side, since 2000 OCR has considered Medicare payments to physicians to be a form of federal financial assistance, suggesting that doctors now fall under Title VI regulations.
75. See Rosenbaum and Teitelbaum, “Civil Rights Enforcement in the Modern Healthcare System.”
76. “AMA announces new program to tackle health care disparities,” 11 December 2002, accessed 3 April 2003 at www.ama-assn.org/ama. At the same site
77. see also “Perception vs. Reality” and “AMA collaborates with others in new health disparities initiative,” 17 February 2003.
78. See Kaiser Family Foundation, “Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence (Summary Report)” (Menlo Park, Calif. 2002).
79. H. Jack Geiger, “Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes,” Papers in Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (Washington, D.C. 2002).
80. The same argument is made in David Barton Smith, “Eliminate the Disparities in Treatment: The Link to Healing a Nation,” Journal of Healthcare Management 47, no. 3: 156–60.
81. The other primary literature review in this area, by Mayberry et al. finds that the evidence for racial disparities in treatment varies according to disease category and service type. They find the evidence for disparate treatment to be relatively strong in the area of heart disease and stroke, and somewhat less conclusive in areas such as cancer, HIV/AIDS, diabetes, and mental health. Mayberry and his colleagues urge further research into the causes of racial health disparities, which remain “poorly understood.” See Robert M. Mayberry, Fatimi Mili, and Elizabeth Ofili, “Racial and Ethnic Differences in Access to Medical Care,” Medical Care Research and Review 57, supplement 1 (2000): 131.
82. On civil rights staffs and budgets, see U.S. Commission on Civil Rights, Federal Title VI Enforcement to Ensure Nondiscrimination in Federally Assisted Programs. On reductions in OCR staffing, see Perez, “The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status.” On the poor use of resources
83. see U.S. Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality, vol. 2 (Washington, D.C. 1999).
84. Rosenbaum and Teitelbaum, “Civil Rights Enforcement in the Modern Healthcare System.”
85. Remarks by Sara K. Pratt, National Fair Housing Research and Policy Forum, Washington, D.C. 13 March 2004.
86. Leadership Conference on Civil Rights, “Position Paper on Administration of Civil Rights Programs,” box 164, Civil Rights/Liberties-Minorities (General), Domestic Policy Staff Files: Eizenstat, CPM.