By MIKE MAGEE
If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only visit America’s Nursing Homes.
This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.
President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”
Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.
Ever the political pragmatist, President Johnson had focused instead on Medicare and hospital compliance, rather than Medicaid and Nursing Homes. And that alone was a pitched battle at the time.
In the 1960s, hospitals throughout the South still maintained segregated restrooms and segregated floors and wards designed to separate black and white populations. The passage of the Civil Rights Act in July 1964 had sent a clear warning: Title VI of the bill stated, “No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, denied benefits of, or be subject to discrimination under any program receiving federal assistance.”
Johnson deployed 1,000 federal inspectors across the country to ensure that the letter of the law was being implemented. Even with this,