The Medicare Hospital Certification Program Oral Histories: NIH Staff Volunteering Against Segregation

In March and April 2021, Gordon Margolin, M.D., a volunteer in the Office of NIH History and Stetten Museum, conducted oral histories of NIH staff who had volunteered to visit hospitals in the southern United States to certify that they had desegregated before the Medicare Act went into effect July 1, 1966. Each volunteer had his own unique experience.

Black Americans in the South experienced slavery and the constraints of the Jim Crow era, both of which included a marked difference in medical treatment and hospital facilities as compared to White Americans in the South. The enactment of the Hospital Survey and Construction Act in July 1946 provided funds for hospital construction in an effort to provide better medical care for all Americans. Called the Hill-Burton Act after its sponsors, Senator Harold Burton of Ohio and Senator Lister Hill of Alabama, the construction funds were contingent upon guarantee of equal treatment of people of all races, color, creeds, or national origin. Because there was no regulation component, however, the Hill-Burton Act did not perform as hoped in offering medical care to all.

In 1964, the Civil Rights Act, signed by President Lyndon Johnson, outlawed discrimination on the basis of race, color, religion, sex, or national origin, required equal access to public places and employment, and enforced desegregation of schools and the right to vote. Similar to the Hill-Burton Act, the Civil Rights Act did not achieve the desired effect in desegregating medical care and facilities.

However, passage of the Medicare Act, set to become law on July 1,1966, provided an incentive to hospitals to integrate as well as Federal oversight: Medicare funds would be withheld from hospitals which failed to comply with the new law and its explicit requirement of equal treatment and care for all Americans. Opposition to this law was extensive, both by community and hospital officials and by organizations such as the Ku Klux Klan. Recognizing that the effective date of Medicare was fast approaching, the Federal government decided to send representatives to the South to assess if hospitals had complied with desegregation requirements. Federal employees were recruited on a volunteer basis to visit hospitals across the South. The four Public Health Service officers listed below were NIH staff members at the time who responded to the call to join this project. Because these interviews capture the memories of events that took place several decades ago, some minor corrections and clarifying words, mostly marked in brackets, were added or substituted upon further reflection.

Dr. Paul Plotz, National Institute of Arthritis and Musculoskeletal and Skin Diseases:

In 1966, Dr. Paul Plotz visited rural hospitals along the Mississippi Gulf Coast and the southwest corner of Tennessee to see if they were integrated in compliance with the Medicare Act. His oral history discusses how the Public Health Service staff trained for their visits and some of his experiences in the South, both congenial and threatening.

Dr. Stanley Rapoport, National Institute of Mental Health:

In 1965, Dr. Stanley Rapoport went on an information-gathering trip to Bogalusa, Louisiana, to see if the Charity Hospital was integrating per the Hill-Burton Act. He met with representatives of the Congress of Racial Equality, stayed with members of the Deacons for the Defense and Justice, faced intimidation by the Ku Klux Klan, and was arrested. His visit became a training lesson for the NIH Public Health Service officers who followed the next year to enforce Medicare regulations on integration.

Dr. Norman Robbins, National Institute of Neurological Disorders and Stroke:

Dr. Norman Robbins visited Jackson, Mississippi in 1966 to see if hospitals in the area were integrating. He touches on the negotiating skills he learned before going, the varying attitudes of the medical community in the South toward integration, and the results of the trip. He witnessed the police beating marchers in Canton, Mississippi, and was threatened at gunpoint when he tried to help the injured.

Dr. Jesse Roth, National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases:

After facing discrimination when he grew up because he was Jewish, Dr. Jesse Roth volunteered to go to West Virginia to inspect hospitals for compliance with the Medicare Act. He discusses how they used scouts to get information about the hospitals, the relationship between rural hospitals and the Federal government, social activism at the NIH, and helping during the 1968 riots in Washington, D.C.

For more information:

Burrows, Vanessa and Barbara Berney. "Creating Equal Health Opportunity: How the Medical Civil Rights Movement and the Johnson Administration Desegregated U.S. Hospitals," Journal of American History, Volume 105, Issue 4, March 2019, Pages 885–911.

Dittmer, John. The Good Doctors. 2009 New York Bloomsbury Press.

Reynolds, PP. “The Federal Government’s Use of Title VI and Medicare to Racially Integrate Hospitals in the United States,” American Journal of Public Health, Nov. 1997, 87:1851-58.

"Power to Heal," BLB Film Productions, Ltd., PBS, 2015.