I’ve decided to start a new Queen’s Category:  U.S. FEDERAL LAWS CURRENTLY ON THE BOOKS THAT ARE NOT ENFORCED AND/OR THAT ORDINARY AMERICANS ARE UNAWARE OF AND COULD PERHAPS BENEFIT FROM KNOWING.  I’ll shorten the category name to “Existing Laws”.  The poor and the middle class often have resources that they are not even aware that exist.  In the coming new year, I promise to uncover at least one of these a month and report on it here at the Queen’s home.

To being with, I have selected the Hill-Burton Act of 1946.

I find it interesting that much of the dissent to the progressive movement comes from people in Southern states when in fact it is actually these people who have benefited the most from these programs.  Using the Hill-Burton Act as but one example:  Hill-Burton was the last and perhaps the most progressive expression of redistributive New Deal liberalism. Many have judged the act to be one of the most ambitious efforts for the development of social capital to that time. Hill-Burton was the first federal program to incorporate a graduated, need-based allocation formula that favored the South, paving the way for federal sponsorship of health, education, and welfare as well as costly new infrastructure that made Sun Belt prosperity possible while allowing southern states to maintain low taxes. As an outgrowth of Florida Democratic senator Claude D. Pepper’s Subcommittee on Wartime Health and Education, Hill-Burton was among the first and most successful examples of a new postwar brand of federal reform that garnered bipartisan support by blending centralized planning, economic development, and a rationale for domestic spending based on national defense. Hill-Burton also fostered the growth of institution-based, capital- and technology-intensive medicine in the South. About 20 percent of projects aided teaching hospitals, including the burgeoning new academic medical centers at the state universities of Alabama, North Carolina, Texas, and Florida.

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The Hospital Survey and Construction Act (or the Hill-Burton Act) is a U.S. Federal law passed in 1946, during the 79th United States Congress. It was sponsored by Senator Harold Burton of Ohio and Senator Lister Hill of Alabama. Senator Burton was a Republican and Senator Hill a Democrat.

The Act responded to the first of President Truman’s proposals and was designed to provide federal grants and guaranteed loans to improve the physical plant of the nation’s hospital system. Money was designated to the states to achieve 4.5 beds per 1,000 people. The states allocated the available money to their various municipalities, but the law provided for a rotation mechanism, so that an area that received funding moved to the bottom of the list for further funding.

Facilities that received Hill-Burton funding had to adhere to several requirements:

• They were not allowed to discriminate based on race, color, national origin, or creed, though separate but equal facilities in the same area were allowed. The U.S. Supreme Court struck down this segregation in 1963.
• Facilities that received funding were also required to provide a ‘reasonable volume’ of free care each year for those residents in the facility’s area who needed care but could not afford to pay. Hospitals were initially required to provide uncompensated care for 20 years after receiving funding. The federal money was also only provided in cases where the state and local municipality were willing and able to match the federal grant or loan, so that the federal portion only accounted for one third of the total construction or renovation cost.
• The states and localities were also required to prove the economic viability of the facility in question. This excluded the poorest municipalities from the Hill-Burton program; the majority of funding went to middle class areas. It also served to prop up hospitals that were economically nonviable, retarding the development wrought by market forces. Once Medicare and Medicaid were enacted, participation in those programs was added to the list of requirements for access to Hill-Burton funding.

For the first 20 years of the act’s existence, there was no regulation in place to define what constituted a “reasonable volume” or to ensure that hospitals were providing any free care at all. This did not improve until the early 1970s, when lawyers representing poor people began suing hospitals for not abiding by the law.

Hill-Burton was set to expire in June 1973, but it was extended for one year in the last hour. In 1975, the Act was amended and became Title XVI of the Public Health Service Act. The most significant changes at this point were the addition of some regulatory mechanisms (defining what constitutes the inability to pay) and the move from a 20-year commitment to a requirement to provide free care in perpetuity. Still, it was not until 1979 that compliance levels were defined.

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QUEEN’S ACTIVISM:    PRACTICAL IMPLICATIONS FOR THE POOR

Hill-Burton Free and Reduced-Cost Health Care

In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 200 health care facilities nationwide are still obligated to provide free or reduced-cost care.

Steps to Apply for Hill-Burton Free or Reduced-Cost Care

1. Find the Hill-Burton obligated facility nearest you from the list of Hill-Burton obligated facilities.
2. Go to the facility’s admissions or business office and ask for a copy of the Hill-Burton Individual Notice. The Individual Notice will tell you what income level makes you eligible for free or reduced-cost care, what services might be covered, and exactly where in the facility to apply.
3. Go to the office listed in the Individual Notice and say you want to apply for Hill-Burton free or reduced-cost care. You may need to fill out a form.
4. Gather any other required documents (such as a pay stub to prove income eligibility) and take or send them to the obligated facility.
5. If you are asked to apply for Medicaid, Medicare, or some other financial assistance program, you must do so.
6. When you return the completed application, ask for a Determination of Eligibility. Check the Individual Notice to see how much time the facility has before it must tell you whether or not you will receive free or reduced-cost care.

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ONE OF QUEEN’S “I’LL NEVER FORGETS”

One never knows, particularly when it comes to the politicians in DC, how stupid and uninformed they actually are, or if perhaps they are being “dumb like a fox.”

Such was my consternation in 2009 when I heard Eric Cantor who was House Minority Whip (R) at the time with a net worth of $6.95 million tell a woman at one of those town hall meetings who was inquiring regarding a friend who had a cancerous stomach tumor and needed immediate care that “there are lot of charities out there who might help her.”  Of course when pressed for detail Cantor couldn’t name a damn one.  He could have at least mentioned Hill-Burton facilities.  Better yet as someone who had $6.95 million dollars and is himself a ward of the generosity of the state, Cantor could have offered to pay for the operation himself.  I would have, but I guess that explains why Eric Cantor is a multimillionaire and I am not.  [At least not yet.  I have high hopes of winning the $200 million Texas lottery tonight.]

Proclaim the Queen!

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