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Broken promise.

Former Alabama Senator Lister Hill is probably best remembered for his strong opposition to civil rights laws in the 1960s. Thus his death, on December 20, may not have brought tears to the eyes of progressives in this country, even though Alabama Governor George Wallace called him "one of the greatest men who ever sat in the U.S. Senate."

Hill retired in 1968 after thirty years in the Senate, and in an interview several years later he maintained that he had been a progressive all along. In at least one area the description was absolutely correct: while he was no friend of his black constituents in particular and civil rights in general, Hill championed legislation to extend health care to the poor and the elderly regardless of race. He sponsored or cosponsored more than sixty health care bills.

Yet today, health rights activists are still battling for enforcement of provisions in one of Hill's most important pieces of legislation--the Hill-Burton Hospital Construction Act of 1946. Designed to alleviate the postwar shortage of hospitals, especially in impoverished areas, the act provides grants for construction of new facilities and expansion of existing ones. In return, the hospitals that receive Federal funds agree to serve all the people of the surrounding community and to provide a measure of free care to poor patients. Since 1946 the act has provided upward of $4 billion in grants and has underwritten more than 7,000 hospital projects.

Despite its good intentions, however, the Hill-Burton program has been a giant giveaway to provate hospitals, which have received 60 percent of the grants. For the first twenty-five years after the act's passage, the government did nothing to insure that recipient hospitals were meeting their obligations to provide community service and free health care. Most Hill-Burton recipient hospitals turned away patients who could not pay, who did not have a private physician or who were on Medicaid. Critically ill patients were even refused admission to emergency rooms.

When, in the early 1970s, health rights activists filed lawsuits against recalcitrant hospitals, U.S. attorneys sided with the health industry, arguing that the courts had no jurisdiction to enforce the community service provisions. The courts rejected that position, however, and after a series of adverse decisions the government was froced to issue a new set of regulations spelling out the hospitals' obligations in detail. Those rules were adopted in 1979, and last summer they survived a court challenge by the American Hospital Association when the Supreme Court declined to review lower court rulings upholding them.

Nevertheless, the government is dragging its feet on enforcement. An April 1982 Government Accounting Office investigation disclosed that among hundreds of other deficiencies, over the preceding two years only seventeen of 690 complaints pending against hospitals had been resolved by the Department of Health and Human Services, the agency responsible for insuring compliance. "Health and Human Services is guilty of repeated wholesale neglect," says Armin Freifield, a staff attorney with the National Health Law Program. "There is a very definite connection between ineffective enforcement and facility noncompliance. I think they are acting in a grossly negligent manner."

As Freifeld points out, where health rights activists have monitored local hospitals, the government has been forced to act. A few months ago, after an investigation by Legal Services Corporation workers, H.H.S. disallowed an improper $11 million write-off by a Minnesota hospital against its Hill-burton free-care obligation. In another case, a Nebraska mursing home was forced to stop setting quotas on the number of Medicaid patients it would admit. Even these scattered victories have prompted some forces in Congress to consider rewriting the Hill-Burton law to weaken its provisions, and H.H.S. is conducting a study of possible changes in the regulations to that end. Thus Senator Hill's most noteworthy piece of legislation may not long survive his death.
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Title Annotation:the non-enforcement of the Hill-Burton Hospital Act
Author:Balter, Michael S.
Publication:The Nation
Article Type:editorial
Date:Jan 12, 1985
Words:644
Previous Article:The long war.
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