Healthcare Reform Landmark Event

Abstract 

An in-depth analysis of the Hill-Burton Act of 1946, which was a pivotal moment in the healthcare sector is extensively examined in this paper. The circumstances that necessitated the formation of the policy and what goals it sought to achieve are also investigated. In addition, the paper looks at the implementation of the legislation and its short-term and long-term impacts on the United States healthcare sector. A comprehensive analysis of how the Hill-Burton Act influenced or was instrumental in the formation of the more contemporary Affordable Care Act is presented. Moreover, the impacts of the 1946 healthcare legislation to the historical evolution of healthcare, and how it helped to shape the sector are addressed. The paper also extensively looks at some of the unanticipated outcomes that arose from the implementation of the Hill-Burton program across the United States, and the new problems that the legislation created in its implementation. Ultimately, the main goal is to enlighten the reader on the impacts of the Hill-Burton Act in America. 

Healthcare Reform Landmark Event 

The healthcare sector is one of the most pivotal in the country, which has far-reaching impacts across the country. The private sector dominates the majority of the healthcare facilities in the United States. There is a comprehensive healthcare coverage system availed through public and private insurance and coverage programs, such as Medicaid to compensate for the lack of a universal healthcare system in the country. In the US, The federal government funds over 60% of health spending via programs such as the Veteran’s Health Administration and Medicare. The US health agencies, which are under the oversight of Congress, formulate policies designed to protect the well-being of the citizens in health-related matters. On the other hand, the Department of Health and Human Services superintends over all major health concerns and issues that American citizens face. Additionally, they lead initiatives that help to advance medical research and better public health. The department is also in charge of helping to lower medical costs and improving patients’ well-being. Several landmark pieces of legislation in history have had tremendous impacts on the delivery of healthcare in the United States. One of the most notable laws that greatly impacted the healthcare sector was the 1946 Hospital Survey and Construction Act, which is more commonly known as the Hill-Burton Act ( Brown, 1979 ). 

The Hill-Burton Act 

The Hill-Burton Act got its name from its sponsors, the Ohio senator Harold Burton and his Alabama counterpart Lister Hill. President Harry Truman signed it into law on August 13 th , 1946, making it one of the greatest examples of a bipartisan approval from all sides of Congress in an effort to promote the well-being of the United States citizens (Schumann, 2016). It was the then President’s initiative, which he pitched to Congress a few months after the official end of World War II, breaking down the five objectives to help better the nation’s health system. This facilitated the creation of many hospitals throughout the country. Truman envisioned an all-inclusive prepaid insurance initiative linked to social security. The Hill-Burton Act facilitated the provision of guaranteed loans and grants by the national government through a rotational mechanism in which a recently funded state went to the bottom of the priority list for further funding. The state granted these facilities loans and grants on condition that the facilities avail free care to a considerable number of needy patients in their area, did not discriminate individuals based on race or other characteristics, and that their host states provided economic feasibility for them ( Rice, 1986 ). The law addressed the acute hospital bed shortage in several states with over half a million beds donated in the period it was effective. The Act was pivotal in the establishment of the contemporary healthcare infrastructure with national funding of over $4.5 billion and an estimated $9.1 billion from state governments (Thomas, 2006). Additionally, it encouraged the growth of modern technology-based hospitals, especially in the southern states of the US. 

Short-term Impacts of the Hill-Burton Act 

The Hill-Burton Act was ambitious in its intended objective and had significant impacts in reforming the ailing healthcare sector at that time. One of the greatest objecting that the legislation sought to achieve was availing an average of 4.5 general-care beds for every 1000 residents in the United States, with the allocation priority based on the intrastate population concentration. More so, it gave a higher priority to rural areas to receive more general-care beds due to problems such as travel logistics. In essence, the Hill-Burton Act called for the distribution of special-care beds tailored for handling conditions such as mental health, chronic diseases, and tuberculosis. By 1946, after the institution of the Act, there was still a low bed-ratio of 3.5 beds per 1,000 US residents, which was lower than the proposed minimum. Moreover, the number of medical facilities required to unveil such ambitious medical expansions were still non-existent. In the subsequent years, the government, through progressive Congress extensions, injected an estimated $4.6 billion in grants and an additional $1.5 billion in guaranteed loans to help fast track the process. The state and local governments also raised over $9 billion to complement the national funding. These funds went into the expansion of facilities throughout the country, with a special focus on heavily populated and rural areas. In between 1947 and 1974, there was a great improvement in the bed ratio and the number of facilities available, including facilities in rural areas that had none. By 1976, the average bed ratio for community hospitals around the country was at the proposed 4.5 beds per 1000 US residents. This legislation called for a comprehensive plan indicating the size and area where the state officials needed to establish medical facilities. It required each state agency to prepare medical facilities’ construction plans, which the United States federal government would approve. By June 30 th, 1950, there were a total of 1,300 government-approved projects, which would facilitate the construction of 250 public health facilities and an estimated 65,000 general-care beds being distributed ( Lochner, 1987 ). In the early years of the legislation’s implementation, about a half of the medical facilities were new ones, specifically created in towns with small populations of less than 10,000 residents, with the other half being renovated or re-equipped facilities. Over 80% of the provided beds by this time were to such medical facilities. 

The Hill-Burton Act of 1946 had impacts stretching beyond the provision of general-care beds and medical facilities. One significant impact it had was in combating the diseases that plagued the US population. The medical facilities’ expansion initiatives across the United States after World War II, the integration of new disease-detection technologies, and the advanced treatment played a pivotal role in combatting some of the diseases. A significant number of rural area residents did not have access to healthcare facilities and treatments before the legislation. Even those in the more urban areas had limited access; thus, there were many victims to easily treatable diseases. However, after the program rollout, there was a significant leap in the number of people able to access hospitals and get treatment. For instance, in 1949 alone, there were over 16 million recorded in-patients who received bed-care and treatment. In the same year, there was a recorded 86% of hospital pregnancy deliveries, a sharp increase from the post-war statistics, such as 37% in 1935. There was also an increase in detections and diagnoses of diseases using widely-availed technology such as X-ray. In 1950 alone, over medical facilities conducted over 15 million chest X-rays, which helped in the detecting of more tuberculosis cases, mostly at the curable stages ( Lochner, 1987 ). In the same year, there was an increase in the number of people examined for venereal diseases, with over 2.5 million examined cases and over half a million diagnoses. This was in part due to better access to local healthcare facilities and the newly-developed attitude towards hospitals. 

Long-term Impacts 

The legislation also had long-term positive impacts on the United States healthcare system. By 1975, the Hill-Burton Act had facilitated the building of one-third of all the hospitals in the United States. In the same year, Congress incorporated the Act into the larger Public Health Service Act, and they cumulatively facilitated the construction of 6,800 medical facilities in over 4,000 locations. In the long-run, the Hill-Burton Act established new facilities in the over 40% of the United States’ counties that did not have hospitals in 1945 (Largent, 2018). Even though the direct federal financing for healthcare facilities construction in communities came to a halt in 1997, there are still several Hill-Burton hospitals and clinics scattered around the country. 

Another lasting positive impact of the Hill-Burton Act on the healthcare sector is in healthcare financing. In fact, its program is still one of the main sources of funding for public hospitals. Despite the legislation coming into effect over eight decades ago, most of its conditions and provisions still apply. This includes the requirement that hospitals that receive federal funding to facilitate construction, renovation, or modernization should avail subsidized or free medical care to a section of indigent or uninsured patients in their region. This is a beneficial program for people who have problems paying for healthcare services due to financial constraints (Largent, 2018). There are several conditions that a citizen needs to fulfill to be eligible for free treatment under this financial aid, including being uninsured by any government or private program and having a family income that is less than the set Poverty Income Level. The family income level may vary the provided financial aid from totally free to subsidized. Even non-US citizens can apply as long as they have resided in the country for three months or more. Public non-profit hospitals, which still constitute a larger portion of the healthcare facilities in the United States, also still get tax exemptions as long as they can show evidence of the benefits they are bringing a specific community. Ever since the institution of the Hill-Burton Act in 1946, states have practiced the federal funds matching protocol. This is important in availing more funds for healthcare facilities development and research advancement. For, instance, the federal government issued $3.5 billion in between 1960 and 1979, an amount which local and state governments matched and often surpassed (Largent, 2018). The national government allocated a further $200 million in between 1980 and 1997 and the allocated states’ funding exceeded the issued amount. 

How the Act Impacted the Historical Evolution of Healthcare 

During the years prior to the passing of the Hill-Burton Act, medical practitioners set customary charges and their respective hospitals on a pre-determined percentage in the cost-plus reimbursement approach. It became increasingly apparent that while hospitals were becoming the center of healthcare delivery, many residents lacked convenient access to them. The legislation caused an increase in national; spending on healthcare, which was already at 4.5% of the country’s Gross National Product, and rising (Thomas, 2006) . Other sectors such as the military already had high spending caps, but the lawmakers largely ignored increasing funds to the health sector. The legislation helped to increase the spending cap on healthcare to record highs, with the spending doubling by 1950. Moreover, it helped to shape the perception of lawmakers on the importance of increased funding of the healthcare sector. 

Prior to the landmark Act, the rate of medical advancement, while remarkable, needed improvement as diseases claimed many lives needlessly. The increased funding availed more resources for better medical research, which led to the discovery of treatments for several conditions such as arthritis and glaucoma. The legislation and the resultant positive medical advancements helped remold the attitude on government spending to incorporate a preventive and eradication approach to diseases (Rice, 1986). This ensured more funds for initiatives such as vaccine development, whose fruits became evident as early as 1954 when the medical researcher Jonas Salk formulated a viable polio vaccine. The advancements stemming from the legislation also helped to significantly reduce infant mortality and increase the success rate of most organ surgeries. Unfortunately, the costs attributed to the medical advancements caused an increase in the medical care expenses in the United States residents by almost double, highlighting the urgent need for further investment in affordable healthcare. 

How the Hill-Burton Act Contributed to the Formation of the Affordable Care Act 

The 1946 Hill-Burton Act made medical services accessible to more people, especially those who could not afford it. It was important that the legislation identified people of a certain income level that could not access medical care and provided either free or subsidized care. In addition, a lot of the financing that the federal and local governments provided was for non-profit and public organizations, as these were the most affordable for a vast majority of US residents. The Affordable Care Act drew inspiration from the Hill-Burton Act in assisting needy patients to access treatment. However, since more hospitals were unwilling to give free medical care, the Affordable Care Act used the subsidy approach only. The Affordable Care Act also incorporated referencing the Federal Poverty Guidelines to identify beneficiaries who could not afford to pay medical expenses. Several amendments to the Hill-Burton Act added provisions to allow its programs to cover Medicaid spend-down amounts as well as Medicaid co-payments, with the exception of extended-length facility care. The Hill-Burton Act, therefore, while not dependent on Medicaid, worked in tandem with it. The Affordable Care Act also integrated Medicaid in its functionality but was dependent on it and Medicare, therefore, they encouraged more enrollment for needy people. 

Unanticipated Outcomes of the Hill-Burton Act 

The Hill-Burton Act brought was an innovative piece of legislation that largely achieved many of the targets it set out to. However, there were several outcomes that the legislators did not foresee when drafting the proposals for the programs. One of the most noteworthy unanticipated outcomes was the increase in the prices that residents had to pay to access healthcare (Brown, 1979). The legislation availed funds as grants and loans to construct new facilities or renovate existing ones but did not prioritize funding operations of established facilities. Some experts argue that part of the reason the healthcare prices rose was the fact that the legislation did not provide for regulation for what medical practitioners could charge. Therefore, the high influx of patients due to improved access to medical facilities brought alongside an unchanging number of medical practitioners. The latter adjusted their prices upwards to compensate for the increased workload. The prices rose so astronomically that it necessitated lawmakers to formulate initiatives, such as Medicaid and Medicare, to provide available healthcare. Another unforeseen outcome of the Hill-Burton Act was the inequality the segregation compromise brought. In order to gain support for the Act, Senator Hill included some compromises to allow hospitals in Southern states to segregate medical practitioners and patients ( Thomas, 2006 ). However, the provision stated that people of different races were to get separate but equal treatment. The legislation’s sponsors and Congress did not have measures to enforce this recommendation. In Southern states where segregation was still rampant, many white doctors were unwilling to treat black patients equal to white patients. Congress and the Senate believed that doctors in these States would comply with the law, but that was not the case. The disparity led to higher mortality among the minority races. 

New Issues Brought by the Hill-Burton Act 

The Hill-Burton Act in the US was beneficial in significantly increasing the number of health care facilities. However, there was no proportionate increase in the number of medical practitioners to fill the opening positions, which led to an acute medical staffing shortage across some facilities. In addition, increased spending in healthcare raised the spending cap and in future years placed more burden on the government to fund the expansion. This necessitated increased government borrowing that contributed significantly to the increasing national debt. 

Conclusion 

It is evident that the Hill-Burton Act was one of the most revolutionary health reform events in history, bringing about unprecedented growth and improvement in the health sector. Most importantly, it paved the way for more contemporary legislation, such as the Affordable Care Act, and helped to bring access to many Americans thus impacting many lives positively. The Hill-Burton Act remains one of the most practical and sustainable healthcare legislation, which provides a reproducible framework that is easy to implement. 

References 

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Lochner, P. D. (1987). Hill-Burton Enforcement: A Proposed Remedy to Cure Hospital Inertia. 

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