Hill-Burton required that funded hospitals promise not to discriminate on the basis of race. Yet Southern Democrats ensured that this funding wouldn’t be used to challenge Jim Crow. First, they had a measure added to the legislation that declared hospitals were private entities that couldn’t be regulated by the federal government, only by the states. This shielded hospitals from public accountability and meant that they could discriminate against Black doctors and other medical professionals in hiring and staffing. Another provision allowed federal funding for segregated hospitals and segregation by race within hospitals, as long as they were purportedly of equal quality of care, which they never were. This funding stream deepened segregation in Southern health care; 65 of 67 counties in Alabama used Hill-Burton money to build hospitals that were segregated. A Social Security Administration official noted that “those of us who were involved in that bill took the position that if that was the price we had to pay for getting this legislation through, we would pay for it.”
This is exactly the kind of publicly funded discrimination that Brown v. Board of Education was designed to stop. Argued twice over two years, Brown was decided unanimously by the Supreme Court in May 1954. The court ruled that “separate but equal” was unconstitutional, and in a follow-up ruling determined the applicable remedy for segregation in schools. Government officials should “take such proceedings and enter such orders and decrees consistent with this opinion as are necessary and proper to admit to public schools on a racially nondiscriminatory basis with all deliberate speed the parties to these cases.”
The court took this monumental action, but a funny thing happened in the aftermath of that ruling: nothing. As legal scholar Gerald N. Rosenberg shows, in 1955, roughly 12 in 1,000 Black children attended a school with whites in the South. Five years later, that number was virtually unchanged, about 16 in 1,000. It took the Civil Rights Act of 1964 to desegregate schools. The number of Black children attending a school with whites in the South went from 2 percent the year the Act passed to 32 percent four years later, and 86 percent six years later. While the Supreme Court can be effective at holding back change, it controls no funding and depends on elite power structures to carry out its decisions. What really creates change is popular mobilization and legislation.
Brown should have applied to the wave of new public hospitals the federal government was funding in the late 1950s under Hill-Burton. Yet there was no mechanism to force action, and the business of white supremacy carried on as normal. The Department of Health, Education, and Welfare (HEW), responsible for carrying out the Hill-Burton funding of hospital construction, refused to investigate whether hospitals were “of like quality” and acted as if the Brown decision didn’t apply to them.
Into this fight came a wave of newly energized doctors and other medical professionals, all finding inspiration from the ongoing civil rights movement. In 1963, Holloman and several of his friends created the MCHR, which coordinated with civil rights leaders in the South to help provide frontline services for protesters. When Martin Luther King Jr. led a march for voting rights across the Edmund Pettus Bridge from Selma to Montgomery, Alabama, the protesters faced a violent police response. Members of the MCHR, including Holloman, were there providing medical services to those that had been beaten.