The Impoverished History of Race And Nursing Homes

After exposés in the 1920s revealed the horrific conditions in existing “workhouses” for the impoverished older Americans and others, President Franklin D. Roosevelt’s New Deal reformers hoped to create alternatives to those state-run institutions.

The New Dealers drafted legislation requiring a states to provide “a reasonable subsistence compatible with decency and health.” The bill placed overall administrative authority with the federal government, including the authority to set eligibility requirements.

However, Southern congressmen, led by the late segregationist, Sen. Harry F. Byrd Sr., D-Va., fought to strike those provisions from the bill. The final law allowed states to retain administrative control and set both eligibility rules and benefit amounts.

Jill Quadango of Florida State University has written that Byrd and his allies “feared that federal benefits would undermine planters’ paternalistic control over tenant labor, particularly black labor . . . [and they] had no intention of letting federal funds go directly to black workers, because such payments could undermine southern industrial wage scales which were significantly lower than those in the North.”

As with other New Deal legislation, President Roosevelt had to accede to the states’ rights demands of the southern lawmakers, who controlled the key con­gres­sional committees. He feared he could not get the 1935 Social Security Act passed without their votes.

In 1950, the Social Security Board proposed that Congress should authorize “vendor payments” for medical assistance to aged, blind and disabled welfare recipients. The plan called for federal matching grants to the states and left untouched a state’s control of eligibility and benefits.

The federal appropriation for vendor payments program grew from about $85 million to more than $500 million by 1960, when Congress expanded the program with passage of the Kerr-MillsAct to cover low-income people who were “medically indigent.” That included those not on welfare, but who would be impoverished if suddenly faced with large medical expenses.

In 1965, the American Medical Association (AMA) pro­posed expanding Kerr-Mills as an alternative to Medicare — the new program designed to cover everyone age 65 or older regardless of income, and which the association had fought against for years.

That strategy failed, however. Medicare was approved and the AMA proposal became Medicaid.

Today Medicaid is a federal-state program that pays the healthcare costs for low-income people, including “indefinite stays” in nursing homes, at rates that vary by state, but are always considerably less than Medicare’s rate or the fees charged to people who pay for their own care.

—Wallace Roberts

This article originally published in the February 16, 2015 print edition of The Louisiana Weekly newspaper.