Promoting Civil Rights through the Welfare State: How Medicare Integrated Southern Hospitals

Although the Civil Rights Act of 1964 outlawed segregation and banned racial discrimination in employment and education, compliance was uneven across institutional spheres. Racial integration proceeded more rapidly and smoothly in the health care system than in other institutions because the new Medicare program, the largest expansion of the welfare state since the New Deal, provided the leverage to force health care providers to comply with the law. In this paper, I extend the axiom that the welfare state is a mechanism of social stratification to theorize processes of racial stratification. Drawing upon power resource and feminist theories of the welfare state, I argue that the welfare state can promote racial equality if 1) political resources are available to challenge racially-discriminatory practices; 2) institutions that reproduce systems of oppression are incorporated into the public sphere; 3) the rules and conditions for the distribution of benefits support the objective of racial equality; and 4) the benefits are provided on a continuous and universal basis.