Promoting civil rights through the welfare state: How medicare integrated southern hospitals

Although the Civil Rights Act of 1964 outlawed segregation and banned racia l discrimination in employment and education, compliance was uneven across institutional spheres. Racial integration proceeded more rapidly and smooth ly in the health care system than in other institutions because the new Med icare program, the largest expansion of the welfare state since the New Dea l, 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 mechanis m of social stratification to theorize processes of racial stratification. Drawing upon power resource and feminist theories of the welfare state, I a rgue that the welfare state can promote racial equality if 1) political res ources are available to challenge racially-disriminatory practices 2) insti tution that reproduce systems of oppression are incorporated into the publi c sphere 3) the rules and conditions for the distribution of benefits suppo rt the objective of racial equality; and 4) the benefits are provided on a continuous and universal basis.