Civil Rights Enforcement in the Modern Healthcare System: Reinvigorating the Role of the Federal Government in the Aftermath of Alexander v. Sandoval

Abstract

On occasion, a decision by the United States Supreme Court in the area of federal civil rights law invites a profound rethinking of rights, remedies, and enforcement under federal law. Faced with such an invitation, the federal authorities charged with civil rights enforcement have often risen to the challenge and responded vigorously. For example, in 1999, the Supreme Court held in Olmstead v. L.C. that the medically unjustifiable institutionalization of persons with disabilities under publicly administered programs constitutes discrimination under the Americans with Disabilities Act. The Court ordered that steps be taken toward community integration "at a reasonable pace. Within days of the decision, the Secretary of the Department of Health and Human Services (HHS) acknowledged the importance of the case in an unprecedented letter to the nation's governors; within months, federal involvement by the Clinton Administration had dramatically expanded. The Secretary instructed both the HHS Office for Civil Rights (OCR) and the Centers for Medicare and Medicaid Services (CMS; then the Health Care Financing Administration) to pursue active implementation strategies, which would include the issuance of interpretive guidelines, technical assistance to aid state compliance, expanded training of federal agency staff, and an aggressive program of internal assessment to determine the extent to which existing federal policies impeded community integration. The incoming Bush Administration continued this national focus on disability rights through executive orders, assessments of the performance of federal programs, and new initiatives to promote community integration.