The reality, however, did not nearly meet the written requirement of the law. For the first 20 years of the act 's existence, there was no regulation in place to define what constituted a "reasonable volume '' or to ensure that hospitals were providing any free care at all. This did not improve until the early 1970s, when lawyers representing poor people began suing hospitals for not abiding by the law. Hill - Burton was set to expire in June 1973, but it was extended for one year in the last hour. In 1975, the Act was amended and became Title XVI of the Public Health Service Act. The most significant changes at this point were the addition of some regulatory mechanisms (defining what constitutes the inability to pay) and the move from a 20 - year commitment to a requirement to provide free care in perpetuity. Still, it was not until 1979 that compliance levels were defined.
one problem with the free care requirement under hill-burton was that it
no regulation