for further funding. Facilities that received Hill–Burton funding had to adhere to several requirements: They were not allowed to discriminate based on race, color, national origin, or creed, though separate but equal facilities in the same area were allowed. The Fourth Circuit Court of Appeals struck down this provision in Simkins v. Cone within its jurisdiction, and the provision was eliminated nationally by Title VI of the Civil Rights Act of 1964. Facilities that received funding were also required to provide a "reasonable volume" of free care each year for those residents in the facility's area who needed care but could not afford to pay. Hospitals were initially required to provide uncompensated care for 20 years after receiving funding. The federal money was also only provided in cases where the state and local municipality were willing and able to match the federal grant or loan, so that the federal portion only accounted for one third of the total construction or renovation cost. The states and localities were also required to prove the economic viability of the facility in question. This excluded the poorest municipalities from the Hill–Burton program; the majority of funding went to middle class areas. It also served to prop up hospitals that were economically nonviable, retarding the development wrought by market forces. Once Medicare and Medicaid were enacted, participation in those programs was added to the list of requirements for access to Hill–Burton funding. Unintended Consequences and Reconciliation Retrospectively, the Hill-Burton Act had “unintended and undesirable consequences. President Harry Truman took advantage of reports that the United States had severe capacity deficits in the hospital sector and that many Americans across the country were unable to access acute care services, using them as a stepping stone to create the Hill-Burton Act. In 1965, President Lyndon Johnson dreamed of a “great society” to push his Medicare and Medicaid agenda through Congress. Both the Truman- and Johnson-advocated programs were passed through political compromises. Over time, however, overbuilding of hospitals and unrestrained use of Medicare and Medicaid funding sent health care costs into an uncontrolled upward spiral. Paradoxically, just when the nation achieved its goal of 4.5 community hospital beds per 1,000 population in 1980, as envisioned under the Hill-Burton Act program (see the Inpatient Facilities and Services chapter), the government concluded that the Medicare and Medicaid programs were no longer sustainable due to the rapid rise in health care