costs. Subsequently, President Ronald Reagan authorized the PPS method of payment to reduce hospital utilization, which started a downward trend in inpatient stays and created a glut of unoccupied hospital beds in many parts of the United States.” 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. References External links Health and Human Services website: Section 48 of the Code of Federal Regulations at the National Archives website: - 42:1.0.1.11.76.4.39.8.24 Public Health Service Act at the F.D.A. website: Health Sources and Services Administration website: CBO Testimony Statement of Robert D. Reischauer Deputy Director Congressional Budget Office Before the Subcommittee on Housing and Community Development Committee on Banking, Finance and Urban Affairs U.S. House of Representatives May 17, 1979 at CBO website: Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982. Stevens, Rosemary. In Sickness and in Wealth: American Hospitals in the Twentieth Century. 1st ed. The Johns Hopkins University Press, 1999. 1946 in law United States federal health legislation Medicare and Medicaid (United States)