<P> 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 . </P>
<P> 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 . </P>
one problem with the free care requirement under hill-burton was that it
one problem with the free care requirement under hill-burton was that it
no regulation
no regulation