People of color were the most likely groups to gain coverage and access to care under the ACA, and in the centuries-old struggle over health, they have never been closer both to racial equality of, access and to, the federal protection of health care as a civil right. But if Republicans have their way, that dream will be deferred.

Just as the ACA’s defenders find themselves between a once-in-a-generation victory and a potential equally devastating loss, so the MCHR found themselves in 1966. King delivered his address just months after breakthroughs a century in the making. In the height of the movement in the early 60s that brought sweeping changes in voting rights, integration, and education, civil-rights actors had also won major victories in a push for universal health care. Chief among those victories were two of the defining pieces of 20th-century American policy: the Civil Rights Act in 1964 and the passage of Medicare and Medicaid in 1965.

Of course, the Civil Rights Act might not seem like much of a health-care bill, and Medicare isn’t usually counted among major civil-rights victories, but as detailed in in health-policy researcher David Barton Smith’s The Power to Heal: Civil Rights, Medicare and the Struggle to Transform America’s Health System, they were complementary pieces of a grand civil-rights strategy.

Key to that strategy was the 1963 Simkins v. Cone lawsuit, filed by dentist and Greensboro, North Carolina, NAACP leader George Simkins against segregation in the local hospital. In finding in Simkins’s favor, the The Fourth Circuit Court of Appeals ruled for the first time that institutions receiving federal funds could not abide by the “separate but equal” legal underpinning of Jim Crow. That ruling in turn helped shape Title VI of the 1964 Civil Rights Act, which bars segregation and discrimination among entities that receive federal funding, and to this day provides the most effective legal mechanism for federal civil-rights cases.

The NAACP and the National Medical Association—the black professional organization that was formed because the the AMA was segregated—led by W. Montague Cobb fought for the passage of the first major American health reform policy in Medicare and Medicaid. They organized direct action, legal challenges, and lobbying efforts in support of the reform, in direct opposition to most of the rest of the segregated medical establishment. “Medicare was in a very real sense a creation of the civil-rights movement,” Smith says. In the ensuing hearings, Cobb was the only leader of any medical association to testify in favor of Medicare and Medicaid.

In 1965, just a week before also passing the Voting Rights Act, Congress passed the amendment to the Social Security Act that authorized Medicare and Medicaid, with Cobb as the witness to Lyndon B. Johnson’s signing ceremony. The law’s effects on segregation were felt immediately. Since Medicare’s universal coverage of elderly people brought federal funds to about every hospital in America, it also bound them by Title VI’s nondiscrimination clauses, which essentially ended segregation in those hospitals—some of the last public arenas in which Jim Crow legally held sway. Medicare was the final federal legal blow for de jure segregation, and without it, there would still be few legal mechanisms to force hospitals to integrate. It’s hard to overstate how much Medicare and Medicaid themselves did to end formal segregation.