CHAS Fellow Anup Malani and colleagues discuss the Civil Rights Act of 1964 and its failure to substantially improve health care for minorities. As the authors explain, de facto segregation continues as evidenced by hospital usage statistics; just 20% of U.S. hospitals treat 80% of all African American heart attack patients, and 40% of hospitals have no African American heart attack patients. Moreover, the authors express concern for the frequency of bias, discrimination, and stereotyping in professional practices leading toward unequal services for minority patients. Their article concludes with a discussion of non-litigation solutions that may improve the situation without relying on dramatic legal reform.