Racial inequality in health care persists in the United States despite laws against racial discrimination in large part because the laws in the United States are inadequate for addressing issues of institutional racial discrimination. The US legal system has had particular difficulty addressing issues of racial discrimination that result from individuals acting on biases and stereotypes and institutions that implement policies and practices that have a racial impact. Furthermore, the legal system requires individuals to be aware that the provider or institution has discriminated against them and that they have been injured by the provider. Two conditions that are highly unlikely in racial discrimination in health care. Finally, the health care system, through managed care, has actually built in incentives which may encourage "unthinking" discrimination.

"It might be that civil rights laws often go unenforced; it might be that current inequities spring from past prejudice and long standing economic differences that are not entirely reachable by law; or it might be that the law sometimes fails to reflect, and consequently fails to correct, the barriers faced by people of color." Derrick Bell

In the case of health care discrimination, the laws do not address the current barriers faced by minorities; and the executive branch, the legislatures and the courts are singularly reluctant to hold health care institutions and providers responsible for institutional racism.