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Same-sex couples have fought for years for the right to be with a partner who is sick or dying in the hospital. Last night, President Obama gave them that right. With no fanfare, he issued a presidential memorandum to the Department of Health and Human Services.

NPR's Ari Shapiro has our story.

ARI SHAPIRO: The memorandum applies to every hospital that receives Medicare or Medicaid funding - which is nearly every hospital in the country. And the language in the memo is not boilerplate government bureaucrat-speak. It says: Gay and lesbian Americans are often barred from the bedsides of the partners with whom they may have spent decades of their lives, unable to be there for the person they love.

Mr. JAMES ESSEKS (ACLU LGBT Project): I'm touched.

SHAPIRO: James Esseks of the ACLU's LGBT project calls this a huge deal. He says it harms no one and helps a lot of people.

Mr. ESSEKS: What we face is a whole series of problems in our daily lives, and certainly in times of crisis, when the relationships that are an integral part of our lives are just not protected. And it shows up in lots of different places, but hospital visitation is a prime example.

SHAPIRO: Some states already have policies like this one, but the country is a patchwork of different rules.

J.P. Duffy is vice president for communications at the Family Research Council. He says President Obama is pandering to a radical special interest group.

Mr. J.P. DUFFY (Family Research Council): There are many other ways to deal with this issue, whether through a health care proxy or a power of attorney, through private contractual arrangements. We have no problem with those situations. But the fact here is, is that this is undermining the definition of marriage.

SHAPIRO: Duffy says most hospitals have no restrictions on same-sex visitation.

Dr. Jason Schneider was president of the Gay and Lesbian Medical Association and he says unless a hospital has a formal policy allowing same-sex visitations, gay couples can run into trouble.

Dr. JASON SCHNEIDER (Gay and Lesbian Medical Association): One person in a hospital can make a huge difference. You know, a security guard, a front desk clerk looking at a same-sex partner and saying, you dont have any right to go back there. So I think this directive gives weight to the importance of recognizing the variety and the breadth of how people define families.

SHAPIRO: The memo also applies beyond same-sex couples. It says a patient can name anyone to be a surrogate decision maker, including a friend or a distant relative. It also says hospitals must follow patients' advanced directives, no matter who the patient designates as a surrogate in a medical emergency.

In the last year, gay and lesbian groups have criticized the Obama administration. They say the White House has not moved quickly enough on Don't Ask Don't Tell and other issues that are important to the LGBT community.

Esseks of the ACLU thinks this might change their view of the president.

Mr. ESSEKS: He put his name on this memorandum. This change could have come simply through Health and Human Services. And the fact that he did it over his name I think speaks to an understanding of the real problem that people are facing.

SHAPIRO: Some prominent gay and lesbian advocates said last night they never thought of using Medicare and Medicaid funding as a tool to force hospitals to expand LGBT access. It's a move that Duffy of the Family Research Council calls...

Mr. DUFFY: A big government federal takeover of even the smallest details of the nation's health care system.

SHAPIRO: But this is not the first time a president has used Medicare funding to expand access to hospitals. When President Johnson signed Medicare into law in 1965, many hospitals were racially segregated. The new law said hospitals that received federal Medicare dollars would have to integrate. There was strong resistance, but within a year of Medicare's beginning, the desegregation of the nation's hospitals was essentially complete.

Ari Shapiro, NPR News, Washington.

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