President Obama issued a memorandum Thursday to the Department of Health and Human Services, ordering hospitals to give same-sex couples the right to be with a partner who is sick or dying. The memorandum applies to every hospital that receives Medicare or Medicaid funding -- nearly every hospital in the country.
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."
James Esseks of the ACLU's LGBT Project called the memo a huge deal that harms no one and helps many people.
"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," Esseks said. "It shows up in lots of different places, but hospital visitation is a prime example."
Some states already have policies like this one, but the country is a patchwork of different rules.
J.P. Duffy, vice president for communications at the Family Research Council, said Obama is pandering to a radical special interest group.
"There are many other ways to deal with this issue, whether through a health care proxy or power of attorney, through private contractual arrangements. We have no problem with those situations," Duffy said, "but the fact here is that this is undermining the definition of marriage."
Most hospitals, he said, have no restrictions on same-sex visitation.
But Dr. Jason Schneider, former president of the Gay and Lesbian Medical Association, said that unless a hospital has a formal policy allowing same-sex visitations, gay couples can run into trouble.
"One person in a hospital can make a huge difference -- a security guard, a front desk clerk looking at a same-sex partner and saying, 'You don't have any right to go back there,' " Schneider said. "So I think this directive gives weight to the importance of recognizing the variety and the breadth of how people define families."
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' advance directives, no matter who the patient designates as a surrogate in a medical emergency.
In the past year, gay and lesbian groups have criticized the Obama administration, saying the White House has not moved quickly enough on "Don't Ask, Don't Tell" and other issues that are important to the community.
Esseks of the ACLU says he thinks this might change their view of the president.
"He put his name on this memorandum," Esseks said. "This change could have simply come through [the Department of] 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."
Some prominent gay and lesbian advocates said they had 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 "a big-government federal takeover of even the smallest details of the nation's health care system."
But this isn't 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. That new law said hospitals that received federal Medicare dollars would have to integrate. Initially there was strong resistance, but within a year of Medicare's beginning, the desegregation of the nation's hospitals was essentially complete.