Through content analysis, the study traces the relative prominence of “biomedical” and “public health” approaches in congressional bills aimed at improving the health of racial and ethnic minorities over a 28-year period. It documents a surge of interest in minority health during the late 1980s and early 1990s and highlights the dominance of biomedical initiatives during this period. Drawing on historical methods and interviews with key informants, the paper explains these patterns by detailing the ways in which policy legacies shaped the interests, opportunities and ideas of interest groups and policy-makers.