EMTALA

-Submitted by David Drumm (Nal), Guest Blogger

EMTALA is an acronym for Emergency Medical Treatment and Active Labor Act passed in 1986 and signed into law by then-President Ronald Reagan. It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. Since there are no provisions for reimbursement, it’s often cited as an example of an unfunded mandate. EMTALA applies only to “participating hospitals”, those who accept funds under the Medicare program, which for practical purposes, is all hospitals. EMTALA was enacted to prevent the practice of “patient dumping”, where, because of the inability to pay or insufficient insurance, hospitals would discharge emergency patients. Hospitals and physicians can incur a $50,000 fine for each violation.

EMTALA provides access to the health care system for everyone.

One effect of EMTALA has been “cost shifting”, where hospitals charge more to those who can pay, to cover their losses from those who can’t pay. Insurance companies have learned how to game the system. They would sign up patients where there was no supporting network of physicians under contract with the insurance company. The insurance company would then dump these patients on ERs where EMTALA would kick in.

EMTALA gives the impression of free health care. Why should someone spend money on health insurance when they know they’ll be saved in the ER? Since the insured are paying for the uninsured, the states don’t have to pay, so they’re not complaining.

The adverse effects of EMTALA are overcrowding and delays at ERs. Many hospitals have simply closed their emergency departments (ED). Physicians have come up with creative ways to avoid ED services. Physicians drop their hospital privileges to treat patients with the kind of disorders that frequently appear in ERs.

If the Affordable Care Act survives its constitutional barrages, insurance providers will pay for the losses now incurred by hospitals and physicians under EMTALA. There will always be patients who cannot afford health insurance and hence, health services. Either society bears the cost or we deny them access to health services.

EMTALA forces those, who can afford to pay for health insurance, to cover the cost for those who cannot. If the government can mandate that you pay for someone else’s care, why can’t it mandate that they pay for their own care? If ACA is unconstitutional, then so is EMTALA.

H/T: Marin Medical Society, Explaining the EMTALA Paradox (pdf), AAEM.

25 thoughts on “EMTALA”

  1. Rafflaw: Obamacare helps my family also as it allows my daughter with a pre-existing condition to stay on my husband’s insurance plan until she is 26. All young people can be covered by their parent’s insurance until they are 26 under the bill. With unemployment high this is very helpful to many families.

  2. Elaine,

    I’d have been satisfied if they had at least gotten as far as the public option as well. It wouldn’t have been a perfect fix as far as the business model goes. It would have, however, been a far sight better than the corporate welfare we ended up with.

  3. Good one Nal,
    As someone who lost their job back in November, I will be losing my COBRA insurance that my former employer was paying for on 2/28/2011 and I will be going on my wife’s policy at her school. Unfortunately, in order to save money, she is shifting to an HMO that covers more for less cost, but we will have to change the doctors that we have been going to for the last 10-20 years. Obamacare will make it easier for people like me to get affordable care when and if it is allowed to go full speed in 2014. I agree with Buddha that universal health care would be the best scenario for all citizens, but this political climate will allow incremental change only, in my opinion. And even an incremental improvement is met with derision by the corporatists on the right and Blue dog Dems. I don’t think the country can afford to not allow this coverage to kick in fully.
    Eniobob, good point about Palin and her freguent use of Ronald Reagan. If she only knew what he did, who knows, she might even tell the truth on occasion. OK,maybe not!

  4. Nal,

    Very timely topic for a post. Should give people pause for thought.

    *****

    Buddha,

    “Universal single-payer not-for-profit health care insurance.”

    I’d have been happy if we had at least gotten a public option. That would give private insurers competition from a “not-for-profit” program.

  5. What is even more incredible that 10 years ago the feds would pay 1,400 for a birth….now the hospitals are good to get 280.00……

  6. “EMTALA is an acronym for Emergency Medical Treatment and Active Labor Act passed in 1986 and signed into law by then-President Ronald Reagan.”

    Palin: America Is Out Of Step With Reagan’s Values

    “SANTA BARBARA, Calif. — America is on a “road to ruin” because of misguided policies in Washington and needs to get back in step with the values of Ronald Reagan, Sarah Palin said at an event honoring the former president’s legacy”

    http://www.huffingtonpost.com/2011/02/05/palin-america-reagan_n_819073.html

  7. This will come to America one day: from each according to his ability, to each according to his need.

    In that respect the right wing nuts are right. Where they’re wrong is in the belief that there’s something wrong with that.

  8. Wootsy,

    ““Government involvement corrupts the whole system and this is why health care is in such a mess.”
    —————————
    You know what Tootie,
    I think the Insurance Industry involvement corrupts the whole system and this is why health care is in such a mess.

    HealthCARE is NOT HealthCorps”

    ———————————————————-

    Well said, and right to the point.

    If I may add – the only healthcare government is involved in is Medicare, Medicaid and SCHIP (that I know of). The industry as a whole is controlled by private corporations … and guess which is representative of the largest “mess.”

    Bueller??

  9. I’ve only been in the ER twice, both in the past year, and to me it’s embarrassing to be taken care of before those I see waiting because the hospital knows my bills will be taken care of by Medicare and theirs will either be paid by Medicaid or passed on by inflated charges to the insurance companies then to the consumers. In either case, it’s not the hospital’s problem.

    The emergency rooms are crowded because people have lost their insurance and wait until severe problems develop before seeking medical help. This will only increase as the Second Depression lengthens.

    Great post and great last paragraph, NAL.

  10. “Government involvement corrupts the whole system and this is why health care is in such a mess.”
    —————————
    You know what Tootie,
    I think the Insurance Industry involvement corrupts the whole system and this is why health care is in such a mess.

    HealthCARE is NOT HealthCorps

  11. Nal,
    Great job as usual. Having availed myself of ER services via 911 Ambulances on many occasions and being well-insured, thus insulated from the fray, your post provides information that I was unaware of and at the same time answers the lie that everyone can get equal health care.

    An ER is not set up to provide adequate health care. Given location, the medical staff is often overwhelmed by the multitude of clientelle, the need to do on the fly triage and gross understaffing. While utterly necessary to deal with medical emergencies, the claims of universal health care opponents regarding the ability of everyone to receive adequate health care via the ER’s are bogus.

  12. The federal government has no lawful power to force this on private businesses. By forcing itself on hospitals then entering into the medical system via funding it is corrupting the whole process and causing the crisis we now see before us.

    At a minimum, the government should have provided its own hospitals to attend to these people and left the private facilities to themselves. Of course, the private facilities should be barred from receiving patients with federal dollars. But once the government enters into an industry like this and provides competition, the real cost of services never finds it true value (because the government has unlimited funny money that grows on trees and harvests as it pleases). When government is in the system at any level the real price of services is not to be found (and that is why the prices soar).

    Government involvement corrupts the whole system and this is why health care is in such a mess.

    Government has to be all in or all out. But constitutionally only the states have authority to run such programs or make demands on hospitals. Which hospitals (private property) should fight tooth and nail.

  13. Thank you Nal for bringing this matter up and for explaining it so clearly. It’s time to write another letter to my representatives both at the State and National level. (I’m in Ohio with a new Republican Administration planning to sue ACA)

  14. Look, if the good Lord had wanted you to have health care He would have given you the money to pay for it, or had you born in one of those depraved countries that provide care for everyone. So if you are too poor to afford care it is YOUR fault and the rich people He has chosen to smile upon should not be troubled by your failure.

    Even the Blew Dog Democrats agree with this and it is why we will be saved from the horrors of the less expensive, better results, European nightmare.

  15. We all agree that is what we want but we are very far from getting it. That’s why I would rather keep Obamacare than move back to the past when people with pre-existing conditions cannot get coverage.

  16. Universal single-payer not-for-profit health care insurance.

    an idea whose time has come!!!!!

  17. In supplement, I point to the conversation of the “Health Care and Federalism: A Response to Professor Charles Fried” thread for further details of why the ACA is not a valid exercise of the Commerce Clause.

  18. However, I must point out a critical difference in EMTALA and the ACA that applies to the Constitutionality of the ACA.

    EMTALA is regulating business practices. Since it has no anti-cost shifting provisions, businesses seek to avoid this cost by passing it along to consumers in a dubious ways that drive up the cost of both insurance and provision creating a double negative reciprocal where costs are shifted from hospitals to insurance companies and from insurance companies to consumers. Where EMTALA fails is that in its narrow scope (provision of life saving treatment), it neglected the business world’s profit driven consequences. It’s a giant game of pass the buck. However, regulating business activity is perfectly acceptable under the Commerce Clause. EMTALA is an example of legislation that is both necessary and flawed in execution.

    The ACA, with its pending mandate to force individuals to purchase coverage from private for-profit insurance companies is not just regulating business. It is attempting to compel consumers to buy a product with a profit margin. It is forcing individual consumerism – not acceptable under the Commerce Clause. It is no more acceptable than if the government mandated that American citizens have to buy American made cars. Telling John and Mary citizen they must purchase a product from a limited pool of for-profit vendors is simply corporate protectionism at best and fascist tyranny at worst. It won’t stop the endless cost shifting game that drains resources from health care provision that could better be spent on patient care. While provisions of the ACA are necessary, in its totality it is flawed in its execution as well.

    Neither EMTALA or the ACA address the actual problem: the health care insurance industry and the lengths they will go to in avoiding costs to slake their profit motive.

    Only one thing will.

    Universal single-payer not-for-profit health care insurance.

  19. Nal,

    Excellent article. The “everyone can get free health care already” crowd often relies upon a misrepresentation of EMTALA. Thanks for throwing a little clarity on their fire.

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