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.