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What the Health is EMTALA?

Posted in: Insights

An explanation of an under-the-radar law with huge implications

Rachel Coyle, Fellow

Rachel Coyle, Fellow

No, it’s not the newest Chevy model. It’s one of the most important laws you’ve never heard of.

EMTALA, the Emergency Medical Treatment & Active Labor Act, is the reason medical staff will treat you when you show up to an emergency room — no matter your complaint, whether or not you can pay.

Many people today think emergency medical treatment is a given. In reality, up until EMTALA was passed in 1986 (Yep, EMTALA is a millennial.), people literally died in the street outside hospitals after being turned away from the emergency room.

In January of 1985, 32-year-old Eugene Barnes was stabbed in the head and collapsed in front of many witnesses. Four neurosurgeons at three different hospitals refused to see or treat Mr. Barnes, despite the ER physician’s call for immediate treatment. By the time a hospital finally agreed to treat Mr. Barnes, it was too late to save his life.

That same year, Sharon Ford – actively in labor – went to two different hospitals seeking a place to have her baby. Both hospitals turned Ms. Ford away, believing she lacked the ability to pay for her treatment. At one of those two hospitals, a fetal monitor found signs of an irregular heartbeat from the baby and then turned Ms. Ford away.

The third hospital performed an emergency C-section, but the baby did not survive.

For some reason, people in the mid 1980s were displeased when they noticed humans dying over an insurance requirement, so they began to complain. Media picked up on a few of the more horrific stories, and public outcry grew louder.

At the same time, hospitals were found to be engaging in “patient dumping,” which involves sending sick or injured patients to another (usually public) hospital without consent because of their inability to pay.

Some states tried to pass their own laws banning such practices, but the laws were difficult to regulate on the state level, and patients slipped through the cracks.

Ergo, despite its own lack of insurance, EMTALA was born.

Passing EMTALA

EMTALA was originally supposed to be its own law, but everyone in Congress was too focused on 1985’s gigantic budget bill (COBRA – the Consolidated Omnibus Budget Reconciliation Act) to care much about it.

So what do you do when no one pays attention to your bill? You sneak it into another bill! Consequently, tucked away inside Title IX of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) – in Subtitle A, Part 1, Subpart B, Section 9121 – hides this little tidbit of language that changed emergency healthcare as we know it.

What does EMTALA say?

  • Anyone seeking emergency care must be properly examined and receive all recommended tests to determine whether or not their condition is actually an emergency (Bonus: The medical professional doing the examination must be qualified.)
  • If an emergency condition is discovered, the hospital has to stabilize and treat the patient, or transfer them someplace that can do so. EMTALA sets strict rules for when it’s ok to transfer a patient.
  • Hospitals offering specialized services, such as neonatal critical care or burn units, must accept incoming patients who need those services (already-admitted patients excluded)
  • In 1989, 2003 and 2008, lawmakers made some changes to EMTALA – tweaking requirements for on-call doctors and adjusting some language about insurance and transfers. However, the law in its basic format has remained largely untouched.

emergencyroom

How on Earth do we pay for this?

Funny you should ask. The answer is: Hospitals pay for it, sometimes with the help of government funding (which comes from you!). The original law in 1986 provided some government assistance through Medicare/Medicaid to help cover the cost of the uninsured.

Under the Affordable Care Act (also known as Obamacare), however, the amount of government funding for hospitals goes down – because we assumed Medicaid would be expanded throughout the states and the rate of uninsured Americans would be dramatically lower.

Now, if you’ve been watching the news, you know that 24 of the states chose not to expand Medicaid. So, hospitals in those states get less government assistance to pay for uninsured emergency patients – even though the number of emergency patients in those states is not going down nearly as much as expected. All together now: Uh oh.

Why should you care?

Anyone who has anything to say about the current national healthcare debate – on both sides of the aisle – should know about EMTALA. It’s one of history’s largest unfunded (or underfunded, if you prefer) mandates. Hospitals and/or taxpayers have to cover the costs for anyone who can’t (or doesn’t) pay their bill.

  • Why conservatives should care – Concerned about current/future healthcare costs or loopholes that allow people to play the healthcare system? Look no further. It is completely reasonable for Americans to demand a less expensive or less easily-abused emergency treatment system.
  • Why liberals should care – This all sounds like a great argument for universal healthcare, right? (It also gives you license to be really angry about states refusing to expand Medicaid.)

So, the next time you’re bleeding profusely, remember why you’re able to get expensive emergency surgery right when you need it. Remember also that Obamacare is not the only important healthcare law on the books.

In the end, it doesn’t matter if you support EMTALA or not – as long as you know it exists.

“I mean, people have access to healthcare in America. After all, you just go to an emergency room.”

-President George W. Bush