Is It True That Everyone Has Access to HealthCare in an Emergency?

Under the EMTALA law, everyone is entitled to medical care at participating hospitals in an emergency, but the care is not free and we all pay for it.

A Summary of Emergency HealthCare

It is common to see social media statements that everyone can receive medical care at any hospital emergency room. However, this is not exactly true. There are many other considerations.

The Emergency Medical Treatment And Labor Act (EMTALA) Requires:

  • In an emergency, all hospitals have to treat people, before citizenship, legal status or ability to pay is determined, as per The Emergency Medical Treatment and Labor Act (EMTALA).
  • However,  the care is not free. You have to get to within 250 yards of a hospital before you are entitled to treatment. You can be charged for ambulance visits. Only very specific things are covered. Emergency care doesn’t address preventive care or cover ongoing medical needs. Hospital bills can cause bankruptcy. Ultimately the taxpayer pays for it as hospitals write off a portion of their uncompensated care and pass along the costs.

In other words, if your appendix hurts, but it hasn’t burst yet, you might not get care; if it bursts, you will be treated and then later get the bill. You can apply for charitable help and may or may not get it.

When we consider that preventive care is often cheaper and more effective, we find real problems with tens of millions of Americans relying solely on Emergency Care. This is the projected result of the American Health Care Act AKA TrumpCare.

So We All Get Emergency Room Care, Right?

Access to a hospital in a life-threatening emergency is a right granted by EMTALA. It is far different from having access to preventive care, antibiotics, and treatment of emerging conditions. It is also different from free, or even affordable, care.

What is EMTALA?

The Emergency Medical Treatment and Labor Act (EMTALA) became law in 1986.[1] It says that everyone who comes to a Medicare Participating hospital (or, later, within 250 yards of its main buildings) must be stabilized and treated regardless of their ability to pay.

The patient can be transferred to a different hospital if their medical needs exceed the hospital’s capability or if they request a transfer.

Pregnant women in labor must now be cared for immediately. They can no longer be turned away.

Since this is a Federal law, it contains complex language. You can explore EMTALA.com for more information on the law, and on fines that hospitals pay for noncompliance.

Why Was EMTALA enacted?

Before EMTALA was enacted, indigent patients and patients seen as undesirable by hospital staff were sent to other hospitals insufficiently stabilized or refused care. Hospitals were not obliged to treat all patients. People, for instance, those without insurance, could be, and were, refused care or had ambulances they were riding in turned away and sent to other hospitals. This was known as patient dumping.

Many people died for lack of care.

See The History of EMTALA for a list of the most important court cases that shaped the law.[2]

Does EMTALA Cover All Hospital Care?

EMTALA covers emergency care.

People can come to hospitals with conditions such as orthopedic damage, dental abscesses, and many other problems that are not life or limb threatening in themselves but may lead to significant injury or disability. In these cases, the individual doctor and hospital may or may not provide care.

The patients in need of access to good non-emergency care are the least well served in emergency services. Anyone with a chronic medical issue will be in this group.

Does EMTALA Provide Free Care?

The law says that triage, stabilization, and care must be provided before the ability to pay is considered.

Once a patient is stabilized, they will be asked for their insurance information and payment. Patients are responsible for their bills or for whatever portion of their bills are not covered by their insurance.

A hospital-based advocate may help an uninsured patient who is eligible for health insurance enroll in it. In that case, the insurance may cover some or all of the bill. If patients are ineligible for insurance or if their insurance does not cover the bill, they can arrange payment plans.

You should note that insurance companies have contracts with hospitals limiting the cost of care. Those without insurance do not receive the insurance adjustment discount because they are not protected by insurance contracts. The uninsured are billed for the full cost, which can be considerably more. For examples see The True Cost of Health-Care.[3]

Charity care is available at most non-profit Medicare Participating hospitals, but it is not automatic. Unfortunately, the hospitals in comparatively wealthy areas have the resources to provide more charity care while the hospitals in low-income areas have the greatest need for it.

Who Pays When Patients Can’t?

Hospitals pay the cost of uncompensated care and, of course, pass that cost along to those who pay. Uncompensated care, which by some estimates is $73 billion a year, is passed along to employers and others who pay for insurance. [4]

Each uninsured person costs hospitals about $900 a year. States that refused to expand Medicaid under the ACA have the largest number of uninsured patients and largest uncompensated care bills. If a hospital closes, the other hospitals near it pick up the uncompensated care. The bills do not go away; they are passed along.[5]

Does Expanding Medicare Help Lower Hospital Costs?

States that expanded Medicare had fewer uncompensated care costs. Their uncompensated costs fell from 4.1% to 3.1% as opposed to the 5.7% in states without expansion. A study found that uncompensated care cost decreased by 21% in March of 2015 for states that expanded Medicare.[6]

Summary

Although life-threatening emergencies must be treated in Medicare Participating hospitals, the cost of that care is passed along to the community.

If people have health insurance, they can go to doctors and treat conditions before they become emergencies. Their insurance will also help pay hospitals and avoid uncompensated care costs. If people lack insurance and their medical condition becomes life threatening, they become eligible for care, and everyone pays higher rates because of it.

Insurance gives people access to necessary care which is both more humane and less expensive in the long run.

Citations

  1. Emergency Medical Treatment and Labor Act (EMTALA)
  2. The History of EMTALA
  3. The True Cost of Health-Care
  4. Most Without Insurance Do Not Pay Hospital Bills: Federal Report
  5. Who Bears the Cost of the Uninsured?
  6. Uncompensated Care Costs Fall in the Medicaid Expansion States

What do you think?

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