Below, a guest post by Harold Pollack, who has recently joined The Century Foundation as an adjunct fellow focusing on issues of Economics and Inequaiity. Pollack is the Helen Ross Professor at the School of Social Service Administration, and faculty chair of the Center for Health Administration Studies at the University of Chicago .–MM
During the health reform debate, many people asserted that the uninsured are, de facto, already covered because they can always get emergency care. Here, for example, was President George W. Bush in 2008: I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."
Thursday, one of Ezra Klein's commenters says something similar, though from a different locale on the ideological spectrum:
If the Republican Party is serious about decreasing government control of health care, they should start by introducing a bill that would repeal the law signed by President Ronald Reagan that mandates free health care for all who seek it. That law, the Emergency Medical Treatment and Labor Act (EMTALA), was the largest expansion of government mandated health care since Medicare.
For obvious reasons, it would be terrible health policy to make emergency departments into our all-purpose free-care safety-net, even in a hypothetical universe where these facilities were actually capable of providing all the care that people need. But that's not what EMTALA actually does.
It's true that under EMTALA that emergency departments must assess and stabilize patients regardless of ability to pay. Hospitals can't provide a lower level of emergency care to patients they do not believe can pay. EMTALA provides other important protections to guard against "patient dumping," and the most heavy-handed hospital tactics. The law was a necessary Band-Aid to deter serious abuses. Unfortunately, it did not address the underlying supply and demand fundamentals that lead so many patients to seek emergency care, and so many hospitals to balk at providing it.
Moreover, the right to receive care is not the right to receive free care, as many Americans have learned to their sorrow. Under EMTALA, your hospital ER must assess you and stabilize your emergent condition. It may then discharge you or transfer you to the county hospital for further care. Two weeks later, that same ER is perfectly entitled to send you a $10,000 bill. Of course, many of these bills go unpaid. Often—but not always—hospitals write off this debt as unpayable.
And as these Jonathan Cohn stories underscore, hospitals can get pretty snippy trying to collect these debts. This happens all the time, sometimes with poignant or tragic results. Hospitals are within their rights to haul you into civil court if you do not pay. Even when patients are unlikely to pay, hospitals may still pursue things.
I can understand why individual hospitals feel driven to do this. They don't want to look like easy marks when their catchment area includes tens of thousands of uninsured or under-insured people. Many hospitals are closing their emergency departments or trying to constrain the financial bleed these facilities can cause. This is hardly surprising within a medical economy that includes 50 million people without health insurance coverage.
Some supporters of the Affordable Care Act claim that universal coverage will reduce emergency department use by providing access to more appropriate care. I'm skeptical. The new law will help to financially stabilize the emergency medical care system, so hospitals feel less of a need to build up their defenses when patients walk through that ER door. This is an essential step in creating an effective and humane emergency care system.