"The dumbest healthcare legislation ever passed"
What if you get hit by a car and your wallet (or purse) flies into a nearby river. Should the ER department wait until they can verify that you have insurance prior to delivering care?
EMTALA ensures that no one is denied life saving care due to lack of insurance, or lack of
proof of insurance. Alternatively, people could just walk into an ER and die after being denied care, and I think many people would have an ethical problem with that. EMTALA not only prevents this from occurring, it also provides legislative rationale for Congress to provide funding to ER departments across the country who would otherwise have to pay for this themselves.
However, EMTALA was abused because the US didn't have universal healthcare coverage. People without insurance would utilize the ER as their primary care provider, or would neglect their health until they wound up in the ER. This was not a failing of EMTALA, but a failing of our healthcare "system."
The recent healthcare reform bill remedies this situation by requiring all individuals to have healthcare insurance. This will give greater access to
actual primary care and prevention, so less people seek care in the ER, or wait until their condition is so bad that they are faced with an emergent care situation.
Did you ever wonder why the Congressional Budget Office (non-partisan btw) said the bill would
SAVE the government money?! It's because even though we will spend a lot to get more people insured, the federal government will be decreasing funding to hosptials for EMTALA and other uncompensated care. Instead, since everyone will have insurance, the hospitals can bill the companies (or Medicaid/Medicare). There is a net savings because:
1. Uninsured people who are now required to buy insurance will no longer be getting a free ride from the government (instead they have to buy insurance)
2. Uninsured people who qualify for the Medicaid extension to 133% of the poverty level (something like $30,000) will still be getting the free ride. However, they will have insurance to go see a primary care physician and obtain preventative care as opposed to only getting care in the ER which is
MUCH more expensive. Therefore the government is saving money by paying for preventative care, instead of emergent care. (I know you might be thinking about providing
NO care, but that's ethically questionable, and I don't think docs and nurses would just let people die if they came into an ER)
Here's a scenario I heard from an ER doc on NPR:
Prior to reform:
Melinda is a single mother of two making $28,000 a year working full-time. She needs blood pressure medication which costs $100 a month but she cannot afford it and doesn't qualify for Medicaid. Instead, 4 years later, she suffers a heart attack and goes to the ER receiving $50,000 of care paid for by the government or the ER. She dies, and the $50,000 of EMTALA required care
dwarfs the cost to have just provided her with the "preventative" blood-pressure medication(in fact we could have purchased 40 years worth) to keep her from getting a heart attack.
After reform:
Melinda is a single mother of two making $28,000 a year working full-time. She needs blood pressure medication which costs $100 a month and is paid for by Medicaid, which she qualifies for under the new law. Medicaid pays for 20 years of medication costing $24,000 dollars. Eventually she either works her way up so she's no longer on Medicaid (makes more than $28,000/yr), retires, or dies. Either way the, cost to society is less if we take the preventative route, instead of paying for her ER visit.
Basically, poor people are drain, and they cost us money. We can let them die, but that's ethically f***ed. Giving them health insurance means that their money-grubbing is kept to a minimum.
Obviously in this anecdote n = 1. However if we apply this situation to a broader demographic, it's been shown that primary care is less expensive.
Wow I really digressed from EMTALA.
TL;DR: EMTALA has a noble purpose, but was warped. Now we've sort of remedied the situation. We'll see how it goes. Poor people are going to drain our money but we can't let them die, so let's just do the cheapest alternative, which is preventative care!
