The Joplin Globe, Joplin, MO

Business

June 20, 2012

Trauma in the ER: Who covers the uninsured?

WASHINGTON — Trauma surgeons at MedStar Washington Hospital Center didn’t know the name of the young man wheeled into the trauma center, unconscious and bleeding from his face and head after being hit by a car. Nor did they know he lacked insurance.

But as they worked to save his life, doctors and nurses at the capital’s largest hospital ran a dizzying battery of lab tests and high-tech scans. Surgeons operated repeatedly, at one point removing a portion of his skull to relieve pressure on the brain.

As happens daily in emergency rooms nationwide, the uninsured patient received medical care guaranteed by a generation-old federal mandate that requires hospitals to care for all in need, regardless of ability to pay.

For 26 years, the Emergency Medical Treatment and Active Labor Act, or EMTALA, has been a bedrock principle of American health care - passed by a bipartisan Congress, signed by a Republican president and largely unchallenged since by hospitals and doctors.

“Whether people know it or not, whether people appreciate it or not, access to emergency care became a right in this country in 1986,” said Dr. Wesley Fields, an emergency physician in Orange County, Calif. “But the law that did that never addressed the big question of whose responsibility it was to deal with the cost.”

That unresolved question - who pays? - helped shape President Barack Obama’s 2010 health care law and its requirement that Americans get health insurance. For years, it even convinced many Republicans, including former Massachusetts Gov. Mitt Romney, to champion an insurance mandate. But today, the insurance mandate is the central target of GOP opposition to the law.

Within days, the Supreme Court will rule on whether the new law is constitutional. If the law is upheld, millions of newly insured patients will have many of their hospital bills covered by insurance. But if the law, or just the insurance mandate, is struck down, those bills will be passed on to taxpayers, hospitals and privately insured patients, as they have been for the past quarter-century.

---

The drive for a hospital mandate emerged in the 1980s out of outrage over stories like Sharon Ford’s.

Ford, who lived in a working-class suburb of Oakland, Calif., gave birth to a stillborn baby in 1985 after being turned away from two private hospitals that erroneously believed she lacked insurance. At one, she was refused admission even after a fetal monitor picked up signs that her baby’s heart was beating irregularly. By the time she made it to a public hospital, which scrambled to do an emergency caesarean section, the baby had died.

Ford’s case was not an isolated one. In Dallas, an 18-year-old man died from a severe infection after a local emergency room wouldn’t perform basic medical tests before sending him to the public hospital. In Chicago, one private hospital reportedly placed yellow stickers on the charts of patients without private insurance to avoid admitting them.

“We were seeing outrageous behavior on a daily basis,” said Dr. Steffie Woolhandler, a professor of public health at the City University of New York who helped document what was called “patient dumping.”

State leaders were the first to require hospitals to provide emergency care to all in need. But by the mid-1980s, pressure was mounting for a national solution.

Democrats who advocated universal health care, including the late Sen. Edward M. Kennedy of Massachusetts and Rep. Pete Stark of California, eagerly embraced a federal mandate on hospitals.

But the idea drew support from leading Republicans as well. “We cannot stand idly by and watch those Americans who lack the resources be shunted away from immediate and appropriate emergency care,” Sen. Dave Durenberger, R-Minn., the lead Senate sponsor of the mandate legislation, said at the time.

Sen. Robert Dole of Kansas, the majority leader and future GOP presidential nominee, said hospitals had an obligation to provide care. “We should expect nothing less,” he said.

The emergency treatment act, which threatens hospitals with the loss of federal Medicare funding, was ultimately included in a massive budget compromise signed by President Ronald Reagan in 1986.

Over the years, hospitals and federal regulators in Democratic and Republican administrations would tangle over how much care hospitals had to provide. But there would never be a serious challenge to the act’s legality or a move to repeal it.

The law requires emergency rooms to evaluate patients and stabilize those in need of urgent care. It does not compel hospitals to admit everyone for ongoing treatment.

There is broad agreement that the law put an end to the worst abuses. “It changed the way many institutions operated,” said Elvia Foulke, a former hospital executive at Citrus Valley Medical Center, a safety net hospital east of Los Angeles.

At MedStar Washington Hospital Center, a sprawling medical campus three miles from the U.S. Capitol, the emergency department sees its daily share of uninsured patients seeking care for everything from heart attacks to insect bites. Last month, more than 400 of 8,400 seen lacked coverage, according to hospital figures. Nationwide, the uninsured account for nearly a fifth of emergency department visits.

In nearly every case at MedStar, doctors and nurses never know who pays the bills. “It doesn’t enter the equation,” said the hospital’s emergency chief, Dr. Bill Frohna.

But the bills come due. And although emergency care accounts for a small fraction of total health care spending, many hospitals are feeling increasingly strained by the free care they provide.

Last year, MedStar Washington reported delivering $107.2 million in care for which it was not reimbursed. Nationwide, the total amount of uncompensated care provided to the uninsured reached an estimated $56 billion in 2008, according to one study.

Those costs have prompted financially strapped hospitals to rely on a complex system of shifting costs. Most of the burden falls on taxpayers, with the government providing tens of billions of dollars annually to help hospitals care for the uninsured. Privately insured Americans also pay a price as insurers raise premiums to reflect higher charges from hospitals.

In the past, the cost shifting was cited by many conservatives as a reason why the federal government should require Americans to have health insurance.

“If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance,” the Heritage Foundation’s Stuart Butler said in 1989. “We will not deny him services - even if that means more prudent citizens end up paying the tab.” Butler, like many Republicans, has since renounced the insurance mandate.

 

1
Text Only
Business
  • Express Scripts expansion could mean 1,500 jobs

    The nation’s largest company that manages pharmacy benefits is opening a new office building in St. Louis County as part of an expansion expected to add 1,500 jobs over the next few years.

    July 28, 2014

  • 5 things to know about coal trade, global warming

    As the Obama administration weans the U.S. off polluting fuels blamed for global warming, energy companies have been sending more of America’s unwanted energy leftovers to other parts of the world where they could create even more pollution.

    July 28, 2014

  • US rig count up 12 to 1,883

    Oilfield services company Baker Hughes Inc. says the number of rigs exploring for oil and natural gas in the U.S. rose 12 this week to 1,883.

    July 25, 2014

  • Business Visa, Amazon pull stock market lower

    Disappointing news on the American consumer, reflected in the results of retail giant Amazon and credit card processor Visa, dragged down the stock market Friday, putting two major indexes on course for a weekly loss.

    July 25, 2014 1 Photo

  • Aviations Bad Week.jpg Very bad week: Airline disasters come in a cluster

    Nearly 300 passengers perish when their plane is shot out of the sky. Airlines suspend flights to Israel’s largest airport after rocket attacks.

    July 24, 2014 1 Photo

  • Dave Ramsey: Keep hands off the 529 money

    Should we use money from our son's 529 plan for college to pay off debt?

    July 24, 2014

  • New Jersey sues over Florida pizza shop logo

    The New Jersey Turnpike Authority wants a Florida pizza shop to pay a big toll for using a logo similar to the Garden State Parkway’s green and yellow signs.

    July 24, 2014

  • Laclede Group gets nod to buy Alabama company

    The Alabama Public Service Commission this week voted to approve the acquisition of Alabama Gas Corp. by The Laclede Group from Energen Corp.

    July 24, 2014

  • France: Air Algerie flight vanishes over N Mali

    An Air Algerie flight carrying 116 people from Burkina Faso to Algeria’s capital disappeared from radar early Thursday over northern Mali after heavy rains were reported, according to the plane’s owner and government officials in France and Burkina Faso.

    July 24, 2014

  • Business US stocks rise as investors weigh earnings

    Stocks mostly rose in early trading Thursday as several big companies across industries reported second-quarter earnings, including Facebook, Ford and equipment maker Caterpillar.

    July 24, 2014 1 Photo

Poll

A new provision by the U.S. Department of Agriculture allows qualifying districts with high percentages of students on food assistance to allow all students to eat free breakfasts and lunches. Would you agree with this provision?

Yes
No
     View Results
Facebook
Twitter Updates
Follow us on twitter
NDN Video
Kerry: Humanitarian Cease-fire Efforts Continue Raw: Corruption Trial Begins for Former Va Gov. The Carbon Trap: US Exports Global Warming UN Security Council Calls for Gaza Cease-fire Traditional African Dishes Teach Healthy Eating 13 Struck by Lightning on Calif. Beach Baseball Hall of Famers Inducted Israel, Hamas Trade Fire Despite Truce in Gaza Italy's Nibali Set to Win First Tour De France Raw: Shipwrecked Concordia Completes Last Voyage Raw: Sea Turtle Hatchlings Emerge From Nest Raw: Massive Dust Storm Covers Phoenix 12-hour Cease-fire in Gaza Fighting Begins Raw: Bolivian Dancers Attempt to Break Record Raw: Israel, Palestine Supporters Rally in US Raw: Air Algerie Flight 5017 Wreckage Virginia Governor Tours Tornado Aftermath Judge Faces Heat Over Offer to Help Migrant Kids Kangaroo Goes Missing in Oklahoma More M17 Bodies Return, Sanctions on Russia Grow