More specifically, the question that a friend and I were discussing recently was:
“Are emergency rooms required to treat all patients? … whether or not they have insurance?”
I said “yes” but decided to fact-check my answer.
Here’s what I found…
There are a couple of factors in play: Federal laws. the old Hippocratic Oath, and pesky trial lawyers.
First, the laws.
According to PolitiFact.com
There are a plethora of state laws that require non-for-profit hospitals to provide a legislated level of services to the needy. That level varies by state and is generally more or a limbo bar than a high jump bar.
More important, the Emergency Medical Treatment and Labor Act was passed by Congress in 1986.
It says any hospital that receives Medicare dollars (and nearly 90 percent of hospitals in the United States do) must “provide a medical screening examination” for an emergency condition “regardless of an individual’s ability to pay.”
The American College of Emergency Physicians defines an emergency as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health (or the health of an unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”
If the patient’s symptoms qualify as an emergency, the law says “hospitals are required to provide stabilizing treatment for patients.”
If necessary, patients must hospitalized.
So, for example, a woman in labor gets treated, a homeless guy having a heart attack gets treated, an uninsured child with a sore throat … well, that’s where things get a bit complicated.
By the letter of the law, a garden variety sore throat wouldn’t qualify as emergency condition, so the child could be turned away without treatment.
That’s where the Hippocratic Oath kicks in.
Docs that I’ve talked to said that the kid wouldn’t be turned away.
First, because most docs think it’s their responsibility to treat the kid.
Second, there’s the possibility that the sore throat turns out to be “a very fast-moving strep, which can happen with little children, and the child could be dead by morning.”
That’s where the pesky trial lawyers come in.
Can you imagine the legal fight if an ER triages a patient as not requiring emergency treatment and the patient dies of from something that wasn’t detected in the screening evaluation?
That ups the ante, for sure.
Can you imagine the damages settlement if the patient were a kid?
The hospital would be toast.
So, bet the over on this one …. the kid’s sore throat will be treated.
But, there is a limit … the patient has to be serious sick or dying when they show up at the ER.
- Follow-up checks aren’t done by most ERs.
- Primary care – e.g. well baby physicals—doesn’t qualify.
- Chemo treatment for a a diagnosed cancer won’t be treated.
So, bottom line, uninsured folks get treated at ERs if they “present” with, well, emergencies.
Anything else is at the goodwill of the medical staff.
All of which raises another question: who pays for these visits?
Simple answer: an insurance carrier (e.g. employer-based plans), the Feds )Medicare), the state or the Feds (Medicaid) … or the hospital has to eat the full cost if the patient can’t pay (or simply chooses not to pay).
As we’ve posted before, ER visits have increased, not decreased, under ObamaCare.
For Extended Medicaid patients — the bulk of the newly insured — a trip to the ER is “free”.
Said differently, the visit to the ER is paid by those who pay income taxes.
As I kije to say, “it’s hard competing against free.”