The Emergency Medical Treatment and Active Labor Act (EMTALA) has been in the news recently. The Biden Administration has sued Idaho over our restrictive antiabortion laws, claiming the Federal Act trumps the states restrictions. Oral arguments were heard before the US Supreme Court this week.

So, let’s step back a bit and try to understand just what EMTALA says.

The law was passed by Congress and signed by President Reagan back in 1986. There were many stories at the time in the press and professional testimony telling stories of patient “dumping” between hospitals.

A patient with no health insurance might show up at an emergency room. Let’s say the ER is in a private hospital.

If the city had a public hospital, like LA County Hospital or Cook County Hospital in Chicago, the private ER would just send the patient down the road to the public hospital without offering any treatment. That is, they performed a “wallet biopsy” and determined they wouldn’t get paid, so sent the patient off to a publicly supported facility.

There were also cases of pregnant women in active labor being shunted off. Tragic outcomes were reported.

Congress acted. Not to fix our messy health care system, just to make such dumping cases sanctionable.

Congress put the Centers for Medicare and Medicaid in charge of enforcing these rules.

EMTALA violations are investigated, and fines are levied. Every year 3-4% of US hospitals are fined. Private, for-profit hospitals have twice the incidence of violations as do nonprofit hospitals. Fines average about $34K per incident.

So, dumping still occurs, I guess, but it just doesn’t stir the outrage it used to.

EMTALA prohibits the transfer of patients based on their ability to pay. It also required patients receive stabilizing treatment before transfer. Indeed, the emphasis on “stabilizing treatment” in the law is at the crux of the Biden Administration lawsuit against Idaho’s antiabortion laws.

I am not a great fan of the Federal EMTALA law. I think it responded to outrageous behavior with bureaucratic hand slaps. Indeed, the cost of healthcare went up after EMTALA. More cost shifting onto insured patients occurred when hospitals were required to provide uncompensated care.

 But it was enacted to put a band aid on our bleeding health care system. Uninsured patients were being treated inhumanely. So, dumping them gets a fine.

Instead, we should have made sure all had health insurance.

Back when EMTALA was passed about 17.6% of the population was uninsured. In 2022, we have gotten down to 7.9%. EMTALA didn’t give anybody health insurance. It just brought civil penalties, fines to violators.

The public and Congressional moral outrage at hospitals denying care based on the patient’s inability to pay lead to EMTALA. But we still have uninsured. We still have the most complicated, mind boggling health care system in the world. Maybe you think it’s what makes America great. I don’t.

Whether the US Supreme Court will decide Idaho’s antiabortion laws violate EMTALA has almost stood the purpose of the law on its head.

Idaho is arguing our laws, to DENY CARE take precedence over the Federal requirement to provide care.

Specifically, in Idaho, if a pregnant woman comes to an emergency room and is unstable due to conditions of pregnancy, she cannot be treated with an abortion, that is, delivery of the fetus that likely will not survive, unless it is to save her life. If she is bleeding, infected, unstable, and the recommended treatment to save organs, her reproductive future, she cannot receive this treatment in Idaho. She must be transferred to a state where such treatment is legal. Six such transfers have occurred since our laws went into effect.  Idaho is dumping our unstable pregnant women on other states.

Little wonder that doctors who treat pregnant patients look at Idaho with trepidation. Such a determination puts them very close to, if not over the line of “do no harm”.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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