10 Jul 2007 Emergency Room Care Quality Harmed by 1986 Federal Law

John S. O’Shea, M.D. of the Heritage Foundation has a new paper on emergency health care access for low-income individuals that explains how a federal law adopted in 1986 is “a major barrier to timely and appropriate emergency medical care” for uninsured people needing hospital emergency room care.

O’Shea begins:

There is a deepening crisis in America’s hospital emergency rooms. More and more patients are show ing up for care without the ability to pay for it. The burden on taxpayers and private insurance policy holders is increasing, and doctors and nurses are often overworked while operating in an environment of complex and confusing overregulation, increased litigation, and rising costs.Moreover, the main federal law that governs the provision of emergency medicine is outdated and counterproductive. It undermines the provision of efficient medical care for all patients, especially for those who are uninsured or underinsured—the very group the law was meant to protect…

The Emergency Medical Treatment and Active Labor Act (EMTALA) is another example of federal legislation that hurts the very people that it was meant to protect: low-income patients in need of emergency medical services. Enacted in 1986, the law is a congressional response to well-publicized cases in which patients were refused immediate medical treatment based on their inability to pay.

However, EMTALA does not even begin to address the underlying causes of the problem, such as the lack of affordable health insurance and the substandard performance of Medicaid as a health care delivery program for the poor and the indigent… Worse, the law itself is a major barrier to timely and appropriate emergency medical care.

Policymakers need to undertake urgent reform of the emergency medical system, especially in the face of an increasing need for disaster preparedness.

For a variety of reasons, the outright repeal of EMTALA is highly unlikely. Nonetheless, federal and state policymakers can mitigate the law’s deficiencies and transcend the problems that it was originally designed to resolve….

And ultimately recommends:

…If Americans could own and control their personal health insurance and carry it with them from job to job, uninsurance would rapidly decline, and uncompensated care resulting from uninsurance would be dramatically reduced, making EMTALA largely irrelevant. Assuming that EMTALA remains on the books for the foreseeable future, Congress could make changes in emergency care — by granting limited relief from medical liability and increasing the reimbursement for physicians who perform these services—that would ease the burden on doctors and hospitals that serve patients seeking urgent care under often difficult circumstances. State legislators could also relieve the medical liability of such medical personnel.Meanwhile, state officials working with the U.S. Department of Health and Human Services could change how public funds are used to care for the uninsured, transforming uncompensated care subsidies to hospitals and other health care facilities into direct assistance to the uninsured that would enable them to buy private coverage that meets their personal needs.

Policymakers could shift health policy to a value-based system that emphasizes personal freedom and expands private health care coverage. Such a system, driven by free-market principles of con sumer choice and competition, will yield much better value than one driven by reams of outdated regulation, misguided government subsidies, and the good will of doctors and other medical professionals who provide “free” care in today’s professionally discouraging environment.