What Is EMTALA?

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

By the 1960s, the formation of unions help to standardized employer health benefits and the access to insurance was prevalent for workers. This system seemed to be well established as the employers, private health insurance carries, physicians and hospitals would recycle health cost amongst each other. However, there were many underlying problems with this tightly organized system. Self employed individuals, small companies, the poor, and the unemployed had no organized access to health insurance. Also, at this time the majority of elderly retirees lost their health insurance in old age when they needed it most. These underserved populations began to seek care in emergency facilities driving the cost of urgent care back on the hospital and

Since the development of the EMTALA Act in 1986, any individual which presents to the emergency department, must be accessed and triaged by qualified medical personnel. (www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. “This mandate does not extend to private physician offices, however, which creates an incentive for those without the means to pay for care to

The Social Security Act of 1965 established Medicare and Medicaid which are health insurance programs for the poor and elderly people of the United States. It is funded by a tax on the earnings of employees and contributions by the employers. “It is now broadly apparent that those who opposed Social Security in 1935 and Medicare in 1965 were wrong in their fears…” (Nicholas Kristof  “The Wrong Side of History”).

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA was enacted to prevent hospitals with Emergency Departments from refusing to treat or transferring patients with emergency medical conditions (EMC) due to an inability to pay for their services. This act also applies to satellite locations whom advertise titles such as “Immediate Care” or “Urgent Care,” and all other facilities where one-third of their patient intake are walk-ins. Several rules and regulations to this act have been established and it has become a very serious piece of legislation and health

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

What is Medicare? President Lyndon Johnson signed Medicare into law on July 30, 1965. When Medicare first began, it had two parts, Part A and Part B. Medicare Part A provides hospitalization coverage to all citizens age 65 and older. It helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not have to pay a premium for this service because they or their spouse has already paid for coverage through payroll taxes. Most beneficiaries over age 65 don’t pay a monthly premium for Medicare Part A coverage if they or their spouse paid Medicare taxes for at least 10 years while working (Mack, 2016). Most Medicare beneficiaries do not have to pay Medicare premiums on Part A because of their employment Medicare tax history (Mack,

The ACA was created to help insure a larger portion of the nation’s population and give people access to affordable and higher quality care. Unfortunately, the ACA completely excludes undocumented immigrants from the eligibility of the program, even though this population consists of 11 million, which is a huge chunk of the nation’s population. As a result, the undocumented population is left with Emergency Medicaid, which is a program that is a part of ACA. This program gives some limited assistance to undocumented individuals in a case of an “emergency” or pregnancy related issues. Emergency Medicaid does not cover any type of prevention care or offer primary physicians to patients. It is also important to note that if the hospital determines that the visit was not an emergency, then the patient is left with a high medical bill that they would not be able to afford possibly leading to bankruptcy.

[2] The law requires care providers to deliver medical services despite patients’ ability to pay. The act outlines specific guidelines for providers that deliver emergency services. If a patient has a medical emergency, such as an injury or active birth, the law obligates caregivers to stabilize the patient and provide treatment up to the point where the patient remains stabilized. If the care provider cannot deliver this service, the law mandates that the provider transfer the patient to a capable facility.

The Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986 and it requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. It further stated Participating

After establishing Medicare and Medicaid in 1965, Congress saw the need to protect the programs from fraudulent activities and practices of unscrupulous providers. The laws on health care fraud were enacted at different time during the history of the health care programs. However, the overall congressional intent has been the same, and the objective is to strengthen existing laws to protect the federal government health care programs from fraudulent activities.

The rising costs of unpaid emergency room expenditures were an issue that had to be addressed by state authorities. EMTALA required that all persons be treated, however, it did not include any legislation to reimburse payment that left hospital left with unpaid bills and growing expenses.

The ethical right for individuals to have access to health care already has a form of legal binding within the United States as seen in the Emergency Medical Treatment and Active Labor Act. “In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), which forbids Medicare-participating hospitals from “dumping” patients out of emergency departments” (Pozgar, 2010, p. 221). The act provides that:

The Emergency Department (ED) is the highest cost environment to receive non-emergent care. The public views the ED as a safety net; more and more people are seeking treatment in the ED for non-urgent problems. This circumstance not only exacerbates overcrowding, it diverts attention from critically ill or injured patients and can diminish the quality of their treatment. Overcrowding in the ED is a problem that leads to delays in treatment and poor health outcomes (Hutchinson, 2015). ED overcrowding historically has been a problem seen most often in inner-city academic hospitals, but the issue is now a crisis in both urban and rural settings. Such use of expensive

According to Sy Mukherjee, when EMTALA became a law, congress authorized a Medicaid fund that would help cover some of the costs, which covers