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Right to health care: The Emergency Medical Treatment and Active Labor Act (EMTALA)

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The U.S. Congress passed the Emergency Medical Treatment and Active Labor Act, section 1867(a) of the Social Security Act, in 1986. It requires three things of hospitals:

  • imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an "emergency medical condition" exists;
  • imposes restrictions on transfers of persons who exhibit an "emergency medical condition" or are in active labor, which restrictions may or may not be limited to transfers made for economic reasons;
  • imposes an affirmative duty to institute treatment if an "emergency medical condition" does exist.

Particularly notable is the lack of a provision for reimbursement of the hospital. If the patient is not covered by private insurance or Medicaid/Medicare, and cannot pay the bill, the hospital must eat the loss. One way hospitals may offset the loss is by increasing charges for paying patients. Since Medicaid/Medicare has fixed reimbursement rates, and most private insurance also has fixed rates set by contract, that means the uninsured who are able to pay out-of-pocket often subsidize the uninsured who aren't.

Outside the emergency room and EMTALA, medical emergencies are handled by public safety agencies. When a person calls for an ambulance for a medical emergency, states generally require emergency medical personnel to respond, regardless of whether there is an ability to pay.

The principle underlying both EMTALA and the state-imposed duty for EMS to respond is that everyone has a right to be treated in case of emergency. It seems that American society is comfortable with this principle. Do you agree that there is a right to receive emergency medical treatment regardless of ability to pay? If so, who should pay?

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