Why scrapping EMTALA is a bad deal

Overcoming oppression has defined the history of the United States to some extent. The fights over slavery, civil rights and suffrage are just a few examples. But there is a curious retrograde movement of late to strip away rights granted years, if not decades ago. A large portion of it impacts healthcare and hospitals in particular.

One of the rollbacks includes heavy-handed regulation of clinics and hospitals that provide reproductive and family planning services, which are extremely successful in states such as Texas. But there is also a slowly brewing battle over a state's ability to turn away patients wholesale from hospitals.

The support for this movement began during one of the Republican candidate debates of 2011, when Rep. Ron Paul (R-Texas) suggested it would be fine to let someone without insurance die after suffering a serious accident--callousness greeted by loud cheering from the audience, MotherJones reported.

Now Georgia Gov. Nathan Deal has thought aloud what he believes an overwhelming majority of his constituents have on their minds: Shutting hospital doors completely to people who can't afford to pay for their care.

Deal floated a trial balloon last month about scrapping the Emergency Medical Treatment & Labor Act  (EMTALA), according to the Newnan Times-Herald in Georgia. "If they really want to get serious about lowering the cost of healthcare in this country, they would revisit (EMTALA)," Deal said in an address at the University of Georgia. "It came as a result of bad facts, and we have a saying that bad facts make bad law."

EMTALA has been on the books since the mid-1980s. Prior to its implementation, a hospital could refuse to treat a poor person who lacked insurance, admit the patient, or transfer the patient to a safety net hospital. EMTALA made it clear: If hospitals wanted to participate in the Medicare program, they had to treat all patients who came through the door and make sure the patients were medically stable before moving them.

There have been some peripheral gripes over the years about EMTALA, specifically regarding emergency physicians claiming they provide more charity care than any other providers. But the conscience and morality of the law is very clear. And virtually all hospital executives think it's bad policy to turn away the poor.

Certainly Georgia's hospitals are under financial strain. Three rural facilities shut last year, and as many as a dozen more are on the brink of closing. Moreover, many large providers face additional holes in their budgets due to the loss of disproportionate share hospital (DSH) funds.

However, based on the woes facing rural hospitals these days, many struggle with keeping their census above water in order to generate the revenue to survive. Although uncompensated care is a factor at every hospital, the poor who thoughtlessly flounce through the doors of ERs are not what's putting Georgia's hospitals out of business.

If there are any "bad facts" in Deal's world, it is his state's steadfast refusal to expand Medicaid eligibility under the Affordable Care Act. Such an act would cost Georgia nothing for the first three years and help stabilize many hospitals--a deal this Deal apparently can't recognize. The Georgia Hospital Association's lobbying on this issue has been underwhelming, and it has yet to capitalize on Deal's remarks to put pressure on the legislature to change their minds.

That may soon change. MoveOn.org, the political activist group, is launching a campaign to pressure lawmakers in states that have refused to expand Medicaid to change their minds. Georgia is not on its initial list, but Deal's remarks should give that state some more urgency in the campaign.

No doubt Deal and other politicians who have rejected Medicaid expansion will scoff at what they will call an incursion by liberal carpetbaggers. But there is little choice here; without strong pushback on this issue, it's plausible that states such as Georgia may take the initiative to defy EMTALA for the sake of fiscal probity. Hospitals already have enough difficulty keeping their doors open on a business basis. Closing them on a moral basis should remain a non-starter forever. - Ron (@FierceHealth)