As several horrific tragedies have unfolded across our country over the last few years, this leads to the following question; who pays for the medical expenses when someone is brought to the hospital in an emergency situation? What happens if the individual does not have medical insurance? The answer is EMTALA, which stands for the Emergency Medical Treatment and Labor Act.

This was passed in 1986 as a part of the Consolidated Omnibus Budget Reconciliation Act (otherwise known as COBRA) in an attempt to overhaul the health insurance landscape. The goal of EMTALA is to ensure that all individuals are treated in an ER, regardless of their citizenship or their medical coverage status.

It’s important to note this only covers the emergency treatment portion, so after an individual is stabilized, regular medical costs are incurred. EMTALA was conceived during the 80s when certain hospitals would refuse emergency care due to the fact individuals didn’t have health insurance. This was commonly known as dumping, where hospitals would simply ‘dump’ patients to a public hospital to avoid losing money when treating an uninsured person in a critical condition.  

What’s Considered An Emergency?

There have been several amendments to the bill in order to expand and properly define an emergency situation.

According to the American College of Emergency Physicians, an emergency is “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

Once a patient if fully stabilized, only then can they be transferred to another hospital. If an emergency room defies this protocol, they can be liable for a multitude of penalties, which include:

  • The doctor being fired or fined up to $50,000
  • The hospital can be fined approximately $50,000
  • The hospital can be sued in civil court

How Is EMTALA Funded?

It’s not, and it remains unmandated, which essentially means the federal government hasn’t paid a single penny since it was enacted in 1986. It’s the hospitals and emergency physicians that end up paying for these patients. According to a report that was commissioned 15 years ago by the American Medical Association, “emergency physicians provide more than 30 hours of EMTALA-related care each week.” Experts predict these figures have drastically increased over the past few years considering the nation has experienced an increase in gun violence and illicit drug abuse.

EMTALA is an important lifeline that inevitably saves the lives of millions of Americans every year. Let’s hope future governments recognize the importance of this bill and start to allocate some money so it’s properly funded.

We understand this subject can be a little intense, so if you have any questions about the health insurance landscape, feel free to give us a call at 855-881-0430 and speak to one of our agents today.