Virginia's attorney general seeks to nullify the recently signed health reform bill. If his suit arises from sincere, principled motives, then logically he must go further and sue to have the Emergency Medical Treatment and Active Labor Act, or EMTALA, repealed.
EMTALA was passed amid growing reports in the 1980s that hospitals were denying emergency health care services to the poor and uninsured.
Signed into law by President Ronald Reagan, it provides stiff penalties for hospitals that fail to adequately treat patients with emergency medical conditions or women in active labor.
Americans with secure health insurance still need to understand the implications of EMTALA.
In some small community hospitals, two-thirds of total operating costs are attributable to uncompensated care. The American Academy of Emergency Physicians estimates that, as a result, hundreds of emergency departments across the country have been forced to close. In Los Angeles alone, 10 hospitals have closed in the past five years.
While it is unlikely that the ED at Mary Washington Hospital would ever close, smaller hospitals do not have the resources to continue to provide free care to a growing number of uninsured patients.
Although it was originally intended only for emergency cases and mothers in active labor, few administrators today will risk their Medicare reimbursements, so for practical purposes EMTALA is applied to anyone who presents himself at an emergency room.
The moral authority of the Patient Protection and Affordable Care Act of 2010 and the Emergency Medical Treatment and Active Labor Act of 1986 rests on the question of whether health care in the U.S. is a privilege of the rich or a right of all citizens.
If access to health care is a privilege for those who can afford it, then EMTALA should be repealed.
If health care is a right, then both acts should be allowed to stand.
Donald E. Bley, M.D.
The writer is site director, Community Health Center of the Rappahannock Region.