Rep. Diane Black (R-Tenn.) proposed on Friday that hospital emergency rooms should be able to turn patients away to help keep health care costs down.
“I’m an emergency room nurse,” Black told MSNBC host Chuck Todd on Friday. “There are people that came into my emergency room that I, the nurse, was the first one to see them. I could have sent them to a walk-in clinic or their doctor the next day, but because of a law that Congress put into place to say, no, I have to treat everybody that walks into that emergency room.”
“You took away our ability to say, ‘No, an emergency room is not the proper place.’ And then, you put a burden on top of that to say, ‘You must do that,’” added the congresswoman, who is also running for governor of Tennessee.
At issue is the Emergency Medical Treatment and Active Labor Act, which was signed into law by former President Ronald Reagan in 1986. It was a congressional response to stories of “patient dumping” ― hospitals would deny treatment to patients or send them elsewhere, usually because the individuals didn’t have insurance. Many of these patients were unemployed or were people of color.
Those transferred individuals were more likely to die, and the delayed care often jeopardized the patients’ health.
The law put a particular focus on pregnant women (hence “active labor” in the law’s name), to ensure that they would be able to deliver their babies and receive full care.
Changing the law, as Black advocates, would send America back to a time when hospitals can use their discretion to turn people away.
“We must treat everybody that walks in whether you’ve had a sore throat for a week, we must see them. And that crowds the emergency room. It drives the cost of emergencies up,” Black added on MSNBC. “And so, yes, if someone comes in from an auto accident, I don’t want to ask whether they have insurance or not. I’m going to take care of them.”
“But what it did is crowd my emergency room, where I work,” she added. “And disallowed me from using my good judgment skills, of which I was trained to do and doctors are as well. And the federal government said, you must ― and you can’t make those decisions. And I think that was a poor thing for us to do.”
This free-for-all system would not be unlike what happened before Obamacare, when there were fewer requirements for insurance companies to accept people for coverage. It was a time when insurance providers were free to turn people away because they had more expensive pre-existing conditions ― or were labeled as potentially having an expensive condition down the line. And since these companies were free to do so, they did.
Nobody thinks EMTALA is perfect and non-partisan organizations, including the Institute of Medicine, have long called for revising some of the law’s regulations as part of a broader strategy to ease emergency room overcrowding. And although conservatives have been among the most critical of the law, even the Heritage Foundation admits that “the outright repeal of EMTALA is highly unlikely,” and it’s not something you hear talked about much in health care debates.
When Todd asked Black whether she would get rid of the law, she replied, “I would get rid of a law that says that you ― you are not allowed, as a health care professional, to make that decision about whether someone can be appropriately treated the next day, or at a walk-in clinic, or at their doctor.”
Also, technically, no doctor or hospital is required to see anybody. But treating all patients is a requirement for hospitals using Medicare funds. So already, a doctor or hospital can turn people away ― as Black suggests they should be able to do ― they just won’t get to bill Medicare.
Jonathan Cohn contributed reporting.
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