Most powerful (and expensive) health care law you’ve never heard of
How Emergency Medical Services provided the legal, economic, and ethical justification for the Affordable Care Act (also known as ObamaCare)
Without devolving into political squabbling, here’s an irony for our times: Since Obamacare leapt over the congressional barbed wire and raced on to become a troubled law, President Barack Obama has been accused of advocating for socialistic health care, the oppression of business in favor of the uninsured (or uninsurable), and by some accounts, the illicit “seizure” of now-unsuitable coverage plans.
I may be more sensitive to the reported details (or lack thereof) regarding the insurance controversy since I spent part of my career as a journalist (and another part in the White House), but an important fact is missing from the current discussion: what deserves to be called “The Most Powerful Health Care Law You’ve Never Heard Of.”
According to the Center for Medicare and Medicaid Services, “In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay.” EMTALA is both powerful and ubiquitous: its text is displayed in almost every emergency department in the United States.
Considering the level of anger infusing Washington’s rhetoric, it seems worth noting that one of America’s most egalitarian health care mandates, designed to address the problem of “patient dumping” by Emergency Medical Service (EMS) providers for years, was signed into law by President Ronald Reagan.
Writing in 2012 for EMS World, a trade magazine, Troy Hagen, president of the National EMS Management Association, described “an estimated $2.869 billion in charity and undercompensated care” provided by U.S. ambulance services each year.
In simpler words: “The nation’s ambulance services provide almost $3 billion in care every year to patients but don’t get paid for it; that is more than half of what Medicare pays for (ambulance) services ($5.2 billion).
These numbers reflect a financial burden that is nearly double that of other health care providers.”
Who pays for services rendered but never-to-be-paid? Ultimately, we all do: higher taxes and station closures must compensate for budget shortfalls when public agencies’ bills go unpaid; private agencies absorb the bad debts, leading to staff reductions, less-robust emergency response, and the risk of bankruptcy.
As was noted by industry leaders at the 2013 New Jersey Statewide EMS conference, held recently in Atlantic City: Ambulances cost money. Fuel costs money. Medics need to eat and drink, to protect themselves when they get sued, and to heal themselves when they get hurt.
The professionals and volunteers who risk themselves to respond to 9–1–1 calls, false alarms, and the front lines of tornadoes, hurricanes and earthquakes, do so regardless of whether their patients can pay for service. This is not their choice (though they would likely jump in to save lives anyway); the federal government requires them to do so.
Few pundits noted it, but Emergency Medical Services were the underslung motif of the Supreme Court’s Obamacare debate. Here’s why: we have the right to choose to eat too much (and too poorly), to never visit the doctor or take antibiotics, to practice unsafe sex or drink in excess; we live and die by these choices. But when our car wraps around a tree and we’re unconscious, and some bystander (or an in-car dispatch) calls 9–1–1, an ambulance will arrive to rescue us. Someone should be paid for that service, because ambulance operations cost money.
Under the current EMS business model, the public somehow pays if the patient can’t — or won’t.
EMS are foundational to modern American life, but they weren’t born of Obamacare; nor were they guaranteed by a Democrat, but rather by a conservative hero.
According to Chief Justice John Roberts: “When you need police assistance or fire assistance or ambulance assistance, the government is going to make sure to the best extent it can that you get it.” We take that service for granted daily (even during major disasters), and it was made universally available by President Reagan. But that doesn’t change that it costs money — and the service is holding a $3 billion, nationwide IOU annually.
Obamacare’s mandates are designed, if nothing else, to help shore up the EMS system’s finances — something every Contra Costa County resident should personally appreciate — by ensuring that each person can cover the cost of his or her own emergency transportation … just in case it’s ever needed.
Jonathon S. Feit, MBA, MA, is co-founder and chief executive of Beyond Lucid Technologies Inc., a health IT firm based in Concord that makes software to connect ambulances and hospitals.
Originally published at www.eastbaytimes.com on November 21, 2013.