The Los Angeles Times reports that emergency department [ED] physicians "and on-call specialists treating poor, uninsured patients at private hospitals in Los Angeles County saw their reimbursement rate slashed by county supervisors Tuesday."

The county "reimburses doctors 27 percent of estimated fees for patients' first three days of care at private hospitals under the Physician Services for Indigents Program," but "supervisors voted unanimously Tuesday to reduce the rate to 18 percent as of July 1." Physicians "would receive 43 percent of what Medi-Cal pays for the same services" under the new rate.

Unlike some states that require hospitals to offer Emergency Services, California requires a separate license to operate emergency departments and regulates various levels of services provided.  The move could prompt private hospitals to close Emergency Departments and flood already over-crowded county facilities with both insured and uninsured patients. 

The federal EMTALA law prevents the hospitals from turning away the patients based on their means or ability to pay.  The option of closing the emergency departments also is complicated by EMTALA which requires hospitals that do not have Emergency Departments to still provide emergency assessment and care of patients presenting with emergencies prior to transferring them to other hospitals.