EMTALA
EMTALA — IT WAS NOT REAGAN16 September 2011
Bizarre Political Spin Being Laid on EMTALA
At first I thought it was just one weirded-out blogger to make this allegation about EMTALA, but it now appears to be to be a spin-agenda as more left-wing extreme bloggers have picked up the chant – EMTALA was a Reagan conservative law.
First, a confession: I am so old, I helped God get the first patent on dirt. I was here 25 years ago when EMTALA was passed and –whether good or bad — it was NOT a Reagan initiative.
LETS GET THIS STRAIGHT
Fact 1 – Yes, Ronald Reagan was in office when this bill passed.
Fact 2 – The bill was passed by a Democrat-controlled Congress.
Fact 3 – The bill was sponsored by Fortney “Pete” Stark, the powerful Democratic chair of the Medicare Committee, and backed by Ralph Nader’s Public Citizen group along with the National Organization of Women.
Fact 4 – The bill was inserted in the Consolidated Omnibus Budget Reconciliation Act – a monster “Veto Proof” bill of more than 2200 pages that lumped all of the government spending in a bill that Democrats designed to be impossible for Reagan to veto.
Fact 5 – The EMTALA provisions were not in the Senate version of the COBRA bill, and just before the Conference Committee session, it was not expected to pass through to the final bill.
Fact 6 – At the Conference Committee, and literally behind closed doors in the dark of night, Stark managed to insert the EMTALA bill into the final version that Congress had to pass in order to find out what was in it. He argued it was “budget neutral” – meaning it did not cost anything to the budget, and in modern terms that meant it was an unfunded mandate.
Fact 7 – The bill was “veto proof” and Reagan signed it.
Virtually no one knew that EMTALA was in the law. It was 4 pages, back behind Agriculture and indexed under Miscellaneous Provisions.
SURPRISE, SURPRISE!
Health care organizations were totally occupied by much more “important” provisions of the COBRA law – continuation of insurance benefits and the new payment scheme from Medicare – the Prospective Payment System. Prior to passage, the only organization to have actively opposed it at hearings had been the newly recognized specialty of Emergency Medicine, when ACEP testified against original provisions that would have sent physicians to federal prison if they violated the law.
If it had passed in the original form, the only place we could now get healthcare would be Club Fed in Levinworth, KS.
Stark told people that the law only regulated the practice of “dumping” uninsured patients from private hospitals to public hospitals. After all, “any expenses could easily be assumed by the hospitals that were getting fat on the huge Medicare payments they received”.
Very valid horror stories told of patients being turned away because they had no money, with moms and babies and the uninsured dying, so opposition to EMTALA was like a vote against motherhood and apple pie (both to later be considered politically incorrect).
BEGINNING OF GOVERNMENT CONTROL
What EMTALA was – as I warned then – was a guaranteed access to healthcare law and a means of regulating physicians through their hospital membership. It was the beginning of overt control of healthcare in the US – the covert beginning had been the commencement of Medicare under Lyndon Johnson.
DID EMTALA CAUSE THE ON-CALL CRISIS?
You may also hear that the EMTALA law caused today’s problem with physicians being unwilling to respond to call. Wrong. In 1986, emergency departments throughout the country were screaming about the on-call crisis. EMTALA did not solve the problem – it was only a temporary and imperfect band-aid – but the problem was there before EMTALA.
DID EMTALA CAUSE HOSPITALS TO CLOSE?
Another common legend of EMTALA is that it closed hospitals. While true, it is a distortion – the Health Care Financing Administration (they changed their name to CMS because their reputation was so evil) used EMTALA to close hospitals. These were the waning days of the Heathcare Planning mentality that government bureaucrats could limit hospitals and technology and plan healthcare delivery to the masses. Actually, maybe it never went away.
When I asked a top HHS official about the likely impact of the EMTALA law and then-pending regulations, he told me that HHS expected EMTALA to close hospitals (a good thing in his mind). When I asked about the vast majority of the country that would lack hospitals, I almost had an AMI when he responded, “That’s their problem for living beyond the Beltway.”
AN UNEXPECTED TWIST
While EMTALA worked as expected in closing hospitals and roping physicians into government control, there was one unexpected glitch. The healthcare planning crowd was eagerly pushing the new solution – Managed Care and HMO’s. They were supposed to reduce costs by promoting healthful living, preventative healthcare, and keeping people out of Emergency Departments. But when they started banning people from ED’s, EMTALA boomeranged on them and forbid their restrictive practices. Interestingly, the most troublesome of managed care on this issue is now the Medicaid program, also administered by CMS.
BOTTOM LINE
While radical left-wing bloggers want to smear Reagan with the EMTALA label to irritate their right-wing enemies, I would just like a little accuracy in the whole EMTALA thing.
Pete Stark has several regulations named after him, but the fact is that EMTALA should have been given the nickname Stark 1, because it was probably the biggest impact he had on healthcare. Stark, in the House from the San Francisco area since 1972, was quoted as saying on more than one occasion: “Medicare is what I say it will be.”
Read MoreMeaning of Memorial Day30 May 2011
The orders from Gen. John A. Logan declare
“The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land. In this observance no form of ceremony is prescribed, but posts and comrades will in their own way arrange such fitting services and testimonials of respect as circumstances may permit. “
Please visit the grave of a veteran of US Military Service today and mark the day with with at least a moment of thanks for the freedom you enjoy the rest of the day.
Read MoreA personal note: Air Travel Hassles24 March 2011
I will be presenting an EMTALA course for the Alabama chapter of ASHRM on April 1 and an EMTALA talk for Health Management Associates National Emergency Services Conference in Texas April 30. While I enjoy the opportunity to get out to talk with folks, I am doing it less these days thanks to the total hassle that air travel has become.
My brother sent me a YouTube video that pretty much catches the essence of things, although being from the UK, it omits any mention of TSA. I was told that things hurt less if you can find something humerous in it, so…http://www.youtube.com/watch?v=HPyl2tOaKxM
Read MoreNew EMTALA Book Released18 March 2011
This book features more than 270 pages of some of the most frequently asks questions by visitors to the Medlaw.com website with my answers, observations, tips and opinions updated through January of this year.
For more information on the book, a look at the full table of contents, and to order the book, please go to www.medlaw.com/faq.htm.
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