Gov. Nathan Deal this week proposed changing the longstanding federal law that requires emergency rooms to treat anyone who walks in, saying people who “consider the emergency room as their family physician” could undermine the health care network.
The governor’s surprise remarks, which came Monday night at a University of Georgia political science alumni gathering, rankled critics who are already frustrated by Deal’s decision not to expand Medicaid under the Affordable Care Act.
“This is the basic firewall against turning away people who have an emergent need for medical attention. It’s the bare minimum we can do as a society to prevent people from needlessly dying,” said Cindy Zeldin, executive director of Georgians for a Healthy Future, a group that is critical of Deal’s health care policy.
“To undo this at the same time that Georgia is turning down the federal funds on the table to expand Medicaid and provide some other form of access to the health care system – it’s problematic.”
But Deal said it is past time for Congress to rework the 1986 law that requires hospitals to provide emergency treatment. Such changes are essential, said Deal, if Americans “really want to get serious about lowering health care costs in this country.”
“It came as a result of bad facts,” Deal said of the law Monday night. “And we have a saying that bad facts make bad law.”
Jason Carter, an Atlanta state senator who seeks to challenge Deal in the fall, said the governor was simply wrong.
“It’s not a solution to any real problem,” Carter said. “We’re not going to just turn people out on to the streets. Our hospitals have a moral obligation to treat people when they show up. That’s not a legitimate way of solving the problem.”
The Emergency Medical Treatment and Labor Act (known by its acronym EMTALA), was adopted after hospitals warned that the government’s reduction of Medicare reimbursements would threaten hospitals’ ability to provide charity care. Stories of pregnant women being turned away from ERs because they couldn’t pay or weren’t legal residents added ammunition for supporters.
The version that stands today, which has survived several court challenges, requires hospitals that take part in the federal Medicare program and offer emergency services to provide medical screening examinations for anyone claiming to have an emergency condition. If the exam reveals an urgent need, hospitals must at the very least stabilize the patient.
Countless patients have benefited from life-saving care in the 28 years since the law was adopted, but the requirement has also strained resources and turned ERs into a first stop, rather than a last resort, for some of the neediest patients. Many Democrats view EMTALA as a cornerstone of health care law, while some Republicans view it as an unfunded mandate.
Deal has long subscribed to the latter view. While leading a key U.S. House health subcommittee, he summoned hospital leaders to Washington to critique the law. One such hearing, in 2005, featured testimony from an executive from Deal's hometown of Gainesville who urged lawmakers to allow hospitals to redirect patients to "more appropriate sources of care."
He backed legislation then that would allow hospitals to divert patients to nearby clinics and urgent care centers, citing statistics that showed patients with non-threatening illnesses such as earaches were flooding emergency rooms and driving up costs. But the governor has talked little of the ER statute in recent years, even as he’s railed against other health care laws.
In his remarks Monday, he signaled he was taking a more vigorous stance out of concern that overuse of ERs could endanger the stability of the nation’s hospitals. He sees a push to change the 1986 law as a better alternative that should be at the centerpiece of any broader health care discussions.
The governor has political reasons to revive the attack as hospitals in Georgia are caught in a fiscal crunch. The new health care law reduced federal cash for indigent care, a pot of money that was to be replaced by new Medicaid funding. But Georgia’s rejection of the expansion is forcing Deal to consider bailing out safety-net hospitals hurting for cash.
Yet health-policy analysts question why he would bother pushing the emergency room change, which could open him to a new line of attack from critics. Tim Sweeney, the director of health policy at the left-leaning Georgia Budget and Policy Institute, said it doesn’t make sense for the governor to push the changes since the law is a federal matter.
“It’s a bit of a distraction from the state health policy issues that are on the table now that we do have the power to deal with, such as expanding Medicaid to provide more coverage to more people,” Sweeney said. “That is one of the major goals of the ACA — to increase health coverage on the front end so that emergency rooms are not flooded with uninsured patients.”
Deal said he has embraced the issue partly because few, if any, other leading GOP politicians have mentioned it amid the broader debate about the cost of health care. He said protections can be built in for pregnant women and others situations that led to the sweeping legislation in the first place.
“I think we should be able in this passage of time to figure out ways to deal with those situations but not have the excessive costs associated with unnecessary visits to the emergency room,” Deal said.
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