At last week's health care summit between President Obama and members of Congress, a range of important issues were discussed, but a key matter plaguing our system went unmentioned: emergency care in many of our nation's hospitals is in bad shape, and doctors and patients are paying the price.
While the debate on health care reform legislation continues, there is very little discussion about the federal government's responsibility to extend a critical funding stream for emergency care in our nation's hospitals.
The Emergency Medical Treatment and Active Labor Act, passed in 1986, requires all hospitals to treat every patient seeking emergency care regardless of the patient's immigration status or ability to pay. But while hospitals are mandated by law to ensure every person who walks into their ER receives medical care, they are often not reimbursed for their services. The resulting financial strain on hospitals lowers the quality of care, increases wait times or even forces them to close their doors entirely.
In my home state of California, more than 70 hospitals have closed in the past 10 years due to financial pressures. In fact, our most populous state has the lowest national ranking in access to emergency care, with only 7.1 emergency departments per 1 million people (compared to an average of 19.9 throughout the country).
In the past, the importance of reimbursing hospitals for federally mandated emergency care was recognized on both sides of the aisle as a key priority. In 2003, both Democrats and Republicans worked together to pass the Medicare Modernization Act, which dedicated $250 million per year to help hospitals recoup the costs they incur for giving emergency care to patients who cannot pay their bills. This provision, called Section 1011, has helped alleviate the financial hardship for a number of participating hospitals and likely prevented many emergency rooms throughout the country from shutting down.
Unfortunately, Section 1011 expired last year and Congress has yet to extend it.
Currently, this extension appears to be mired in the legislative clutter - neither the President's nor Congressional Republicans' healthcare proposals contained any reimbursement provisions consistent with Section 1011. I urge the administration and my colleagues to act quickly to address the issue of reimbursing hospitals for mandated emergency care.
If a healthcare reform plan is passed, ERs will still be needed to administer emergency care, and serve as a safety net for both insured and uninsured patients. But if a healthcare plan is not signed, the importance of emergency care throughout the country will be even more pronounced as growing numbers of uninsured people will turn to the emergency room when they have no other options. Unless hospitals are adequately reimbursed for the mandated emergency services they provide, the quality of care will increasingly deteriorate and more facilities will close.
Congress and the administration must work together to extend this urgently needed fix. This is an issue that has bipartisan support, and more importantly, impacts the public health of every community in America.
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