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Insuring millions of previously uninsured Americans was expected to decrease reliance on emergency room care. The exact opposite happened,.

If you are in the United States and you are sick, the one place that has to treat you is the emergency room (ER). Strictly speaking, there is no law that absolutely requires hospitals to offer treatment regardless of ability to pay. However, since the passage of the Emergency Medical Treatment and Active Labor Act in 1986, any hospital that accepts Medicare or Medicaid payments (which make up 42 percent of hospital income nationally) is also required to treat any patient who comes in for treatment through the ER.

No matter what your citizenship, no matter whether you are in the United States legally or illegally, and without regard to your ability to pay, the law requires hospitals to offer emergency care to all.

Every ER patient has certain basic rights:

  • Patients are seen in order of their medical needs, not on the basis of their ability to pay.
  • Patients cannot be refused care just because they do not have medical insurance. However, the hospital can send the patient a bill, sue for non-payment, and get non-payment noted on a credit report.
  • Patients who are unable to care for themselves must be admitted to the hospital. All patients must receive the same level of care.
  • If the hospital does not have the facilities to treat the patient's condition, the patient must be transferred to an appropriate facility that does. This includes long-term care and rehabilitation services. "Dumping," refusal to treat people because of anticipated high costs, is prohibited by the act (but still sometimes occurs).
  • Treatment can only be delayed to keep the patient from harming himself or herself or others.
  • Treatment cannot be denied on the basis of an outstanding bill not yet paid to the hospital.

The rights of ER patients as ER patients stop when they become "stable." Stable patients may have serious conditions that are "non-emergent." Who is a stable patient?

  • The patient must be conscious, awake, and alert.
  • The cause of any symptoms reported by the patient must be ascertained.
  • The cause of any other symptoms that may be life-threatening, limb-threatening, or organ-threatening, even if not reported by the patient, must be ascertained.
  • Any condition that is immediately life-threatening, limb-threatening, or organ-threatening must be treated to the best of the hospital's ability.
  • No patient can be released to self-care who does not have the ability to move, dress, eat, go to the toilet, attend to personal hygiene, take medicines, and communicate, unless another person is available to help the patient after discharge.
  • Any patient who has an emergency while already admitted as an in-patient is not covered by this law.

The standards of emergency care, however, are not the same as the standards for care in your doctor's office. Emergency care only treats "emergent" conditions. Pregnancy is not an emergent condition. Cancer is not in itself an emergent condition. If you have diabetes, for example, and you need insulin, and even if you don't get insulin you will have to come right back to the ER a few hours later, the hospital is not required to provide it to you. If you have extreme high blood pressure, so high that you are likely to have a stroke, the ER is not required to give you medicine. However, you will probably at least get a prescription so you can buy medicines on your own.

Why would even more Americans come in for a system that doesn't promise to keep them well even after health insurance has become much more widely available?

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