Congress passed the Emergency Medical Treatment and Labor Act (EMTALA) in 1985 in response to reports of "patient dumping." EMTALA was intended to ensure patients' timely access to emergency medical care by preventing hospitals from transferring or refusing to treat patients based on their ability to pay.
EMTALA requires hospital emergency rooms (ERs) to screen patients presenting there to determine if an emergency medical condition is present. If so, ERs must either stabilize the patient prior to transfer or obtain a certification that the transfer is appropriate. Although hospitals and physicians are required to screen and stabilize patients, payment for that treatment is not guaranteed. They may not ask about an emergency patient's financial situation - including any possible insurance coverage - until the patient is stable or certified for transfer. Likelihood of payment for services covered under EMTALA also is compromised by patients' ability to pay.
While the passage of EMTALA was worthy and justifiable, its unintended consequence is that hospital ERs and emergency and on-call physicians have become the de facto source of care for the nation's uninsured. Uninsured patients know ERs cannot turn them away when they seek care. Uninsured and underinsured patients use ERs not only for emergency care but also for minor illnesses, which can be treated more cost-effectively in physicians' offices and clinics. With some 5 million Texans lacking health insurance (25 percent of the population), EMTALA has placed significant financial burdens on physicians and community hospitals. In fiscal 1998, the Texas Comptroller of Public Accounts estimated that the state spent $4.7 billion on care for the uninsured.
State Allocation of Funding
Section 1011 of EMTALA provides $250 million per year for fiscal years 2005-08 to pay eligible physicians and providers for emergency health services to undocumented immigrants. This new funding was intended to offset uncompensated care resulting from EMTALA. Two-thirds of the total yearly appropriation, or $167 million, is to be divided proportionally among all 50 states and the District of Columbia. Allotments will be based on the percentage of undocumented aliens residing in the state as of 2003, based on the 2000 census. Texas' projected state allocation per year is $47.5 million. Yet, the state comptroller estimated Texas border counties alone spent $74 million on care for undocumented immigrants in 2000. The remaining third of the total appropriation, or $83 million, will be divided among the six states with the highest number of undocumented aliens each fiscal year. Preliminary data indicate these states will receive the remaining funds: Arizona, California, Florida, New Mexico, New York, and Texas.
Medicine's 2009 Agenda
- To ensure that critically needed EMTALA services provided by physicians remain appropriately accessible and geographically available, TMA strongly urges Congress to, at a minimum, maintain funding for the program at 2006 levels.
2009 Federal Legislative Issue Briefs
U.S. Congressional main page