EMTALA and our cruel health care system in Texas

[TexasTowelie]

There’s much that is being lost in the hyperventilating over the mistake-riddled roll out of the Patient Protection and Affordable Care Act, or ACA. But the discussion of our health care system comes down to a few simple things. Before this law was passed our health insurance system was a disaster. The ACA was not designed to “fix” our health insurance system. It’s a plan that is palatable enough for the health insurance corporations, and was therefore allowed to pass through our corrupt political system. And yes, Obama and the Democratic Party own it.

To show what a cruel disaster the former system was, and will continue to be in Texas – because of the decision not to expand Medicaid – please read this article, Texas’ Other Death Penalty, A Galveston medical student describes life and death in the so-called safety net. The description of how the emergency room law, Emergency Medical Treatment and Labor Act (EMTALA), works is shocking and it’s despicable that we allow this to continue.

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

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But UTMB is no longer the state-subsidized charity hospital it used to be. The changes began before Hurricane Ike in 2008. But after the storm, UTMB administrators drastically cut charity care and moved clinics to the mainland, where there are more paying patients. The old motto “Here for the Health of Texas” was replaced by “Working together to work wonders.” Among those wonders are a new surgical tower and a plan to capitalize on Galveston’s semi-tropical charm by attracting wealthy healthcare tourists from abroad. Medical care for the poor is not, apparently, among the wonders. Whereas UTMB accepted 77 percent of charity referrals in 2005, it was only taking 9 percent in 2011.

UTMB ascribes these changes to financial strain from Hurricane Ike, the county’s inability to negotiate a suitable indigent-care contract and loss of state funding. The state blames budget shortfalls. The Affordable Care Act, better known as Obamacare, could have been a huge relief. However, Gov. Rick Perry rejected billions of dollars in federal funding to expand Medicaid, funding that should have brought access to more than a million Texans, including many St. Vincent’s patients.

More at http://eyeonwilliamson.wordpress.com/ .