When you think about it, the emergency room and the dive bar aren't that different. Both places are usually the last stop of a long night. The television in the corner is too small and rarely turned to anything decent. Driving yourself home after a visit is usually a terrible idea. But one way the ER trumps the bar? Try shrugging your shoulders at the pub next time they demand $3.50 for your pint. Because at the emergency room, they're obligated to give you urgent care should you need it.
Turns out the question of whether emergency rooms have to treat you is not a clear yes or no — like a lot of health care-related questions in the United States. At the crux of the issue is the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal law that seems to dictate that all people who enter an emergency room with an emergency must be treated. But don't run to your nearest emergency department in hopes of a free dose of codeine for your troublesome cold.
The EMTALA was passed in 1986, and it doesn't mean walking into the emergency room guarantees you care. Instead, it makes clear that those with an actual emergency (i.e., not your stubborn sinus infection) must be treated and in a stable condition before they can be transferred. Transferred, you say? Why can't those in an emergency just be kept at the hospital they walked into?
Because, you see, the point of EMTALA wasn't entirely just to treat everyone equally, regardless of what they could pay. The act was also passed to make sure that hospitals weren't trying to "dump" Medicaid or uninsured patients onto public hospitals, so the burden for care could be more equally spread outside the state-run facilities. So a lot of the provisions of the act are more complicated than simply, "don't turn anyone away and never ask if they can pay or not."
Instead, it's a bit of a balancing act for emergency rooms. Sure, it does mean that all hospitals have to treat patients regardless of income, insurance and the usual host of personal characteristics (race, gender, ethnicity, etc.). But look closer and you'll see that it actually calls for docs to simply stabilize all patients before they make the decision about transferring them.
So yes, an emergency room must treat you, even if you can't pay, until you're stable enough to be transferred if the hospital deems that appropriate. And remember, you're still going to get a bill in the mail if you don't have health insurance.
- American College of Emergency Physicians. "EMTALA." 2014. (April 6, 2015) http://www.acep.org/content.aspx?id=25936
- Centers for Medicare and Medicaid Services. "Emergency Medical Treatment and Labor Act." United States Government. March 26, 2012. (April 6, 2015) http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/01_overview.asp
- Families USA. "Romney '60 Minutes' Statement about Emergency Care for the Uninsured Is Both a Change and Lapse in Judgment." Sept. 24, 2012. (April 6, 2015) http://familiesusa.org/press-release/2012/romney-%E2%80%9C60-minutes-statement-about-emergency-care-uninsured-both-change-and-lapse
- Fosmire, M. Sean. "Frequently Asked Questions about the Emergency Medical Treatment and Active Labor Act." Emtala.com. October 10, 2009. (April 6, 2015) http://www.emtala.com/faq.htm
- Murphy, Tim. "No, You Can't Just Go to the Emergency Room -- Unless You Want to Go Broke." Mother Jones. Oct. 18, 2013. (April 6, 2015) http://www.motherjones.com/politics/2013/10/emergency-rooms-instead-health-insurance