The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) for anyone seeking treatment for a medical condition regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when the patient's condition requires transfer to a hospital better equipped to administer the treatment. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004, or roughly 44% of all medical expenditures in the United States, make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.

The cost of emergency care required by EMTALA is not covered directly by the federal government, so it has been characterized as an unfunded mandate. In 2009, uncompensated care represents 55% of emergency room care, and 6% of total hospital costs.

Mandated and non-mandated care

Congress passed EMTALA to eliminate the practice of "patient dumping"—that is, refusal to treat people because of inability to pay or insufficient insurance or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual seeks treatment for a medical condition "or a request is made on the individual's behalf for examination or treatment for that medical condition." That means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.

Cost pressures on hospitals

When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. In the first decade of EMTALA, such cost shifting amounted to a hidden tax levied by providers. For example, it has been estimated that cost shifting has amounted to $455 per individual, or $1,186 per family, in California annually. but it is unclear what percentage of the amount was emergency care and therefore attributable to EMTALA.

Financial pressures on hospitals in the 20 years since EMTALA's passage have caused hospitals to consolidate or close facilities, thereby contributing to emergency department overcrowding. According to the Institute of Medicine, from 1993 to 2003, emergency department visits in the United States grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Ambulances frequently get diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances got diverted more than half a million times—not necessarily due to patients' inability to pay. According to the guidance, which does not change policy, EMTALA, as a federal law, supersedes state laws that ban abortion. So, doctors who perform emergency abortions to stabilize a patient are protected by EMTALA. Hospitals that fail to do so could face fines or be booted from Medicare. The guidance also says EMTALA does not prevent a doctor from being sued, though EMTALA may be used in defense of the doctor in state court actions. Idaho appealed the ruling, arguing that the federal government “cannot use EMTALA to override in the emergency room state laws about abortion any more than it can use it to override state law on organ transplants or marijuana use.” The Supreme Court agreed to hear Idaho's challenge to that interpretation of the law in Moyle v. United States (2024), which was argued that April.

Texas sued the federal government, winning in federal court. A 5th Circuit judge preliminarily enjoined the Biden administration's EMTALA guidance in Texas. However, the issue remains unresolved, with the ruling only seen as delaying the Idaho state law banning emergency abortions rather than striking it down altogether.

See also

  • Health care in the United States

Notes and references

  • CMS EMTALA overview from hhs.gov
  • State Operations Manual from hhs.gov
  • EMTALA: Its Application to Newborn Infants, by Thaddeus M. Pope, ABA Health eSource, Vol. 4, No. 7 (March 2008)