Tweet
Illegal immigrants do - and will - get free ER treatment
Dr. Tim Nesper and Dr. Martin Ogle
Posted: 11/04/2009
More than a month has passed since Rep. Joe Wilson's "you lie" moment during President Obama's health care speech to Congress.
And, since then, as the debate over health care reform has raged on, it's been picked over and dissected by the media and has served as a launching pad for a range of discussions on civility, race and congressional conduct. A couple weeks ago it even inspired a copycat outburst by a Bay Area assemblyman directed at Gov. Arnold Schwarzenegger.
But at its core, Wilson's comment was - and still is - really about one thing: making sure the health care reform bill spelled out how the federal government would prevent illegal immigrants from receiving federal health insurance subsidies.
As veteran Southern California emergency physicians, we think there are key facts still being overlooked in the health care debate vis a vis illegal immigrants. Regardless of the final language in the health care bill, illegal immigrants will continue to receive emergency medical care in this country - as required by federal law - but hospitals, health care providers and other patients will continue to pay for it.
Congress passed a law in 1986, which President Reagan signed, called the Emergency Medical Treatment and Active Labor Act (or EMTALA). The law requires hospitals and doctors to admit, treat and stabilize all patients seeking emergency care, without regard for income or immigration status. However, because no reimbursement provisions were included in the legislation, it's essentially been an unfunded mandate that imposes a major financial strain on doctors and hospitals resulting in lower quality care and longer wait times for anyone who has to visit the emergency room.
Many ERs have had to consolidate or close as a direct result of underfunding.
Fortunately, Congress helped to temporarily alleviate the problem by passing legislation to cover some of the costs of this required care for a few years. In 2003, Democrats and Republicans passed the Medicare Modernization Act, which included federal funding for mandated emergency care - up to $250 million per year to help hospitals and providers recover a portion of the costs they incur for providing emergency medical care to patients who can't pay their bills. This federal reimbursement, also known as Section 1011, has been especially helpful to participating hospitals and providers in border states like California that are disproportionately burdened with providing care to illegal immigrants.
Unfortunately, this funding was not permanent and recently expired.
We've been practicing emergency medicine in and around the counties of L.A., Riverside, San Bernardino and Orange - counties where the illegal immigrant population has traditionally been among the highest in the country - for decades, and have seen first-hand how this unfunded mandate has affected our local public hospitals.
In California alone, dozens of hospitals have closed in the past 10 years due to financial hardship, even though demand for emergency care has gone up. A recent study by the American College of Emergency Physicians (ACEP) shows that California has only 7 emergency departments per 1 million people, compared to an average of almost 20 among the other states. Hospitals in Arizona, New Mexico, Texas and Florida are confronted with similar challenges.
Absent the federal reimbursement that the 2003 Medicare law provides, our hospitals and care providers cannot continue to offer the quality of care expected in our emergency rooms. Patients will no doubt have to wait longer for treatment in increasingly overcrowded waiting rooms because of facility closures and staff and supply shortages.
We recognize how emergency medicine plays a vital role in our country's health care system and believe in providing quality care for those who need it. For example, if an illegal immigrant with tuberculosis or the H1N1 virus doesn't receive emergency treatment, he or she could put an entire population at risk. So we're thankful we live in a compassionate country where no one is turned away from emergency care. But we're also adamant that hospitals and emergency care providers should not be solely responsible for absorbing the costs of health care for illegal immigrants.
The federal government should bear this responsibility because it is responsible for securing our borders.
Whatever Rep. Joe Wilson did to fire up the debate over health insurance for illegal immigrants, an important point was missed. Even without insurance, illegal immigrants will continue to receive medical care in our nation's emergency rooms. Congress should either extend Section 1011 or find another way to reimburse hospitals and health care providers for this mandated care. Otherwise, American doctors, hospitals and patients will continue to bear this burden - through higher costs and lower quality care.
Tim Nesper, M.D., is the director of emergency medicine at Riverside County Regional Medical Center. Martin Ogle, M.D., is an attending physician at Saddleback Memorial Medical Center in Laguna Hills and a fellow of the American College of Emergency Physicians. Both doctors are members of CEP America, one of the largest providers of emergency department management and staffing solutions in the nation.
Dr. Tim Nesper and Dr. Martin Ogle
Posted: 11/04/2009
More than a month has passed since Rep. Joe Wilson's "you lie" moment during President Obama's health care speech to Congress.
And, since then, as the debate over health care reform has raged on, it's been picked over and dissected by the media and has served as a launching pad for a range of discussions on civility, race and congressional conduct. A couple weeks ago it even inspired a copycat outburst by a Bay Area assemblyman directed at Gov. Arnold Schwarzenegger.
But at its core, Wilson's comment was - and still is - really about one thing: making sure the health care reform bill spelled out how the federal government would prevent illegal immigrants from receiving federal health insurance subsidies.
As veteran Southern California emergency physicians, we think there are key facts still being overlooked in the health care debate vis a vis illegal immigrants. Regardless of the final language in the health care bill, illegal immigrants will continue to receive emergency medical care in this country - as required by federal law - but hospitals, health care providers and other patients will continue to pay for it.
Congress passed a law in 1986, which President Reagan signed, called the Emergency Medical Treatment and Active Labor Act (or EMTALA). The law requires hospitals and doctors to admit, treat and stabilize all patients seeking emergency care, without regard for income or immigration status. However, because no reimbursement provisions were included in the legislation, it's essentially been an unfunded mandate that imposes a major financial strain on doctors and hospitals resulting in lower quality care and longer wait times for anyone who has to visit the emergency room.
Many ERs have had to consolidate or close as a direct result of underfunding.
Fortunately, Congress helped to temporarily alleviate the problem by passing legislation to cover some of the costs of this required care for a few years. In 2003, Democrats and Republicans passed the Medicare Modernization Act, which included federal funding for mandated emergency care - up to $250 million per year to help hospitals and providers recover a portion of the costs they incur for providing emergency medical care to patients who can't pay their bills. This federal reimbursement, also known as Section 1011, has been especially helpful to participating hospitals and providers in border states like California that are disproportionately burdened with providing care to illegal immigrants.
Unfortunately, this funding was not permanent and recently expired.
We've been practicing emergency medicine in and around the counties of L.A., Riverside, San Bernardino and Orange - counties where the illegal immigrant population has traditionally been among the highest in the country - for decades, and have seen first-hand how this unfunded mandate has affected our local public hospitals.
In California alone, dozens of hospitals have closed in the past 10 years due to financial hardship, even though demand for emergency care has gone up. A recent study by the American College of Emergency Physicians (ACEP) shows that California has only 7 emergency departments per 1 million people, compared to an average of almost 20 among the other states. Hospitals in Arizona, New Mexico, Texas and Florida are confronted with similar challenges.
Absent the federal reimbursement that the 2003 Medicare law provides, our hospitals and care providers cannot continue to offer the quality of care expected in our emergency rooms. Patients will no doubt have to wait longer for treatment in increasingly overcrowded waiting rooms because of facility closures and staff and supply shortages.
We recognize how emergency medicine plays a vital role in our country's health care system and believe in providing quality care for those who need it. For example, if an illegal immigrant with tuberculosis or the H1N1 virus doesn't receive emergency treatment, he or she could put an entire population at risk. So we're thankful we live in a compassionate country where no one is turned away from emergency care. But we're also adamant that hospitals and emergency care providers should not be solely responsible for absorbing the costs of health care for illegal immigrants.
The federal government should bear this responsibility because it is responsible for securing our borders.
Whatever Rep. Joe Wilson did to fire up the debate over health insurance for illegal immigrants, an important point was missed. Even without insurance, illegal immigrants will continue to receive medical care in our nation's emergency rooms. Congress should either extend Section 1011 or find another way to reimburse hospitals and health care providers for this mandated care. Otherwise, American doctors, hospitals and patients will continue to bear this burden - through higher costs and lower quality care.
Tim Nesper, M.D., is the director of emergency medicine at Riverside County Regional Medical Center. Martin Ogle, M.D., is an attending physician at Saddleback Memorial Medical Center in Laguna Hills and a fellow of the American College of Emergency Physicians. Both doctors are members of CEP America, one of the largest providers of emergency department management and staffing solutions in the nation.
Comment