Ronald Reagan, EMTALA & the Roots of Obamacare

I was visiting at a friend’s house one day when her three-year old son asked to look at photos.  My friend told him, “We’ll look at the pictures after [CW] leaves.”   He looked at me and I immediately knew what was going through his young mind.  The solution to his problem was plainly obvious and simple, and without another second’s hesitation here’s what he said to me: “Leave.” 

I can definitely relate to that little boy, because ever since Obama began lobbying to create the massive entitlement program known as Obamacare on the basis that hospitals are overwhelmed treating the uninsured for free the solution was obvious to me:  stop doing that.  Problem solved.  But like my friend’s child who had to learn a lesson about the delicacies of polite behavior with company, I’ve had to learn the hard lesson that mistakes made by those in government can virtually never be undone (which is the reason, of course, that Obama is so desperate to march forward with Obamacare in spite of its infamous problems).  When I suggest that instead of ruining the country with Obamacare we simply put an end to the mandate for free-loading it usually earns me a blank stare, as if I’d suggested doing the impossible.

Let me just say that most people pay their federal income taxes because the potential consequences for not paying can be pretty dire.  I’m no fan of our federal tax system but there’s a lesson to be learned here, to wit:  the possibility of bad consequences is usually sufficient to make most people want to avoid them.  Thus if the consequence of being uninsured means that you could potentially get hit with a huge medical bill or else face penalties akin to those of not paying your taxes, trust me when I say that a lot more people would get insurance voluntarily and much of the purported impetus for Obamacare would go away.  But since common sense seems to be off the table, let’s at least look at who we have to thank for helping to sow the seeds of our destruction.

When I brought this subject up in my last post, a commenter (hat tip to Drpete) pointed me to The Emergency Medical Treatment and Active Labor Act (EMTALA), described this way in a 2012 article in Forbes:

“EMTALA, one of the great unfunded mandates in American history, required any hospital participating in Medicare—that is to say, nearly all of them—to provide emergency care to anyone who needs it, including illegal immigrants, regardless of ability to pay. Indeed, EMTALA can be accurately said to have established universal health care in America—with nary a whimper from conservative activists.  In response, many health policy types worried about a “free rider” problem, in which people would intentionally go without health insurance, knowing that federal law required hospitals to care for them anyway.”¹

EMTALA inexplicably included no requirement for free-loaders to reimburse hospitals at a later time.  It was passed in 1986 by a republican Senate and a democrat House and signed by… Ronald Reagan.

According to an article from the website for The National Center for Biotechnology²:

“Although only 4 pages in length and barely noticed at the time, EMTALA has created a storm of controversy over the ensuing 15 years, and it is now considered one of the most comprehensive laws guaranteeing nondiscriminatory access to emergency medical care and thus to the health care system. Even though its initial language covered the care of emergency medical conditions, through interpretations by the Health Care Financing Administration (HCFA) (now known as the Centers for Medicare and Medicaid Services), the body that oversees EMTALA enforcement, as well as various court decisions, the statute now potentially applies to virtually all aspects of patient care in the hospital setting.”

And…

“Although the initial intent of EMTALA was to ensure nondiscriminatory access to emergency medical care, its practical ramifications have broadened significantly over the years and arise from 3 sources: the statute's original language (5); the interpretive guidelines that have been issued by HCFA, which are not merely suggestions but have the force of law; and the various federal court decisions that have resulted from alleged EMTALA violations.”

Ezra Klein, liberal columnist with the Washington Post, summed up why EMTALA is a Progressive’s dream:  “A universal health-care insurance program is the logical endpoint of the bill Ronald Reagan signed into law mandating (pretty much) universal emergency hospital care.”³

That’s government racketeering explained in a nutshell:  create the problem (strain on hospitals due to mandated free care) and use it as an excuse for wealth transfer, which is what universal healthcare amounts to in the end.  And look how perfectly it works.  The requirements under EMTALA are ostensibly what led to “Romneycare” and inspired the Heritage Foundation and Newt Gingrich to propose government- mandated health insurance coverage, giving liberals and libertarians a fair basis for pointing to “conservatives” as the ones who first proposed health insurance mandates. 

I suppose it’s fair to say that the federal government’s involvement in decreeing that hospitals provide free care didn’t exactly begin with Reagan.  My brief research on it traced the start back to 1946 with passage of The Hospital Survey and Construction Act (or the Hill–Burton Act), a bi-partisan sponsored law passed at the behest of Harry Truman in 1946 with a democrat senate and house.  It was amended and extended over the years by various administrations and congresses before culminating in the disaster that is EMTALA, which vastly expanded the free care decree.

I don’t know what Reagan and other republicans were thinking when they passed this law.  I think it’s fair to say…they weren’t.  Now we’re all paying the consequences.

~CW

¹http://www.forbes.com/sites/theapothecary/2012/02/07the-tortuous-conservative-history-of-the-individual-mandate/

²http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/

³http://voices.washingtonpost.com/ezra-klein/2011/01/repeal_emtala.html