In a recent interview on CNN’s New Day, Rep. Mark Meadows (R-NC) responded to a comment from host Alisyn Camerota that ‘access and coverage were not the same thing’ during a discussion about replacing the ACA. He said: “Well, we’ve got 318 million people. The goal is to allow access to all. There’s a federal law right now that if you show up at a hospital, you get coverage, Alisyn. And so, it’s a false narrative to suggest we have people who can’t go in and get coverage. It’s a federal law.” The congressman was talking about EMTALA, the federal law that requires hospitals that operate emergency departments, and the physicians who staff these EDs, to prove a medical screen exam to anyone who comes to the ED, and stabilizing care to anyone who has a medical emergency, regardless of insurance status or ability to pay. EMTALA, however, is an unfunded mandate: the federal government never allocated funds to pay for these services. As a consequence, EMTALA provides a guarantee of access to emergency care for all, but if you have no health insurance coverage, you will receive bills for these services, and be expected to pay them. Without insurance coverage, a single medical emergency could easily bankrupt many families, and this has already happened hundreds of thousands of times.
Now it is possible that Representative Meadows does not really understand that EMTALA guarantees access, but does not provide coverage. Many legislators are ignorant of the provisions of this law, or misinterpret what EMTALA really means for patients who do not have health insurance. Even when confronted with the assertion (by Ms. Camerota) that access and coverage are not the same thing, however, the congressman went on to conflate the two terms by stating that access to emergency care for all was the same as coverage for these health care services. This leads me to believe that Representative Meadows was not inadvertently confusing these terms: he was deliberately misleading his constituents. In defending the effort to repeal Obamacare, and replacing it with something that might leave a lot of Americans who currently have insurance coverage with nothing to help them pay their medical bills, Rep. Meadows was throwing up a smoke screen by equating the EMTALA guarantee of access to emergency care to having a form of health care insurance coverage. The false narrative here is not that people may not be able to get coverage under Trump Care, or whatever the replacement plan may be called. The false narrative is that all Americans have health insurance coverage by virtue of guaranteed access to emergency care.
Why is coverage important? Many people who have health insurance coverage currently pay through the nose for that coverage, but the single most important advantage of coverage is that those who do not have it have to pay retail for health care services, while those who have coverage usually have to pay only a portion of a discounted (call it wholesale) fee for the same services (including services falling under the deductible). When it comes to really expensive, complex, or prolonged health care services, like one might experience in a true medical emergency, the net effect of having this coverage and access to this discount is huge, even when the plan carries a large deductible. Coverage, either through Medicaid or through a government subsidized commercial plan, is even more important for those who are not wealthy. A single health care bill not covered by insurance of some sort can cripple a family, and destroy whatever credit they may have. The uncovered may not be allowed to ‘die in the street for lack of health insurance’, but EMTALA will not protect them from the death of a 1000 cuts inflicted by unpayable health care bills that pile up. Health care coverage is also important because, at least under Obamacare, health insurance plans must provide coverage for routine and preventative health care services, and not just coverage for health care catastrophes. There is a price to pay for failing to receive such care, and the price may be paid, not just by the individual, but also by the community and by taxpayers, which suffer from lost productivity and the cost of providing other incurred social support services.
Wading through Rep. Meadows smoke screen, and similar assertions by his colleagues, you can readily see that access to emergency care is NOT health insurance coverage, even for medical emergencies. Why legislators, and even Presidents (Bush and others) continue to promote guaranteed access to emergency care as a backstop for the failure to provide universal health insurance coverage, while at the same time bemoaning the high cost of a visit to the ED, and the ‘unnecessary’ use of ED services, is baffling. You can trace the path from this kind of political dishonesty to the closure of hundreds of emergency departments all across the country. It is a circuitous path, no doubt, crossing through inadequate Medicaid reimbursement and failure to enforce fair payment rules; around circumvented PPACA regulations and inadequate (soon to be expunged) network adequacy standards; and under uncollectable high deductibles and health plan consolidation and profiteering. The end result is reliance on an emergency care safety net that is overburdened, underfunded, inappropriately castigated, and constantly under assault even though it is essential to the maintenance and proper function of the existing health care system and the security and well being of more than 150 million citizens a year. This is what happens when deceitful or uninformed legislators confuse access to emergency care and health insurance coverage.
Ps: Congressman Mark Meadows’ DC office tel. no. is: (202) 225-6401