Commentary: EMTALA and the high cost of hospitalization

In 1985, America's health care industry was forced into an era of spiraling costs when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA).

A teenage Mexican resident changed history when she arrived at a Southern California emergency room in active labor, hoping to deliver an "American" baby. The ER refused treatment due to inability to pay, and the young lady eventually died in the parking lot outside the hospital - a tragic death.

Congress responded with EMTALA, which now requires emergency rooms to see all patients for any symptom from cough to headache to psychiatric distress, and of course, active labor, regardless of citizenship or ability to pay.

EMTALA became the safety net for all uninsured Americans and all illegal immigrants. The cost of unpaid services at the emergency room and, if required, hospitalization soon began driving up the price of these services.

American private insurance companies responded by raising their rates, thus putting the burden of paying for the unpaid services on American citizens who have health insurance. By providing health coverage to non-citizens, EMTALA completed the needs of uninsured immigrants and helped increase the rate of illegal border crossings to an estimated 3,500 per day.

Any solution to rising costs in health care will have to reverse the harmful effects of providing free health care in the most expensive way possible - the high tech emergency room.

Because of EMTALA, emergency room physicians provide much of the free health care given to the uninsured in America. By 2005, 84 Southern California hospitals closed their doors when unpaid services reached more than 50 percent of the service provided. A Florida hospital recently made news when, after providing three years of free rehabilitative care to an El Salvadorian national with a traumatic head injury, the hospital paid the plane ticket to send the non-resident back to El Salvador.

Even here in Carson City there are unconfirmed reports that our local hospital's budget of $25 million to cover EMTALA free service in 2009 already was depleted by July.

If Congress were not in such a hurry to pass legislation, they might have taken the time to consider the long-term effects of EMTALA. Now in 2009, Congress is once again in a hurry to solve a crisis of its own making, the high cost of health care.

One of their proposals was to take over the entire industry by becoming the single insurance payer. There are many other options available to reverse the damage of EMTALA and provide a safety net to the uninsured without forcing care to our most expensive treatment center - the high tech ER.

• Dan E. Rowe, M.D., is a founding partner of Skin Cancer and Dermatology Institute, with offices in Carson City, Reno and Fallon.