Last week I talked about my experience in the hospital that was Not Meant to Be. Among the many issues was an overarching theme of access to healthcare. As I said before, only by the grace of the passage of EMTALA (the Emergency Medical Treatment and Labor Act) passed in 1986, was I able to get the care I needed.
EMTALA requires Medicare-participating hospitals that offer emergency services to provide medical screening examination and stabilizing treatment for patients with emergency medical conditions regardless of an individual’s ability to pay. EMTALA is incredibly important for the uninsured, but it isn’t enough.
I cannot pay for my medical care. It is not that I do not wish to pay for my medical care. I do believe that the time and expertise of the providers who treated me should be compensated. Their knowledge and skill are valuable and not to be taken for granted. And if I could pay whether through insurance or self-pay I would do so.
Sadly though, I do not qualify for any health insurance in Texas and thus I do not qualify for any healthcare except through a hospital’s emergency room. I make $875 a month on Social Security Disability Income which is too much to qualify for Supplemental Security Income. If you are disabled, you can qualify for SSI if you make less than $721 a month. In Texas, you are only eligible for Medicaid as an adult if you are eligible for SSI or a pregnant woman.
I do not qualify for coverage under the Affordable Care Act which was never meant to cover those with such low incomes. The Affordable Care Act was meant to provide insurance options for those above the poverty line yet whose employers don’t provide coverage or were self-employed or unemployed – places where the individual market was too expensive for regular families. The Affordable Care Act was going to ask states to take responsibility for their poor and would pay 100% of the cost for expanding Medicaid to low income citizens. But in 2012, the Supreme Court found that the way the law was written was unconstitutionally coercive, leaving it up to the states to voluntarily decide to expand Medicaid for its citizens. Texas, along with 19 other states, decided not to expand Medicaid.
Thus, EMTALA is still important because there are millions more like me who fall in a coverage gap and still need medical care.
While doctors’ jobs are to treat patients and not necessarily to get mired in payment details, health care providers do have a responsibility to think about costs of care. But I was surprised to find how very few providers – social workers, nurses, and doctors – realize that there are still many who do not have options for health insurance. Understanding my situation, which mirrors many of those seeking care in the hospital, is vital to ensure that people get the care they need.
The hospital was going to send me home the same night I entered the emergency room. They figured they had “stabilized” me and told me they’d give me a prescription for antibiotics (not knowing that I had a multi-drug resistant infection that the antibiotic would not have helped) and a referral to a surgeon. I had to explain to them as I have written here – that I don’t have and cannot get insurance. Therefore, I probably wouldn’t be able to get the prescription and I would never get to see a surgeon.
But EMTALA only goes so far in ensuring one has access to healthcare. I still had to make the case that I was not in fact “stabilized” given my type 1 diabetes. People with diabetes are more susceptible to infections and infections can raise blood sugars and high blood sugars make a perfect breeding ground for infections – a perfect symbiosis. Sending me home with an infection that could result in sepsis on antibiotics that would only establish future antibiotic resistance seemed a poor decision to me. Though I was able to see a doctor because of EMTALA, I was still not going to get the care I needed unless I fought for it. And I fought.
Those who come through the emergency room doors of a hospital deserve the very best care. EMTALA assures us that we will all get some care, that is why it matters. But it is only the first step to really providing care. Many patients may not be able to advocate for themselves. As part of the care we receive, we all deserve the advocacy of the providers who care for us – advocacy to be treated instead of “streeted” as is the normal course of business in a hospital.
If I had insurance, I would have qualified for care outside of a hospital. If I’d had insurance, I could have seen a primary care physician days before and maybe I wouldn’t have been in such a bad state as when I arrived in the ER. If I’d had insurance, I could have been referred by that primary care doctor to a surgeon and skipped all the pain caused by and mistakes made by the hospital and hospitalists. But I don’t have insurance; I only qualify for care through the doors of an emergency room.
#TexasLeftMeOut but thank goodness for EMTALA. Without this Act I, and many others, wouldn’t be here. Almost 3 decades later though, EMTALA isn’t enough. It’s time do more to ensure healthcare for all both in and out of the hospital, both in emergency and non-emergency situations – because health is a human right.