With the announcement yesterday that another judge has found the “personal mandate” aspect of the Affordable Care Act unconstitutional, I wanted to point to this post by Ezra Klein that deals with another acronym with which you might be less familiar, EMTALA.
Passed in 1986 and signed into law by none other than Conservative Superman President Reagan, the Emergency Medical Treatment and Active Labor Act specifies the obligations that a hospital must fulfill when someone arrives at the hospital requesting “examination or treatment for a medical condition.” EMTALA specifies that should an initial examination provide evidence that the patient is suffering from an “emergency medical condition”, the hospital has an obligation to provide “such treatment as may be required to stabilize the medical condition”, or if their facilities are not adequate, a transfer to another hospital.
As Ezra’s commenter pointed out, this requirement provides a very strong argument for the need for an insurance mandate by acting as an “insurance-of-last-resort” for those who are not insured through other means. The problem with this “insurance-of-last-resort” is that it is free; nobody is forced to pay a premium to be covered under EMTALA. This “mandate gap”, requiring hospitals to provide care without requiring potential patients to be able to pay for it, introduces a large externality into the health care system: the costs of emergency care are not necessarily borne by those seeking such care.
The idea that a hospital does not have the option to turn people away from care but that people have the option of putting themselves in the position where they will be unable to pay for such care is incoherent, and results in higher costs for those responsible and financially sound enough to purchase their own insurance. We need for people to be responsible for the costs that they impose on the health care system, and we can accomplish that in one of two ways: (1) an individual mandate that ensures everyone has an arrangement in place for paying their medical bills or (2) eliminating EMTALA, allowing hospitals to turn away people based on their ability to pay to prevent free-riding in the health care system.
In my eyes, the choice between the two is a no-brainer.