The emergency room is not health insurance

It’s an argument I’ve heard a lot covering health policy: The United States already has universal health coverage because emergency rooms are required to treat everyone who shows up in their waiting rooms.

While that last part is true--federal law does require emergency rooms to stabilize a patient with a life-threatening condition--there are a few recent stories worth reading to understand why that doesn’t mean the United States has universal access to health care.

The federal law that requires hospitals to take all patients into emergency rooms is EMTALA, or the Emergency Medical Treatment and Active Labor Act passed in 1986. It requires hospitals that receive federal funds (just about all of them, thanks to Medicare) to provide treatment to anyone needing emergency care, regardless of their ability to pay.

It does not, however, specify what treatments hospitals have to provide. And there, Kaiser Health News’ Jenny Gold reports, new research shows that privately-insured children tend to get more comprehensive care:

Children with public insurance (Medicaid or CHIP) or who had no coverage are at least 22 percent less likely than those with private insurance to receive testing or to undergo procedures when they visit the hospital emergency departments, researchers from Children’s Hospital Boston found. In addition, children with no insurance are less likely to receive any medication than children with public or private insurance.

EMTALA only requires hospitals to provide care to those in an “emergency,” which the law defines as situations where a lack of care could place “the individual’s health in serious jeopardy” or cause “serious impairment to bodily functions.” That does not leave much space for many of the things health insurance covers like primary care, screenings and follow-up treatment. Namely, all the things that, after an emergency room trip, are supposed to keep us out of there in the future.

“If you’re acutely obstructed by massively advanced colon cancer, it’s likely you can get emergency surgery to end the blockage,” Aaron Carroll writes for CNN. “But your cancer is likely too far advanced to cure at that point. Moreover, you’re not going to get chemotherapy in the emergency department nor could you have gotten the colonoscopy that might have detected the cancer far earlier.”

As for the care that patients receive in an emergency room, it’s not always free.Gold recently looked at a hospital that has been chasing after one low-income patient for a $1,800 bill for prenatal care. That patient currently has $1.25 in her bank account. The New York Times has also probed the aggressive tactics used by hospitals to recoup unpaid bills.

Emergency rooms are indeed required to treat the most serious cases that show up at their doors. Calling that universal coverage, however, is probably somewhat of a misnomer.