An "anti-dumping" provision approved by Congress would forbid hospitals to turn away emergency room patients or "dump" them on other institutions for fear they can't pay.
The provision is part of a little-noticed section of the reconciliation bill approved March 20 and awaiting the president's signature. The overall bill was designed to cut the federal deficit by $18 billion over the next three years.
The same bill would require private employers with 20 or more workers to continue health insurance coverage for 18 months for employes who are laid off and for three years for the families of workers who die. The laid-off worker or the surviving family would have to pay the premiums, but could do so at the low group rate.
The anti-dumping provision seeks to address a problem that has received increasing attention in recent years: hospitals turning away women in labor and other patients needing immediate attention because they do not have cash or a health insurance card.
Last June 20, when Sen. Edward M. Kennedy (D-Mass.) and Rep. Fortney H. (Pete) Stark (D-Calif.) introduced the anti-dumping and insurance continuation provisions, Kennedy said that because many people do not have health insurance, "All across our country, emergency patients are being killed or crippled because they cannot find a hospital that will take them in . . . . When one of our citizens arrives at a hospital emergency room with a potentially life-threatening illness or injury, he deserves a checkup and treatment, not a credit check and a trip down the road."
The anti-dumping provision would prohibit a hospital's emergency room from turning away a patient without first stabilizing his condition and making sure another institution was willing to receive him.
Failure to follow the new rules could result in civil penalties of up to $25,000 per case against a hospital or doctor involved, hospital exclusion from participation in the Medicare program, and lawsuits for damages suffered by the patient or by the hospital on which the patient was "dumped."
The requirements would apply to all patients, not just those funded by Medicare and other government programs, and to almost all hospitals with emergency rooms.
Although much health legislation in recent years has been tailored to reduce federal costs and in some cases to shrink medical services, the measure passed last week includes half a dozen provisions running counter to this trend.
Taken together, the provisions could improve health protection for millions. Since costs would be paid mainly by hospitals and by laid-off workers or workers' survivors, the costs to the government are small.
When Stark and Kennedy proposed their package, many observers said it had no chance of enactment. But others pointed out that at least some of the proposals were akin to concepts backed in the past by legislators of both parties, such as Rep. Willis D. Gradison Jr. (R-Ohio), Senate Majority Leader Robert J. Dole (R-Kan.) and Rep. Henry A. Waxman (D-Calif.).
With the support of Gradison, Sen. David F. Durenberger (R-Minn.), Sen. John Heinz (R-Pa.) and others, the provisions were locked into the reconciliation bill that is going to the president.
Under the anti-dumping provision, any hospital that has an emergency room must screen an emergency patient's condition if it has the equipment to do so. If a woman is in active labor, the hospital must provide appropriate care. In cases of patients with serious medical conditions, the hospital must attempt to stabilize the condition. If the hospital then wants to transfer the person to another institution, it must obtain that institution's consent in advance, use an ambulance or other appropriate transportation and send along the medical records.
Another provision of the bill calls for extra Medicare payments of up to 15 percent per case for hospitals where more than 15 percent of the patients are poor and elderly. The bill also calls for demonstration projects on illness prevention to screen the elderly for incipient problems and to provide diet information, immunization and other preventive steps. And it mandates a study of whether inner city hospitals, which treat a high proportion of poor patients, have higher labor costs.