The Emergency Medical Treatment and Labor Act as a federal health care safety net program

Despite the greatest economic expansion in history during the 1990s, the nu mber of uninsured U.S. residents surpassed 44 million in 1998. Although thi s number declined for the first time in recent years in 1999, to 42.6 milli on, the current economic slowdown threatens once again to increase the rank s of the uninsured. Many uninsured patients use hospital emergency departme nts as a vital portal of entry into an access-impoverished health care syst em. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payme nts from public and private payers, as well as increasing demands from a la rger uninsured population, have placed unprecedented financial strains on s afety net providers. This paper reviews the financial implications of EMTAL A, illustrating how the statute has evolved into a federal health care safe ty net program. Future actions are proposed, including the pressing need fo r greater public safety net funding and additional actions to preserve heal th care access for vulnerable populations.