By Ted Chan, Founder & CEO of CareDash
Millions of Americans might be about to lose health care, potentially triggering a crisis at medical facilities across the nation. The GOP now controls the executive and legislative branches of the federal government. They will likely make good on their promise to repeal the Affordable Care Act (also known as Obamacare.) While Republican lawmakers have consistently promised to “repeal and replace” the law that insured 22 million, so far Congress has offered no plan for insuring those who can’t afford insurance or can’t get covered because of pre-existing conditions.. We anticipate this will have major ramifications for caregivers, and significantly impact the work experience.
Difficult Decisions When Providing Care for Uninsured
Hospitals cannot turn away patients solely because they lack insurance coverage. The Emergency Medical Treatment and Labor Act (EMTLA) is a federal law mandating the provision of stabilizing treatment in emergency situations and to women in labor. Hospitals that don’t comply can lose Medicaid funding.
Providers are not, however, required to offer anything beyond stabilizing care. No law mandates cancer treatment, extensive diagnostic services for non-emergent medical issues, or other potentially life-saving treatment. The Affordable Care Act provides coverage for preventative care, but that mandate may also soon disappear.
This leaves providers to interpret the law and assess what ethical care demands. Provide too much care to an uninsured patient and you may bankrupt your hospital. Offer too little care, and you could lose Medicaid funding. This dilemma doesn’t even take into account that providers are treating human beings. The stress—and bad publicity—of turning away someone in need can be overwhelming.
High Costs of Unpaid Care
The EMTLA is an unfunded mandate. One recent study found that half of hospital bills go unpaid. Compliance with the law, particularly in poor and disenfranchised areas, can cost hospitals millions. Providers may try to make up for this loss by limiting unreimbursed care only to emergencies, and never providing extra care when the law does not require it.
No provider went through years of school to view their patients as paychecks, but the realities of unreimbursed care can fundamentally alter the patient-provider relationship. Health care professionals may find themselves assessing whether a patient can pay before they recommend treatment, or may adjust their care recommendations based on perceptions about a patient’s finances. Research shows that the uninsured receive fewer health interventions and stay for shorter periods in hospitals.
Worse Health for Patients and Lower Morale for Health Care Providers
When patients lose insurance coverage, they turn to emergency rooms for treatment. This consistently results in lower quality care. Rather than the ongoing monitoring and communication that marks a healthy doctor-patient relationship, patients seeking care in the emergency room receive only stabilizing treatment. They don’t form relationships with doctors and nurses who understand their lifestyles and needs, and they’re unlikely to receive preventative care, weight loss counseling, advice about nutrition, and other medical information that can empower good health.
The cost is high. The uninsured have a 39 percent higher mortality rate. There’s simply no way to quantify the emotional toll on families, friends, and communities of this tragic outcome.
Opponents of government programs to increase health care coverage, including the ACA, argue that the programs are too expensive. Cutting these programs merely shifts the burden. When hospital bills go unpaid, taxpayers and local governments are often forced to pick up the tab. The question is not whether health care coverage should be paid for; it’s who pays. No one benefits when the poorest among us are denied care.