This Government Mandate Is Driving Up The Cost Of Health Care In America

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Robert Donachie Capitol Hill and Health Care Reporter
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The cost of health care is skyrocketing in America, and it is having drastic effects on already burdened emergency rooms.

Health care costs, from the price of prescription drugs to doctors appointments, rose more in August than any other time since 1984.

Adding to the financial woes of consumers is that the cost of obtaining insurance on the exchanges is becoming so expensive it is burdensome, even prohibitive.

The Obama administration announced in late October that insurance premiums would rise by the double-digit percentages in 2017. Premiums will increase at an average of 25 percent across the 39 states serviced by the online marketplace Even worse, around 20 percent of consumers, or one in five, will only have one insurer to choose from in the marketplace. (RELATED: White House: Obamacare Premiums Will Rise By Double-Digits Next Year)

As a result of the rising costs of health care and the lack of other available options, Americans without health insurance, particularly minority groups, are driven to emergency rooms to get necessary, even minor, medical treatment. The Center for Disease Control reports that 136.3 million Americans visited the emergency room in 2015.

Latinos are twice as likely as the general population to use the emergency room for non-emergent care, according to a survey by FAIR Health. Furthermore, Latinos and African-Americans are nearly twice as likely to use the emergency room for dental care. The use of emergency rooms for preventable conditions costs as much as $30.8 billion a year.

Overuse of emergency departments is estimated to cost as much as $38 billion in wasteful spending annually. The main drivers of said overuse are lack of access to other primary care services and financial and legal obligations by hospitals to treat all patients who arrive in their emergency departments, the New England Healthcare Institute reports.

Emergency Medical Treatment and Active Labor (EMTALA) laws require that anybody presented to an emergency department get screened.

If a hospital declines a patient who arrives in the emergency room, it could be hit with a fine (up to $50,000 per patient) or lose its Medicare accreditation. If a hospital loses Medicare accreditation, it essentially cannot do business, according to the National Center for Biotechnology Information.

Dr. Mark Reiter, the immediate past president of the American Academy of Emergency Medicine and current associate professor and residency director of the University of Tennessee College of Medicine, says that EMTALA laws work to raise the overall cost of health care for emergency rooms, hospital systems and, in turn, consumers.

Nationally, some 15 to 20 percent of patients entering emergency departments in the U.S. are self-pay, meaning they pay out-of-pocket for health care in the absence of insurance. “A relatively small number of these self pay patients actually pay anything. Even more troublesome for hospitals is that, of those that pay, a lot of them pay less than the costs of their care,” Dr. Reiter told The Daily Caller News Foundation..

The unpaid costs of these patients is then saddled on hospital systems and emergency room physicians. When a patient receives medical care from an emergency room, they are faced with two main types of bills: the facility fee, which covers the hospital’s overhead costs; and the professional fee, which covers the cost things like the salaries of emergency room physicians.

Dr. Reiter explains how this situation can play out in hospitals across the U.S. Typically, a patient with no means to pay shows up in an emergency room and has a legitimate medical emergency. Because of EMTALA laws, the emergency room triages them and gives them an examination. The patient then has a prolonged hospitalization and racks up hundreds of thousands dollars in hospital costs.

Hospitals can only “get a tiny portion of that back,” Dr. Reiter Says. “Physicians won’t get any of that back. So hospitals have to charge more for everyone else because they have to offset the lost costs.”

Your average emergency physician isn’t coming “anywhere close to their salary when seeing self-pay patients,” Dr. Reiter told TheDCNF. As a result, privately insured patients are “subsidizing the rest of patients seen by emergency departments.”

Emergency room care is so expensive because you have “so many patients who don’t pay their bills,” Dr. Reiter said. While hospitals aren’t taking a total loss, as their losses are somewhat offset by federal subsidies, they are still taking a substantial hit. “It is taxing on a hospital’s budget,” Dr. Reiter explains.

As a result of EMTALA laws, emergency departments provide a tremendous amount more charity care than anywhere else. Your average emergency room doctor was “providing $138K in charity care in 2000. Sixteen years later, that number is no doubt significantly higher,” Reiter says.

Reiter says that emergency physicians pride themselves in giving as away as much charitable work as they do, but wishes that the federal government recognized the undue burden it puts on emergency departments. “It would be nice if the federal government recognized this does put a significant burden on those that apply EMTALA care, burdens not placed on the rest of the medical community.”

The physician finishes with an interesting point: There is no where else in society where the federal government mandates by law that professionals provide their services to the indigent. “If someone is indigent, the government might offer food stamps, but the government does not require the supermarket or restaurants to give their meal away for free. It’s the only profession in society that we mandate by law,” Dr. Reiter said.

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