Закон EMTALA: Обеспечение доступа к неотложной медицинской помощи в США.

Act of Congress in the United States

The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) for anyone seeking treatment for a medical condition regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when the patient's condition requires transfer to a hospital better equipped to administer the treatment. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004, or roughly 44% of all medical expenditures in the United States, make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients. The cost of emergency care required by EMTALA is not covered directly by the federal government, so it has been characterized as an unfunded mandate. In 2009, uncompensated care represents 55% of emergency room care, and 6% of total hospital costs.

The Hill Burton Act of 1946, which provided federal assistance for the construction of community hospitals, established nondiscrimination requirements for institutions that received such federal assistance including the requirement that a "reasonable volume" of free emergency care be provided for community members who could not pay for a period for 20 years after the hospital's construction. Amendments to the act in 1975 removed the 20 year expiration date and instead required hospitals receiving Hill Burton funding to provide free care in perpetuity. However, the provisions of the act were vague and rarely enforced.

Congress passed EMTALA to eliminate the practice of "patient dumping" that is, refusal to treat people because of inability to pay or insufficient insurance or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual seeks treatment for a medical condition "or a request is made on the individual's behalf for examination or treatment for that medical condition." That means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.

According to the Centers for Medicare & Medicaid Services, 55% of U. S. emergency care now goes uncompensated. When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. In the first decade of EMTALA, such cost shifting amounted to a hidden tax levied by providers. For example, it has been estimated that cost shifting has amounted to $455 per individual, or $1,186 per family, in California annually. According to the Institute of Medicine, from 1993 to 2003, emergency department visits in the United States grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Ambulances frequently get diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances got diverted more than half a million times not necessarily due to patients' inability to pay. According to the guidance, which does not change policy, EMTALA, as a federal law, supersedes state laws that ban abortion. So, doctors who perform emergency abortions to stabilize a patient are protected by EMTALA. Hospitals that fail to do so could face fines or be booted from Medicare. The guidance also says EMTALA does not prevent a doctor from being sued, though EMTALA may be used in defense of the doctor in state court actions. Idaho appealed the ruling, arguing that the federal government “cannot use EMTALA to override in the emergency room state laws about abortion any more than it can use it to override state law on organ transplants or marijuana use.” The Supreme Court has agreed to hear Idaho's challenge to that interpretation of the law, to be argued in its April 2024 argument session. Texas sued the federal government, winning in federal court. The 5th Circuit judge preliminarily enjoined the Biden Administration’s EMTALA guidance in Texas.