EMTALA + Vaccines: A Get Out of Jail Free Card

“Down to the banana republics, things aren't as warm as they seem.

None of the natives are buying any second-hand American dreams.”

-       Jimmy Buffet, Banana Republics

Freedom to choose and not loose

A growing number of consumers are opting not to receive vaccines for themselves or their children. This trend has been driven by any number of forces: social media, politics, religious beliefs, lack of access. But regardless of the reason, if a consumer becomes ill with a serious disease preventable via vaccination, they can show up at an emergency room and receive treatment despite having made a choice that may have prevented the episode of care in the first place. This is because the Emergency Medical Treatment and Active Labor Act (EMTALA) requires all emergency rooms that accept Medicare must screen and stabilize anyone that presents, regardless of age, religion, or (unstated but implied) vaccination status.

Choices have consequences

The State of Texas Health and Human Services department is tracking a measles outbreak this month, with 48 cases identified to date and 13 individuals hospitalized. 42 of the 48 are children under 18-years old. It is believed all of these cases were unvaccinated. Some of these individuals require ICU care.

This is only the most recent example of consumers making choices, which they are free to do, that directly impact the total cost of healthcare across the industry. If the insured public does not feel vaccinations for serious illnesses are needed, federal and state laws should be modified to reflect that new reality. Those changes should include modifying EMTALA and regulations limiting what factors health insurance companies can consider when setting their premiums.

A brief history of EMTALA

EMTALA was signed into law by President Ronald Reagon in 1987. It was intended to prevent hospitals from "patient dumping," i.e. refusing individuals with the inability to pay or without health insurance. It is the primary federal law ensuring non-discriminatory access to emergency medical care country.

The law requires Medicare-participating emergency departments (virtually all hospitals) to provide medical care to anyone in need. They must provide:

• An appropriate medical screening examination

• Stabilization of any emergency medical condition

• They are prohibited from transferring unstable patients unless the transfer is medically "appropriate"

• The law applies to everyone who walks in the door, regardless of “age, race, religion, nationality, ethnicity, residence, citizenship, or legal status.”

Changes in attitudes need changes in regulations

The Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act(HIPAA) both limit the factors health insurance companies can consider when setting premiums. Insurers cannot consider vaccination status of those enrolled to set differential premium levels. However, these insurance carriers are at risk for any healthcare expenses incurred, including unvaccinated individuals. The cost of care required by the unvaccinated is then distributed across the entire insured risk pool when premiums are increase in the future – thus passing on the increased costs to all consumers and employers.

The increasing trend toward non-vaccination calls into question the current interpretation of EMTALA and what if any modifications should be made to the law. Emergency room providers may well be faced with an ethically dilemma during a disease outbreak like measles. If the emergency capacity is constrained due to the outbreak across unvaccinated individuals, what choices should they make? What are they to do with their normal case load? How are they to triage and manage the influx of individuals who made a personal choice and now are facing serious, potentially avoidable illness. Current law seems to imply they need to treat everyone equally, not a sustainable option but a reality.

The bottom line

If there is a belief – social, political, religious – that vaccinations are a personal choice, then the costs associated with that choice should be transparent and apportioned appropriately. There may not be a clear right or wrong to this topic. But there are clear costs and capacity impacts on an already stressed healthcare system.

Personal choices are everyone’s right. But there shouldn’t be a get out of free card for the results of those choices.

This article was written by a human being; no chatbots or AI were used. No permissions are granted for any use of this content.

Copyright 2itive 2024

2itive is a Portland based consultancy founded by Erik Goodfriend, offering a unique combination of market intelligence, knowledge of healthcare payment systems and creative business strategy insights. Feel free to contact us at info@2itive.com