And, at the same time that the ACA is being implemented, payments to hospitals to fund care for the uninsured are being decreased -- in spite of estimates that 30 million people will remain uninsured in 2020.
The authors conclude: "Ultimately, the ability of the US health care system to satisfy the ethical obligation to ensure access to care -- first codified in EMTALA -- will be a core measuring stick for the success of the ACA and for any future reforms."
The article grew out of discussions that Vickery and Sauser had with Matthew Davis, M.D., M.A.P.P., who is co-director of the RWJF Clinical Scholars program at the University of Michigan and holds faculty positions in the U-M Medical School and U-M Gerald R. Ford School of Public Policy.
Vickery, who had previous experience treating undocumented immigrants at a Federally Qualified Health Center, notes that the issue of access to primary care for that population, and for others who will not become insured under the ACA, still needs to be addressed. She recalls instances where patients had to be hospitalized for severe complications of diabetes that had never been diagnosed or controlled, because their only health care access came through emergency rooms.
On the flip side, Sauser notes that not having to consider someone's insurance status in the ER feels like a "luxury" but that every day she sees a need for better ability to coordinate the care of a patient who has been seen for an emergency.
Both say that the accountable care organization, or ACO, model of care encouraged under the ACA may help patients within ACOs get access to more coordinated care.
By looking back at lessons from EMTALA which will continue to be the law of the land even under the ACA they hope to inform policy makers and health leaders who are working to implement or introduce pote
|Contact: Kara Gavin|
University of Michigan Health System