Ronald Reagan, EMTALA & the Roots of Obamacare

I was visiting at a friend’s house one day when her three-year old son asked to look at photos.  My friend told him, “We’ll look at the pictures after [CW] leaves.”   He looked at me and I immediately knew what was going through his young mind.  The solution to his problem was plainly obvious and simple, and without another second’s hesitation here’s what he said to me: “Leave.”

I can definitely relate to that little boy, because ever since Obama began lobbying to create the massive entitlement program known as Obamacare on the basis that hospitals are overwhelmed treating the uninsured for free the solution was obvious to me:  stop doing that.  Problem solved.  But like my friend’s child who had to learn a lesson about the delicacies of polite behavior with company, I’ve had to learn the hard lesson that mistakes made by those in government can virtually never be undone (which is the reason, of course, that Obama is so desperate to march forward with Obamacare in spite of its infamous problems).  When I suggest that instead of ruining the country with Obamacare we simply put an end to the mandate for free-loading it usually earns me a blank stare, as if I’d suggested doing the impossible.

Let me just say that most people pay their federal income taxes because the potential consequences for not paying can be pretty dire.  I’m no fan of our federal tax system but there’s a lesson to be learned here, to wit:  the possibility of bad consequences is usually sufficient to make most people want to avoid them.  Thus if the consequence of being uninsured means that you could potentially get hit with a huge medical bill or else face penalties akin to those of not paying your taxes, trust me when I say that a lot more people would get insurance voluntarily and much of the purported impetus for Obamacare would go away.  But since common sense seems to be off the table, let’s at least look at who we have to thank for helping to sow the seeds of our destruction.

When I brought this subject up in my last post, a commenter (hat tip to Drpete) pointed me to The Emergency Medical Treatment and Active Labor Act (EMTALA), described this way in a 2012 article in Forbes:

“EMTALA, one of the great unfunded mandates in American history, required any hospital participating in Medicare—that is to say, nearly all of them—to provide emergency care to anyone who needs it, including illegal immigrants, regardless of ability to pay. Indeed, EMTALA can be accurately said to have established universal health care in America—with nary a whimper from conservative activists.  In response, many health policy types worried about a “free rider” problem, in which people would intentionally go without health insurance, knowing that federal law required hospitals to care for them anyway.”1

EMTALA inexplicably included no requirement for free-loaders to reimburse hospitals at a later time.  It was passed in 1986 by a republican Senate and a democrat House and signed by… Ronald Reagan.

According to an article from the website for The National Center for Biotechnology2:

“Although only 4 pages in length and barely noticed at the time, EMTALA has created a storm of controversy over the ensuing 15 years, and it is now considered one of the most comprehensive laws guaranteeing nondiscriminatory access to emergency medical care and thus to the health care system. Even though its initial language covered the care of emergency medical conditions, through interpretations by the Health Care Financing Administration (HCFA) (now known as the Centers for Medicare and Medicaid Services), the body that oversees EMTALA enforcement, as well as various court decisions, the statute now potentially applies to virtually all aspects of patient care in the hospital setting.”


“Although the initial intent of EMTALA was to ensure nondiscriminatory access to emergency medical care, its practical ramifications have broadened significantly over the years and arise from 3 sources: the statute’s original language (5); the interpretive guidelines that have been issued by HCFA, which are not merely suggestions but have the force of law; and the various federal court decisions that have resulted from alleged EMTALA violations.”

Ezra Klein, liberal columnist with the Washington Post, summed up why EMTALA is a Progressive’s dream:  “A universal health-care insurance program is the logical endpoint of the bill Ronald Reagan signed into law mandating (pretty much) universal emergency hospital care.3

That’s government racketeering explained in a nutshell:  create the problem (strain on hospitals due to mandated free care) and use it as an excuse for wealth transfer, which is what universal healthcare amounts to in the end.  And look how perfectly it works.  The requirements under EMTALA are ostensibly what led to “Romneycare” and inspired the Heritage Foundation and Newt Gingrich to propose government- mandated health insurance coverage, giving liberals and libertarians a fair basis for pointing to “conservatives” as the ones who first proposed health insurance mandates.

I suppose it’s fair to say that the federal government’s involvement in decreeing that hospitals provide free care didn’t exactly begin with Reagan.  My brief research on it traced the start back to 1946 with passage of The Hospital Survey and Construction Act (or the Hill–Burton Act), a bi-partisan sponsored law passed at the behest of Harry Truman in 1946 with a democrat senate and house.  It was amended and extended over the years by various administrations and congresses before culminating in the disaster that is EMTALA, which vastly expanded the free care decree.

I don’t know what Reagan and other republicans were thinking when they passed this law.  I think it’s fair to say…they weren’t.  Now we’re all paying the consequences.

~ CW






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18 Responses to Ronald Reagan, EMTALA & the Roots of Obamacare

  1. Kathy says:

    Excellent, CW!! It makes me wonder what the circumstances were surrounding Reagan when he signed that law. Not that he was perfect, because no one in government is immune to those backroom deals, but that just doesn’t fit his character.

    • CW says:

      Thanks, Kathy. I’d like to hear someone explain the reasons for this. It’s hard for me to imagine any deal that would have been worth it.

  2. BrianR says:

    Yep. One of Reagan’s big errors, along with signing amnesty into law and the law that let all the loons out of insane asylums. He wasn’t perfect.

    One of the main drivers of our current high med costs is that particular law, which saddled hospitals with a bunch of costs to treat people who’d never pay back that money. Further enhancements to the law prevented giving just the minimal care required to keep them from dying, to the point where anyone who showed up at an ER for anything, the mildest cold to the worst case of cancer, got full medical care on the HOSPITAL’S dime, driving many out of business, and forcing everyone else to raise prices on those who COULD pay to compensate for all the deadbeats.

    All while prohibiting those hospitals for suing the mooch for recovery.

    • CW says:

      Hey there Brian,

      Yes, it was indeed a very big error and for me the disappointment runs deep.

      Thanks for stopping by.

  3. Clyde says:

    Excellent piece, CW. As Brian alluded to, Reagan wasn’t perfect, but who knows what he traded away for this screwup? Time to kick THIS mistake to the curb as well.

    • CW says:

      Thanks, Clyde. I wish we could kick it to the curb but too many people are thinking inside that box where it’s not even a consideration.

  4. tannngl says:

    The really funny thing about this universal health care thing and forcing hospitals to care for people no matter what is:

    Back when I started into nursing, hospitals did not turn anyone away. There were charity wards and charity clinics for everyone who could not pay. And guess what? those hospitals were started by real charity (love) as stated in the Bible. Started by church groups.

    Oh! one more thing! Every doctor on staff always took his/her turn in the charity wards and clinics. The patients got the best of care. Best doctors!

    Now govt feels they have to mandate this and it just doesn’t work out as well. No one is treated with respect in govt mandates. It’s only with true charity (love) which includes full respect for the person, that it truly works to the patient’s benefit and the medical personnel and hospital.

    • CW says:

      Great comment, tannngl. Ironically I think gov’t involvement destroys the natural willingness to help as those who take advantage of the mandate inspire cynicism and make people distrust the needy. It’s tragic.

  5. Hardnox says:

    Excellent piece CW. I had forgotten about this.

  6. Buck says:

    tanngl is right. Where I grew up was a Catholic hospital and a City/County hospital. Both took charity cases. My first “health” insurance was from BC/BS, called, “Hospitalization Insurance”, was only good if I was in an accident requiring hospitalization but only cost me $5.00 a month. Today my policy for the lil’ woman and me is close to 5 Grand a year…

    • CW says:

      From $5 to $5,000? I was about to make a crack about how old you must be but given the gov’ts meddling I realize that kind of inflation can happen over night.

  7. PT Bohan says:

    Maybe this is why Reagan did so well with Hispanics (this and his immigration law). And maybe this is why we have had such a large influx of illegal immigrants. I find it odd that Republicans and conservatives today make an issue of the debt when Bush also ran up huge deficits. My point is Republicans, like Dems, are hypocrites.

  8. CW says:

    Hi Patrick,

    I think amnesty had much more to do with the influx of illegal immigrants.

    I see pretty broad acknowledgment by republicans that Bush was not the conservative voters expected him to be, although it certainly wouldn’t be fair or realistic to put him in the same category with Obama. Bush is living proof of the folly of allowing name recognition and local popularity to serve as substitutes for principled leadership (let that be a lesson to the Christy cheerleaders).

    As far as hypocrisy goes, no one is entirely innocent but it’s not as simple as you make it sound and an analysis of the numbers and the situation is in order before everyone should be painted with the same brush, but that would be a bit complicated to address in this comment.

    As always I’m glad you stopped by.

  9. Right Detour says:

    Another case of unintended consequences from government “compassion.”

  10. Dave Levine says:

    Not only did Reagan sign EMTALA in 1986, he also signed the IRCA General Amnesty Act that legalized 3.5 million illegal alien lawbreakers. It was a BAD year for the nation!

    • CW says:

      There’s no doubt about it, Dave. Reagan made some mistakes that led to serious problems for the nation. It underscores the importance of sticking to conservative principles and the dangers of “compromise.”

      Thanks for your comment!

  11. Pingback: How Did Illegal Aliens Manage To Get Free ER Care In U.S. Hospitals? (by Dave Levine)