In their zeal to attack the ACA, the GOP has finally found a chink in its armor, but exploiting it could end them
Patient dumping is an epidemic in the United States, and it’s a big cover up from everyone to hospital administrators, doctors, nurses, social workers, Medicare, Medicaid, the Greyhound Bus line, and even taxi companies.
California is number one in the country for patient dumping, especially on Skid Row, but it’s been happening in every major metropolitan city for years. Now it is starting in rural areas of red states as well, especially if that state did not take the Medicaid expansion. We won’t touch veterans who are patient dumped here. A book could be written about that issue alone, if it hasn’t already.
The history of patient dumping began in the early 1900’s. The phenomenon mostly occurred prior to health insurance and Medicare, vaccines, and antibiotics. At that time, there was plenty of space in hospitals, mental hospitals, and outpatient free clinics for medical and mental health patients. Some individuals were committed to mental institutions unnecessarily, especially women. Remember “One Flew Over the Cuckoo’s Nest” or “Frances Farmer?”
The homeless population barely existed as it does now and were referred to as hobos until Ronald Reagan signed the Emergency Medical Treatment and Labor Act. Passed by the United States Congress in 1986 as a section of the Social Security Act, the EMTALA provides that when hospital emergency departments deny medical screening or stabilizing treatment it has the capacity to provide, and/or inappropriately transfers an individual with an unstable emergency condition, that hospital is illegally “dumping” the patient.
This Act prohibited hospitals and emergency rooms from denying a patient evaluation, treatment and stabilization before being transferred to another facility or discharged, even if it means to a family member, group home or other facility, and regardless of insurance coverage. Many times patients who do have insurance are sent home prematurely to family members who are overtaxed and under-trained for caring for acute illnesses.
At the same time, President Reagan cut mental health to the extent that there was literally nowhere for mentally ill patients to go. Insurance companies did not offer mental health benefits so if a mentally ill patient showed up at the emergency room, many times they were discharged with 30 days of medication and either to a local jail or the streets.
In 1996, President Clinton signed into law the Mental Health Parity Act. This mandated that all insurance carriers provide insurance to the mentally ill, especially if a psychiatrist (medical doctor) is prescribed medication. This changed many things for the better since a chronic mental illness such as schizophrenia was treatable on a regular basis. Evaluation, treatment, follow up care and prescriptions were all covered by insurance.
However, this still left a gaping hole in what to do with the mentally ill once they have been stabilized at the emergency room. With a psychotic or schizophrenic patient, an emergency room visit for a few hours isn’t going to stabilize them.
Public Citizen, a watchdog group, did a study back in 2001. That report primarily covered the years 1997, 1998, and 1999, with some violations of the Mental Health Parity Act from 1996 (not covered in previous reports) and 2000. Their data shows the following:
* For-profit hospitals violate the act nearly twice as often as not-for-profit hospitals.
* A patient’s insurance status influences hospital compliance with the act. A patient may not be covered by insurance or may have coverage, such as an HMO, which requires preauthorization for treatment and frequently denies payment when the exam rules out an emergency condition.
* Over 90 percent of the hospitals guilty of violations had breached the screening, stabilizing treatment or transfer provisions of the act, the most serious categories of offenses.
* Less than one-third of the hospitals identified as engaging in illegal patient “dumping” were fined, and the total of such fines averages barely $1 million a year—a pittance for the trillion-dollar health care industry. This was a decade before the Affordable Care Act.
From 1994 to 2005, the number of emergency department visits increased 18 percent from 93.4 million to 110.2 million annually, a rate that coincided with the rising costs of care and lower reimbursement by managed-care organizations and other payers, including Medicare and Medicaid.
The trend disproportionately affects low-income patients, naturally, who generally do not have access to health care and have to seek it in emergency rooms. Many of these patients are subsequently put in taxis and driven to homeless camps or hangouts. In some cases, patients, especially the mentally ill, were given Greyhound bus tickets to different states. See the story of Rawson-Neal Psychiatric Hospital in Las Vegas who issued bus tickets to psychiatric patients to California.
This June, the Supreme Court will make a decision in King v. Burwell case, to make a provision in the Affordable Care Act that would make the tax subsidies in the law available only in states that established their own health insurance marketplaces, and not in the three dozen states with federal exchanges. The case hinges on four words of the 900 page legislation; “ Established by the State.”
In a New York Times article, Olympia J. Snowe, a former Republican senator from Maine who helped write the Finance Committee version of the bill said:
“I don’t ever recall any distinction between federal and state exchanges in terms of the availability of subsidies. It was never part of our conversations at any point. Why would we have wanted to deny people subsidies? It was not their fault if their state did not set up an exchange.”
The four words in dispute, she said, were perhaps “inadvertent language,” adding, “I don’t know how else to explain it.”
According to prior Senator Jeff Bingham:
“As far as I know, it escaped everyone’s attention, or it would have been deleted, because it clearly contradicted the main purpose of the legislation. In all the discussion in the committees and on the floor, I didn’t ever hear anybody suggest that this kind of distinction between federal and state exchanges was in the bill.”
This decision has the power to gut the ACA, potentially leaving over 750,000+ Americans in jeopardy of losing their health coverage and leaving them subject to patient dumping. The rate of dumping before the Affordable Care Act has been monitored, although the rate of it is more difficult to track, the phenomenon has lessened significantly. If the Supreme Court strips the ACA of the subsidies, then patient dumping will be on the rise once more, even if it’s as simple as the patient being discharged to their home and denied further treatment.
Sorry about those cancer treatments, kiddo, hope you enjoyed them while they lasted!
Republicans in the Senate, not realizing the damage their zeal to defeat Obamacare was doing to their own careers, let alone their constituents, who are surely going to blame them, are now scrambling for a back up plan. As of this writing, they don’t have one. Considering how difficult a road the ACA has had, it certainly won’t be a plan that could be implemented overnight, but would take years. How many people will die unnecessarily in that time?
The GOP realized right from the start that the four words they were using to unravel the ACA were an unfortunate simple error, but they hinged their entire case entirely on them anyway with no thought to the disastrous consequences of a win. The Affordable Care Act was never intended to hurt or discriminate against anybody. An unfortunate choice of words happened in its several revisions and amendments and Republicans tried to bring down the whole thing because they say it’s “sloppy work.”
Should they succeed in doing so, it’s highly doubtful they would survive the political and popular backlash against them solely on the basis that they found a “T” that wasn’t crossed. Oh, so my kid had to die because you found a grammatical error, Republican Senator? Hard to put a positive spin on that, don’t you think?
Hopefully, the Supreme Court realizes that although the ACA does say that it is up to the state to set up exchanges. The Federal exchange was agreed upon in Congress as a way for all Americans to have access to several policies. The website may have had some issues but all in all, it has been a success.
Thanks Republicans. Sometimes (maybe) you get what you sue for. Now what are you going to do? You’ve been raging against the ACA for so long that you’re blind to how it’s hurting your own people.
Will you blame President Obama? You can’t for this one. But rest assured, he has a back up plan for this too.