Freestanding ERs confuse patients — especially when they get the bill

So, when you think of an emergency room, you probably picture the part of a hospital where ambulances bring people who need immediate, life-saving measures.

You probably don’t picture a small facility in a strip mall “next to a nail place.” That’s something altogether different, isn’t it? Like an urgent care, perhaps.

Not according to the bill.

Freestanding emergency rooms are popping up all over the country. While many of them are operated by hospitals, some are operated by independent companies, including the largest provider, Adeptus Health. Some sticker-shocked patients complained in a lawsuit.

The suit targets Adeptus Health, the largest provider of freestanding ERs in the country, claiming that Adeptus “actively conceals its billing practices” and operates a business model meant to “trick patients into believing that its centers are appropriate for non-emergent care for the purpose of extracting extravagant fees.”

NBC News, 4/25/2017

The lawsuit might be a moot point. According to The Dallas Morning News, Adeptus Health filed for bankruptcy in April. Even without Adeptus Health in the picture, many freestanding emergency rooms will continue to operate.

What about EMTALA?

There’s another significant way in which freestanding emergency rooms can differ from hospital emergency rooms. The federal Emergency Medical Treatment and Labor Act (EMTALA) does not apply to them, meaning federal law doesn’t require them to accept all patients regardless of ability to pay. Some states have passed EMTALA-like laws for freestanding emergency rooms, but some have not.

So, are these facilities really emergency rooms, or are they merely urgent care facilities gouging non-emergent patients with ER-like prices? It’s an important reminder to be really sure about the level of care you are seeking before you receive it…or else you could pay a hefty price.

 

Health policy wonks of all stripes agree: GOP health plan is terrible

Despite the terrible news, I was heartened to see the phrase “healthcare policy wonks” in this article. It’s a shame these wonks weren’t included in writing the Republicans’ American Health Care Act (AHCA).

Experts from across the ideological spectrum who actually understand health care policy know that the GOP’s health care plan doesn’t pass muster.

Here are a few objections.

From the left

The repeal bill will transfer money from low-income and middle-class Americans to millionaires.
Topher Spiro and Harry Stein, Center for American Progress

From the center

Some parts of the country will see very large financial hits even if they retain coverage.
Matthew Fiedler, Brookings Institute

From the right

The flat credit will price many poor and vulnerable people out of the health insurance market.
Avik Roy, Foundation for Research on Equal Opportunity and health policy adviser to Rick Perry, Marco Rubio, and Mitt Romney presidential campaigns

This bill misses the mark primarily because it fails to correct the features of Obamacare that drove up health care costs.
Edmund F. Haislmaier, The Heritage Foundation

Did Aetna use its participation in the exchanges as leverage to get its merger approved?

Last year, Aetna ran into some headwinds at the Department of Justice in getting its proposed merger with Humana approved. 

So they resorted to a particularly unsavory trick: pulling out of the ACA exchanges, even in places where it was profitable for them to stay in. 

Despite their insistence to the contrary, a federal judge found Aetna used its exchange participation as leverage against the Obama administration to get its merger approved.

As you might remember, insurers pulling out of the exchanges was a major source of embarrassment for Obamacare.

What happens to Pence’s HIP 2.0 if Obamacare is repealed?

I’ve written previously about the Healthy Indiana Plan started by former Indiana governor Mitch Daniels and updated to version 2.0 under Governor and Vice President-Elect Mike Pence as Indiana’s unique take on the Patient Protection and Affordable Care Act‘s Medicaid expansion.

In short, I’ve never been the biggest fan of Pence (to put it mildly), but I gave him credit where was due for finding a way to expand access to health care in Indiana even when it meant negotiating with his political rivals in the Obama administration.

But the Obama administration is about to come to an end, and the incoming Trump administration has made repealing and replacing PPACA (more commonly known as Obamacare) one of its top priorities in its first 100 days, which might cause as many as 21 million Americans to lose their health coverage.

Senate Democrats will have enough votes to filibuster any bill to repeal Obamacare, but just as Democrats got the fix-it bill through the Senate in 2010 via the budget reconciliation process to avoid a GOP filibuster, Republicans will probably not shy away from using the same tactic.

So, assuming Republicans go this route, what will happen to one of Pence’s signature achievements as governor of Indiana? After all, HIP 2.0 relies on the federal funds for the Medicaid expansion in the Affordable Care Act.

That’s going to be an awkward conversation.