Last week, in an unfortunate and thankfully brief sequence of events, I found myself in the emergency room of the Ohio State University Wexner Medical Center.
A progressively concerning headache brought a halt to my weekend visiting a friend, but my short and eventful stay in the ER that night revealed much about the flaws and dangers of the current United States health care system.
Apart from the anxiety caused by my subpar health and the surrounding chaos of doctors and nurses, I was taken aback by an understated consequence of the ER—the financial burden. Sitting with an IV in my arm, a man came up to inform me that in addition to the hundreds of dollars in medical costs my insurance plan would cover, I had to pay a $150 copay out of pocket for my visit.
Fortunate enough to be able to cover this expense, I did so while keeping in mind the prospect of someone unable to pay this cost for the treatment of the critical medical problem they might be experiencing. Because of the steep costs, emergency rooms deter countless low-income patients seeking immediate medical treatment, and those who come and cannot pay place an additional burden on the hospital. Until emergency rooms and hospitals make health care more affordable, they will continue to impose stresses on their patients as well as the medical service providers themselves.
In a 2014 study conducted by the Healthcare Cost and Utilization Project, results highlighted that low-income patients comprised only 34.4 percent of total ER visits, despite the fact that adults who fall under the federal poverty line are five times more likely to report being in fair or poor health than those with incomes four times higher than the poverty line.
This statistic illustrates the dangers that high-cost health care can have on the well-being of those who cannot afford it. Poor adults, some of whom live in areas without adequate nutritional and medical resources, are at a preexisting disadvantage when it comes to bearing the burden of hospital costs. Without the means to sustain a healthy lifestyle, ER visits would seem more prevalent within this group, yet the data reveals a general inability to pay for these medical services.
According to the 1986 Emergency Medical Treatment and Active Labor Act, in the case of an emergency, neither private nor public hospitals are allowed to deny care to any patient. This presents a moral dilemma to any patient who does not have health insurance to cover the costs: Either find another, less effective treatment to a potential emergency or go to the hospital knowing a collection agency will hunt you down should you not pay.
While the data reveals the majority of low-income patients choose not to go to the ER at all, the hospital also bears a large burden from those who do come and cannot pay, a cost for “uncompensated care.”
In fact, even when President Barack Obama passed the Affordable Care Act in 2010 to provide health care for more Americans, hospitals incurred about $40 billion in uncompensated care costs. With President Donald Trump’s constant attempts to weaken the ACA, it follows that the uncompensated care costs for hospitals will increase as fewer people own health insurance.
Ultimately, the consequences of a low-income, uninsured patient visiting the ER fall across a number of parties.
The patient endures the stress of receiving medical care that is necessary, yet at the same time medical care that they know will cause long-term financial consequences. A 2016 study showed that an uninsured patient who visits the ER doubles their chances of filing for bankruptcy in the next four years, highlighting that the burden on the patient is financial as much as it is emotional.
For the hospital, uncompensated care costs can lead to pay cuts for employees, layoffs and the cutting of certain services. But not all of these costs fall on the hospital —taxpayer money is used to support the debt accrued due to poor patients, and some government spending is allocated toward financing this deficit (per the ACA).
Thus, it is evident the consequences of high health care costs for low-income patients who need immediate medical care are wide ranging and effect more than the patients themselves.
And while most hospitals cannot turn a patient away at the door, most low-income patients make their decision not to visit the ER far before this would present an issue. If hospitals continue to charge high premiums for basic, necessary emergency care, the proportion of low-income patients with ill health and the burden on hospitals and taxpayers will all rise.
Given that Trump wants to dismantle the ACA altogether, it will take a strong and animated defense of Obamacare principles to ensure that the health care system continues to advocate for the needs of the poor.
Ben Charlson can be reached at bencharl@umich.edu.