Emergency Services to Suffer Under ObamaCare

New regulations short-change first responders and emergency room care for millions of patients.

Every shrill wail of an ambulance siren signals the inefficiency of the federal mega-program, namely, the Patient Protection and Affordable Care Act (ACA)—ObamaCare. The arrogance and officialdom embodied in the Act are making orphans of emergency medical services (EMS). With the enormous increase in patient coverage proposed in the supposedly all-encompassing act, not enough money is provided for the expected huge increased need for EMS, a Jan. 11 analysis by the National Center for Policy Analysis (NCPA) explains.

In addition, the American Academy of Emergency Medicine (AAEM), representing emergency room doctors, is letting the government know that it opposes the emergency services reimbursement provisions. The reimbursements under the new law will not allow hospital emergency departments to care for the “tens of millions of patients who pay little or nothing for emergency care services.” Meanwhile—even before provisions of ObamaCare give millions more people emergency room services, emergency departments can “no longer afford to remain operational,” declared the report from AAEM.

It reminded the politicians and the public that emergency departments are required by an unfunded federal mandate to “treat anyone who arrives at their door, regardless of their ability to pay.” Payments from government sources “are already insufficient to cover costs or expenses.” It said.

Unless the ACA law is declared unconstitutional or enough pieces of it are peeled away by conservatives in Congress, ultimately the pool of privately and publicly insured Americans “may be as large as 30 to 49 million people” by 2016, according to The Incidental Economist. So, the need for emergency medical services (EMS) will increase dramatically. This is particularly true because insured persons, on average, consume nearly twice as much health care as the uninsured, the NCPA noted. Also the number and frequency of emergency department visits is much higher for Medicaid and Medicare recipients than for uninsured and those with private insurance. The NCPA, a non-profit research organization, estimates that ObamaCare will generate 848,000 to 901,000 added emergency room visits annually. There won’t be enough ambulances or responders to rush patients to hospitals. Emergencies will proliferate.

“Every year,” The New York Times reported February 18, “the nation’s emergency rooms treat 117 million patients,” many delivered by ambulance. Ambulance trips to hospitals grew by 13 percent from 1997 to 2006, according to figures available from the U.S. Centers for Disease Control and Prevention (CDC). In 2006, the 18.4 million ambulance transports to hospitals accounted for 15.4 percent of emergency department visits, according to the NCPA. But that’s only a smidgen of what lies ahead if ObamaCare stays on the law books with its grandiose promises of health services for the nation.

Each year, approximately 700,000 people have a stroke. The severity of stroke-related disability, which occurs in up to 30 percent of stroke victims, can be reduced with timely treatment. This includes rapid transport to a hospital. According to the CDC, prompt arrival and brain imaging has significantly reduced the danger for those arriving by ambulance. The CDC analysis also said, “Patients arriving (at a hospital) by ambulance had significantly shorter wait times for brain imaging.”

The percentage of non-injury emergency department visits in which patients with chest pain (indicating possible heart attack) arrived by ambulance was 26.8 percent in the year 2007-2008, according to the National Center for Health Statistics.

Of the 117 million emergency room visits in 2010, CDC statistics say the number of visits was 39 for every 100 persons. Not all these arrived by ambulance. But 13 percent were sick enough to be admitted to the hospital. So, many likely arrived by ambulance. A Medicaid enrollee is much more likely than a privately insured or uninsured individual to visit the emergency room and also more likely to use it multiple times in a year, according to the National Center for Health Statistics.

There is an ambulance fee schedule under Medicare. It applies to all ambulance services including such providers as volunteer, municipal, private, independent and those associated with hospitals. It calls for a base rate payment, plus a fee for mileage. Air ambulance providers also get a fee from Medicare. This reimbursement is a partial source of revenue, but not nearly enough. “The primary source of funding is property taxes,” said NCPA. Budget restraints, sharply declining property values, and restrictions on the use of municipal bonds to pay for ambulances and related equipment will make it difficult for most communities to increase financial support, NCPA said.

On average, NCPA said, EMS agencies lose money responding to calls from Medicare and Medicaid beneficiaries. The ObamaCare law gives Medicare a slight increase, but only for one year—2011. Nationally, Medicare pays only about 70 percent of the cost of an ambulance, and Medicaid pays only about 60 percent of such cost, according to Devon Herrick, a health economist with NCPA.

Paramedics and EMTs are leaving the profession at a record rate, according to EMSWorld. In some parts of the country the turnover rate is 20 percent. Half of health-care workers leave after the first year. Retention strategies “must be broad and varied” to address the reasons employees leave health-care organizations, the article said.

Congressional Democrats stressed that it was an emergency to enact the health overhaul. But apparently the emergency has passed, except where patients are concerned.