The inventory of Creative Commons images in a search for “Heritage Foundation” is rather small, so this is a picture of a jaguar named Khan from the Wildlife Heritage Foundation. How do you not include a picture of a Jaguar named Khan?

The Heritage Foundation, the conservative think tank that has been on the front lines of recent opposition to the Affordable Care Act (a/k/a “Obamacare”). It has not always been so opposed to aspects of the law like the individual insurance mandate, as it rather strongly supported such an idea way back in 1989. As it turns out, its support for various parts of the ACA was in evidence much more recently.

The “universal health care” that many Republicans have recently touted is formally known as the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986. In short, EMTALA states that hospitals accepting payment from federal programs, including Medicare and Medicaid, cannot deny treatment to a person due to inability to pay or insufficient insurance coverage, if that person is experiencing an acute medical emergency. The government does not directly cover the costs of care required by EMTALA, meaning that the costs either get unloaded as tax write-offs for bad debt, or they are covered by higher hospital costs charged to other patients and private insurers. EMTALA had the best of intentions, but it has had the effect of shifting the costs onto other private actors, not the public. Although the Tea Party has tried, no one has ever seriously argued in recent years that people should not have access to acute care because of a lack of ability to pay. It’s a fundamental human decency thing, at least in my opinion.

The Heritage Foundation generally agreed with these sentiments, i.e. that EMTALA had good intentions but caused many problems, as recently as 2007, and their analysis and recommendations included features now found in the Affordable Care—sorry, Obamacare that they so vehemently oppose all of a sudden. Back in July 2007, John S. O’Shea, M.D., a Health Policy Fellow at The Heritage Foundation’s Center for Health Policy Studies, wrote the following:

The Emergency Medical Treatment and Active Labor Act (EMTALA) is another example of federal legislation that hurts the very people that it was meant to protect: low-income patients in need of emergency medical services. Enacted in 1986, the law is a con­gressional response to well-publicized cases in which patients were refused immediate medical treatment based on their inability to pay.

However, EMTALA does not even begin to address the underlying causes of the problem, such as the lack of affordable health insurance and the substandard performance of Medicaid as a health care delivery program for the poor and the indigent. Even after several rounds of additional regulation and clarifica­tion, EMTALA remains a poorly understood, incon­sistently enforced, unfunded mandate. Worse, the law itself is a major barrier to timely and appropriate emergency medical care.

Policymakers need to undertake urgent reform of the emergency medical system, especially in the face of an increasing need for disaster preparedness. [Internal citations omitted]

He went on to tout “tort reform” and other measures that protect insurance companies more than they help patients, but acknowledged that such initiatives are “short-term fixes” at best.

More promising than these short-term fixes, how­ever, would be a serious effort to reduce the number of Americans without health insurance coverage. One way to do this would be for state and federal officials to take the funds for existing public subsidies to hos­pitals and other public facilities that offset the costs of uncompensated care and redirect those funds into a pool to provide health care vouchers or “premium assistance” for low-income families to secure private health insurance coverage. This innovative approach, originally developed by analysts at the National Cen­ter for Policy Analysis, could significantly reduce the reliance of so many Americans on the nation’s already overcrowded emergency rooms for primary care. A variant of this approach was incorporated into the 2006 Massachusetts health care reform.

That sounds a bit like the subsidies included in Obamacare, but, you know, more American or something.

Dr. O’Shea discusses how the federal government regulates hospital emergency rooms, the uses the totally-not-hyperbolic term “metastasizing regulation,” and analyzes the enforcement mechanisms of EMTALA. He concludes that EMTALA has not helped patients as much as Congress might have originally hoped, a conclusion that is difficult to dispute given the financial pressure the law places on for-profit hospitals. He then goes more into depth on how to improve access to health insurance:

A more comprehensive solution would address the fundamental problem that led to the enactment of EMTALA: the large and growing number of Ameri­cans without adequate health insurance. In principle, a program for covering the uninsured would remove incentives for patient dumping, thus making EMTALA irrelevant.

Perhaps the quickest way to accomplish this objective is to redi­rect existing government funds that offset the costs of uncompensated care in hospitals and other institu­tions into a pool for direct assistance to individuals and families toward the purchase of private health insurance. This innovative policy was developed initially by health policy analysts at the National Center for Policy Analy­sis, and a variant of this proposal was successfully advanced by Governor Mitt Romney (R) as part of a compre­hensive Massachusetts health care reform signed into law in April 2006. With waivers from HHS, Massachu­setts officials are transforming an esti­mated $1.3 billion in federal and state uncompensated care funds into a pre­mium assistance program for unin­sured persons to help them buy health insurance. Eligibility for the Massachusetts premium assistance program broadly tracks the income eligibility for federal individual health care tax credits originally proposed by President George W. Bush. [Internal citations omitted]

It is revealing, with regard to how much this country has shifted to the right, that a policy proposal advanced by a conservative think tank just over six years ago now sounds a little bit….socialist.

Photo credit: “Khan approaching and looking at me” by Tambako the Jaguar [CC BY-ND 2.0], on Flickr.