If Congress doesn’t fix health care, emergency departments will soon be a mess

If Congress doesn’t fix health care, emergency departments will soon be a mess
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As a physician, I have worked hours in a row in Emergency Departments (ED) caring for patients, some of whom were seriously ill and waited hours to see me.  Maybe some of them were like you.

Unless Congress acts, that next trip you make to the ED may take even longer — if you can even get in the door.

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Ten years ago, the Institute of Medicine declared U.S. emergency departments “at the breaking point,” citing growing demand for emergency care. We’re about to find out if the situation can get any worse.

 

Congress has eliminated health insurance subsidies for low-income people. Most Americans don’t realize it, but the individual mandate has been scrapped as well. As a result of both, insurance costs are on the rise.

For example, Georgia projects rates on its exchange marketplaces this year to be 57 percent higher than in 2017, while Florida officials say some premiums will increase by 45 percent. The White House’s recent proposal to expand short-term health insurance could exacerbate this problem even further.

The individual mandate was a blunt tool — essentially, it penalized people who struggle to afford insurance. In one of the few mentions about health care in the State of the Union, the president got it right: the mandate was cruel because it penalized Americans simply for being unable to afford health care. Nevertheless, the mandate was effective in achieving its goal of motivating people to sign up for health insurance.

Now, with health insurance costs soaring, and no mandate on the books to force people to buy that insurance, we’ll almost certainly see the number of uninsured people in this country increase. And that means hospital emergency departments are likely to become even more overcrowded.

Physician’s offices can deny the uninsured care, but by law, EDs cannot. When the growing uninsured population starts putting more pressure on EDs, all of us will feel it — even those who have insurance. And the impact of that shift will be seen in EDs nationwide.

The strain on EDs has impacts beyond simply inconveniencing patients with long waits. Crowding in EDs can contribute to the spread of infectious diseases. One study found crowded EDs have a five percent higher mortality rate for patients who are admitted to the hospital than those with less crowded EDs.

Another real danger is that patients without true emergencies crowd out those who do have true emergencies. Depending on the study, about half of patients seen in U.S. EDs don’t have an emergency. Those numbers will worsen as the number of uninsured grows. In the extreme, this crowding could cause hospitals to declare “diversion” in which they no longer accept new patients in the ED. Those who have a true emergency, and those who have insurance, don’t get a special pass.

After Senate Republicans failed to repeal the Affordable Care Act this summer, President TrumpDonald John TrumpComey: Trump's 'Spygate' claims are made up Trump taps vocal anti-illegal immigration advocate for State Dept's top refugee job Seattle Seahawks player: Trump is 'an idiot' for saying protesting NFL players 'shouldn’t be in the country' MORE laid out his strategy for pursuing health reform: “Let ObamaCare implode, and then do it.” Just after Christmas, he reiterated that he expects to see a bipartisan congressional effort to rewrite the ACA. But congressional leaders have signaled reluctance to take up the issue again soon. And with elections looming, it’s unlikely to take any meaningful action.

So when will members of Congress decide that ObamaCare has “imploded” sufficiently? If stark projections of rising premiums and increasing numbers of uninsured haven’t sent that signal, perhaps EDs will offer useful insights.

EDs keep very good records, from the number of patients they receive, to wait times, to the number of patients who leave because they can’t stand the wait, to their count of diversions. Members of Congress should closely watch hospitals in their districts and see how they function in this changing environment. They should also listen to anecdotes from their constituents, or perhaps friends and family members, who will enthusiastically share stories about their experiences inside overburdened hospitals.

So far, rising insurance costs haven’t been enough to spur members Congress to take meaningful action on health reform. Neither have public opinion polls, which show that health care is the most important issue to voters as the midterm elections approach. But when they see their inaction affecting the very hospitals their constituents and families depend on, it might just be enough.

Arthur “Tim” Garson, Jr., M.D., M.P.H. is director of the Texas Medical Center Health Policy Institute in Houston, past president of the American College of Cardiology and past Provost of the University of Virginia.