In an America where millions of people are underinsured or without health insurance

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but the Emergency Rooms still are required to save lives, we go back to the way things were before the ACA:

People who are severely ill or injured will be taken to the ER and their lives will hopefully be saved. But emergency care, drugs, surgery and specialty doctors cost a lot of money. If a patient cannot pay the bills, they risk losing their assets. The cost of the emergency care will be borne by the ER center. Often there is cost shifting so that the more lucrative areas of the hospital end up covering the non-reimbursed areas of the hospital.

Nobody has to run an emergency room. If they lose too much money hospitals can decide not to treat the Level 4 trauma patients any more. The fewer the ERs, the longer the ambulance ride, and the more likely we all are to die.

If the hospital cost shifts to other departments, they will ultimately end up raising prices to cover it. This in turn will make insurance and copays higher for everyone.

I have a gut feeling that the next GOP step is going to be alllowing ERs to decline providing treatment to severely ill or injured patients who do not have insurance or who cannot prove that they are able to self-pay. People will simply die, because society no longer has an obligation to save lives.

[Talk Is Cheap]

1. Are you saying that 100 million Americans are without health insurance?

Where's the citation for that claim?

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2. No I didn't say that.

But I do think that a lot of people will not be able to afford insurance under the GOP plan, or they will have lousy insurance that doesn't provide enough coverage for catastrophic health events. So I think it could easily go that high.

[SFnomad]

5. We didn't have anywhere close to 100 million people without insurance BEFORE the Affordable Care Act

Pulling this number out of your bum is just unnecessary histrionics.

[yeoman6987]

9. A lot of people can't now. The premiums are too high and then they add the

Deductible on top of it. Single payer is the only option to keep everyone at an affordable rate.

[SFnomad]

10. I see you've edited the OP and taken out the 100 million uninsured reference n/t

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12. Is that good enough for you?

Or should I dig a hole and crawl into it?

[SFnomad]

14. You could have acknowledged it, rather than just made the changes and make my post look like

"wtf is he talking about".

[csziggy]

3. Now a lot of ERs are separately owned by outside corporations

I know the one my sister took my Mom to after she fell is and anecdotally I know of three other ERs that are also. When the doctor at the ER handled Mom's case badly - he never got an X-ray for a woman in her 90s with a HUGE bruise on her hip who could not stand or sit without tremendous pain my sister threatened to sue but found out there were no deep pockets to go after.

Separating the two entities limits the liability of the hospital and might limit liability for the ER companies, too. The ER company owns no physical location or equipment - they lease the facility from the hospital and their equipment from various medical suppliers - they hire the doctors, nurses and aides on an "as needed" basis. The hospital makes money on their ER facility but has no legal obligation for anything done there.

I am not even sure if the ER companies have the legal obligation to treat patients the way that hospitals do.

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4. Ultimately a very sick patient will require hospitalization. What happens then?

If there is no requirement for an ER company to treat a patient without insurance, what is the uninsured person supposed to do?

If there is a requirement, I don't see how an ER company could stay in business.

[dalton99a]

8. Free-standing ERs do not accept Medicare or Medicaid.

[csziggy]

15. This was not free standing and they did accept Medicare for both my parents

In fact when my sister had the dispute with them, they never billed for the 20% Medicare didn't pay.

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16. No X-ray for a woman in her 90s with a bruise on her hip and pain sitting or standing

is pretty awful.

[csziggy]

17. Yeah - the nurse in the hospital was the one who insisted Mom get an X-ray

She cracked her tibia but it was not displaced so they didn't have to put her in a cast.

[greymattermom]

6. How about requiring a trauma center no more than maybe

100 miles away from any point on a federal highway? Then add a fee to the gas tax to pay for it. At least there would be emergency rooms, especially in some rural areas.

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7. Who is the party required to set up the trauma center?

[dawg]

11. With all due respect, I think you underestimate the depth of the problem.

Trumpcare wouldn't be the same as the conditions that existed before the ACA. It would be much worse.

By ostensibly maintaining the ban on pre-existing conditions without enforcing an individual mandate or providing people with enough of a subsidy to purchase coverage, Trumpcare would set off a death spiral that would eventually price everyone out of the individual health insurance market. I'm already looking for ways to somehow get my family covered under a group plan, but even group plans are likely to be impacted as large employers will no longer be required to subsidize coverage for their employees.

Many rural and local hospitals and ER's will be forced to close.

And only certain ER's are forced to accept indigent patients. Others are free to turn patients away.

Only government employees and employees of the largest and most generous corporations would be safe. And even they will be asked to contribute more and more.

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13. According to Paul Ryan and the GOP, this is what freedom looks like.