First, it is necessary to establish that no service is “free”—there are costs incurred for all healthcare services, typically both in physical resources and specialized labor. Healthcare services, like all other aspects of the service industry, must be financed. Whether we choose to levy that cost on individuals gradually (such as universal healthcare systems that provide funding through taxation), in a lump out-of-pocket sum, or through employer-sponsored health insurance coverage, the costs are very real. Why, then, would hospitals be obligated to provide some healthcare services for free?
The legal obligation for this practice is based on the Emergency Medical Treatment and Active Labor Act (EMTALA), which set forth conditions addressing the widespread occurrence of hospitals releasing patients presenting to the emergency room without fully stabilizing their conditions. Many lower-income citizens had also reported being refused medical treatment outright by healthcare providers, specifically citing reasons of economy. With the passage of EMTALA, hospitals are now obligated to provide examinations and treatment to patients presenting to the emergency room to the extent that patients are stabilized, regardless of their ability to finance the costs incurred. This has led to re-examination of the terminology associated with stabilization, with many healthcare providers refusing to treat individuals who are unable to pay beyond a certain point.
The cost of these “free” healthcare services has been passed on to employers and employees in the form of higher health insurance premiums, as well as higher baseline costs for healthcare services. Higher health insurance premiums have resulted in an overall shift toward part-time and contract labor. A given company incurs many less healthcare-related expenses when it is not responsible for providing health insurance to its workforce. This in turn has produced a shortage of full-time positions with insurance benefits relative to the working population of the United States. To potentially correct this discrepancy, the Affordable Care Act was passed in 2010. The Patient Protection and Affordable Care Act contains a mandate that establishes companies in the United States must either a) provide health insurance to its full-time staff or b) opt out by paying a significant fine for each full-time worker that is not given health insurance benefits.
The Affordable Care Act also contains a stipulation that all citizens not currently covered by employer health insurance or another applicable plan