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COBRA Antidumping Act
1985
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| Epidemic of
dumping
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Imagine...a young child has
been hit by a golf ball while retrieving golf balls at a local
driving range. The boy is unconscious and has suffered an
obvious fractured arm. An ambulance is called by the police.
The child is taken to the closest hospital and family is told the
emergency room is "closed" and cannot accept new patients. The
ambulance proceeds to the next emergency room which is 25 miles
away. That emergency room is also on "reroute". During
the trip to the next hospital site 57 miles away, the child dies.
The parents wonder whether the "closed" and "reroute" messages are
due to the fact that they have no health insurance.
Imagine...a young woman is in the 9th month of
her third pregnancy. She is experiencing problems with high
blood pressure and she is showing signs of being in active labor.
Her husband rushes her to the nearest hospital. He is told the
hospital is on "reroute" and he must take his wife to the next
hospital which is 123 miles away. During the trip, the woman
delivers her baby in the car. Both are in critical condition
when they arrive at the second hospital.
Stories like this appeared regularly in
newspapers back in the 1970s and 1980s. One public hospital,
Parkland Memorial Hospital in Dallas, Texas, found that they
received 28% unexpected patients who were sent from other local
hospitals. Another study in Texas showed 27% of patients
transferred from another hospital were in unstable condition when
they arrived at the second site. |
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| Congress acts
in 1985; President Reagan signs bill in April 1986
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Congress included provisions in
the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985
to end this pattern of "no room at the inn". They passed
legislation which was modeled after a Texas statue enacted the
previous year. Now hospitals who participate in the Medicare
program may not reject persons who require emergency medical care
nor women who are in labor. Each violation, when identified,
carries a $50,000 penalty. |
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| Requirements of
COBRA 1985
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There are four major
requirements of this COBRA legislation which directly affect
delivery of healthcare services. These requirements are:
- Stabilization of patients prior to
transfer
- Acceptance by receiving hospital before
the patient is sent to the new site
- Consent by the patient for the transfer
to another hospital
- Transfer of adequate medical records
along with the patient
All hospitals (participating in the Medicare
program) must now provide a screening exam and treatment for
patients with emergency medical conditions and for women in labor.
Prior to transfer to another hospital, the first hospital must
stabilize the patient or deliver the baby. This action must be
taken even if a person is unable to pay for this treatment.
Two key question areas for the student to
consider are:
- Should an emergency room be forbidden by
law to close its doors or transfer patients? Is your answer
the same whether the hospital is established as a non-profit
hospital or for-profit hospital?
- Should a physician be forced to work
without compensation? If a patient cannot pay, who should
pay the medical care providers for the services they offer?
Other features of COBRA 1985 are better
known to the general public. This concerns continuation of
health insurance if a person is terminated from his/her job or if
work hours are reduced and health benefits are lost. Now a
person may select to receive continuation of health benefits up to
18 months when the employee pays the insurance premium. Also
children and other dependents may continue to receive insurance
coverage up to 36 months after divorce of the parents.
Dependent children may also receive coverage up to 36 months after
they cease to qualify as eligible dependents. |
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