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By Dan Gorenstein July 22, 2011

Mitt Romney says federal law requires hospitals to provide free care

Responding to a question about health care at a Wolfeboro, N.H., town hall, Republican presidential candidate Mitt Romney defended the health care law he signed in Massachusetts, saying it was partly a response to people who took advantage of a federal law that allows them to get free emergency coverage.

The former governor told the crowd he expanded health coverage in the Bay State in part so citizens could "take personal responsibility" for their health care.

"We found that because of federal law, federal law requires that hospitals treat people whether or not they can pay. So someone (who) doesn’t have health insurance -- they can go to the hospital and get free care. And we found a growing number of people were dropping their insurance and going to the hospital if they got real sick."

Whether hospitals were properly compensated for treating the poor was one of the issues the Massachusetts health care law tried to address. In this case, we wondered if Romney was accurately describing the federal law and whether it truly equates with free care.

His campaign told us he was referring to the Emergency Medical Treatment and Labor Act., which Congress passed in 1986. It says any hospital that receives Medicare dollars (and nearly 90 percent of hospitals in the United States do) must "provide a medical screening examination" for an emergency condition "regardless of an individual's ability to pay."

The American College of Emergency Physicians defines an emergency as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health (or the health of an unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs."

If the patient’s symptoms qualify as an emergency, the law says "hospitals are required to provide stabilizing treatment for patients."

So what does "stabilizing treatment for patients" mean in practice?

Matt Fenwick with the American Hospital Association says it means "your condition has been stabilized. (Medical providers) have done everything they can do to make sure your condition is not getting any worse."

But there’s no guarantee a hospital will provide some level of treatment, even if a person is really sick, says George Washington University health policy professor Sara Rosenbaum.

"For example, you bring a child who is running a fever and has a sore throat. They say that’s not an emergency. If it turns out the sore throat is very fast-moving strep, which can happen with little children, your child could be dead by night."

Rosenbaum says whether a patient actually gets treatment can be a matter of lucky timing and whether they show up at the emergency room just as the medical concern has blossomed into a true emergency.

She said that even when a person receives some care, there often is a big gap between stabilizing a patient’s condition and providing them with treatment.

Dr. Arthur Kellermann, a health analyst with  the Rand Corporation, a policy think tank, echoes that sentiment. He says a patient "will be stabilized and if necessary hospitalized. They are not entitled to primary care, they are not entitled to preventive care, they are not entitled to followup. That is more humane then letting people die in the gutter. But it is a ridiculous way to try to manage a health care system."

Our ruling

Romney said that federal law "requires that hospitals treat people whether or not they can pay. So someone doesn’t have health insurance they can go to the hospital and get free care."

Experts told us that one aspect of Romney's argument has some validity: Many people rely on emergency rooms for care when they have nowhere else to go, which is expensive and a burden on the health care system and the larger society. And hospitals sometimes provide more free care than the law requires.

But Romney is wrongly suggesting more extensive treatment is required by federal law. He implies that hospitals are required to provide more free care than is actually mandated. In fact, the law just requires stabilizing treatment in an emergency. We rate his claim Barely True.

Editor's note: This statement was rated Barely True when it was published. On July 27, 2011, we changed the name for the rating to Mostly False.

Our Sources

Politico, Video of Wolfeboro Town Hall with Mitt Romney, July 5, 2011

Centers for Medicare and Medicaid Service, EMTALA Overview,  accessed July 12, 2011

American College of Emergency Physicians, EMTALA Main Points, accessed July 12, 2011

Email and telephone interviews with Matt Fenwick, Senior Associate Media Relations American Hospital Association, July 12, 2011

Email and telephone interviews with George Washington University Health Policy Professor Sara Rosenbaum, July 12, 2011

Telephone interview with Rand Corporation Health Analyst Arthur Kellermann, July 13, 2011

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