Perspective from the 19^th Hole is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.  I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf.  The middle ground is often where the best public policy decisions lie.  And it is where you want to be on a golf course.

How’s this for a long title?

“The federal Emergency Medical Treatment Act, or EMTALA.”

That’s the federal law that requires almost all hospital emergency rooms in the United States to remain open to anyone who shows up 24 hours a day, seven days a week.

Anyone.  Regardless of ability to pay.

More specifically, the law says this:  “Any hospital emergency department that receives Medicare funds — covering nearly all U.S. hospitals — is mandated to remain open to the public 24/7.  They must provide a medical screening exam and stabilize any patient with an emergency condition, regardless of insurance status or ability to pay.”

I dealt with issue for my 25 years as a lobbyist in Oregon when my firm represented Providence Health and Services, including its eight hospitals in the state.

The law was a reality not well understood by Oregon legislators and state government management executives.  Or, perhaps, they didn’t want to understand it as they made decisions about the State of Oregon budget, including money for hospitals under the Medicaid program.

In simple terms, EMTALA means hospitals, not wanting to go broke, shift the costs of free care in ERs to those who pay for services.  Which means charges go up for everyone – you and me.

If you add another issue to the equation – the fact that hospitals have to do work in the community to earn their non-profit status – it makes budgeting even more difficult.

Is this good policy?  Well, you could find several answers to this question, but, in my view, it is good policy as a means to provide critical health care services to the poor and downtrodden who cannot get care on their own, so they often end up in emergency rooms as “their primary care provider of choice.”

And, to require hospitals to do good work in their communities, is also good policy.

It’s just that hospitals, including those I represented, should have been given credit for HAVING to stay open regardless of the ability of those who showed up to pay for care, as well as for investing in their communities.

All of this came to light again this week when Salem Reporter ran a story that appeared under this headline:  Salem Health spent $162 million in 2024 on subsidized care, other community programs

Here is how the story started:

“Salem Health spent $162 million in 2024 to provide free health screenings, forgive patient bills and cover the cost of care for hospital patients on Medicaid, according to recently-released state data. 

“That spending is a part of what the state requires from non-profit hospitals to maintain their tax-exempt status.  Each year, the Oregon Health Authority sets a minimum amount hospitals must spend on programs and services that support the communities they serve.  Often, that includes care provided for free or below cost. 

“In 2024, Salem Health was required to spend $130.5 million but exceeded that amount by nearly 25 per cent.  Most of that spending went toward covering the cost of caring for patients insured through the Oregon Health Plan, the state’s Medicaid program.”

So, the point of this blog is to point out that hospital budgets are complicated affairs, involving EMTALA, earning non-profit status, and absorbing lost money in general under low-income health care.

Which, I submit, should make us proud of the good work done by Salem Health in our community.  It is one of the best-run hospitals in all of Oregon, which doesn’t make it perfect; it just makes it credible.

I know because I have used many Salem Health services and always found the provider to be very good at what it does.