In all the Republican debates, the Presidential candidates vow to repeal the Patient Protection and Affordable Care Act, or Obama Care, pointing specifically to the provision of the bill which mandates that people have health insurance or pay a fine. Not once can I remember any candidate advocating the repeal of the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) which mandated that hospitals provide emergency care to anyone regardless of citizenship, their legal status or their ability to pay. Twenty-five years ago, this law was passed by a Democratic House, a Republican Senate and signed by a Republican President, Ronald Reagan. The law dictates but provides no funding for its mandate. Obama Care finally provides a mechanism to fund the 1986 law – a “put up or shut up” provision that a lot of people don’t like. If Republicans are truly against federal mandates, are truly for more state autonomy, why are they not calling for EMTALA’s repeal? Although I have not heard Ron Paul recommend repeal of the 1986 law specifically, he has consistently voiced his opinion that the federal government should get out of the medical care business.
The health care debate is part of a larger issue. Are we as a people prepared to put up or shut up? Should hospitals be forced to treat patients? If so, how to pay for it? Should Congress be allowed to pass these unfunded mandates?
“Repeal and replace” is an argument I have heard frequently. Replace with what? Last March, Bloomberg analyzed various Republican proposals to replace Obama Care and found that it was mostly hot air, saving far less money than the lofty claims. Again, I ask – are we going to put up or shut up? Is Ron Paul the only Republican candidate who shows a consistent adherence to principle? Have we become a nation of people who elect only those politicians who tell us that it really is possible to have our cake and eat it too?