Danielle Campoamor
April 01, 2020 1:12 pm
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I was a few weeks post-op from what ended up being my fifth of seven knee surgeries when I started feeling sick. My fever was spiking, I felt fatigued, and my knee was swollen and hot to the touch. After consulting with my physician’s office, I sought care at a local urgent care center, only to be told they could not see me. Confused, I continued to press the woman on the other end of the phone—surely they had room to see me. I was sick. I was in pain. My father, who was born and raised in Puerto Rico and whose dark complexion had always made me jealous, realized what was happening long before I did.

“You have to tell them you have insurance, Danielle,” he said. “You have a Hispanic last name. They’re assuming you aren’t covered by health insurance.”

After a few sobering seconds processing what my father had said, I told the receptionist I did, in fact, have health insurance. “Oh, well, then yes. Um, we could actually see you in the next 30 minutes.” I asked my father to drive me to the nearest emergency room instead. 

One in five patients reports experiencing healthcare discrimination, according to a 2017 analysis from researchers at UC San Francisco, Stanford University, and UC Berkeley. But “there are laws that ensure that everyone can access emergency healthcare from a hospital emergency room, regardless of whether they have insurance,” Erin Jackson, a healthcare attorney at the national firm of Jackson, LLP, Healthcare Lawyers, tells HelloGiggles. The Emergency Medical Treatment and Active Labor Act (EMTALA), which was enacted in 1986, states that federal law requires that anyone who comes to any hospital with an emergency is to be treated if their health care need is emergent, and they must continue to receive treatment until they’re stabilized, even if they lack healthcare coverage. “They are required to stabilize patients to prevent imminent losses of life or limb, but not provide long-term care,” Jackson explains. 

But just like laws forbidding discrimination based on race, gender, sexual orientation, religion, or place of origin haven’t eradicated systemic racism, homophobia, and sexism from the healthcare system—rising maternal mortality rate disproportionally impacts Black moms, healthcare workers can deny care to LGBTQ patients under the guise of religious freedom, and women seeking care in emergency rooms are still less likely to be taken seriously than men—laws that require people to be provided emergency health care regardless of their health insurance status do not protect people from health insurance discrimination. And since Black and brown people are most likely to experience discrimination within the health care system—a 2019 study found that millions of Black people are denied care that is offered to white people, and in 2008, 27% of Black patients with chronic health conditions reported experiencing discrimination, in which 48% of instances were due to race, 29% were due to age, and 20% were due to financial status—it is also Black and brown people who’re more likely to be discriminated against due to a lack of or perceived lack of insurance.

“It does happen, but there are severe penalties for hospital emergency rooms refusing to stabilize a patient because they don’t have health insurance,” Jackson says. “In general, they tend to be pretty compliant with the law that requires them to stabilize those needing emergency care. If someone is denied care, it is likely after a nurse has triaged their condition and determined that it’s not an emergency and that, therefore, the hospital isn’t required to provide them with care.” 

Now that the United States is facing the ramifications of a global pandemic, and the consequences of failing to proactively respond, the possibility of health insurance discrimination, and other forms of healthcare discrimination, are being considered by those who may not have otherwise worried about their ability to access care. For instance, a 17-year-old victim of COVID-19 was turned away from an urgent care center in California due to a lack of health insurance. (It’s unclear if any other factors, including race or sexual orientation, also came into play.) Instead of treating the minor, the healthcare facility told him to go to the nearest public hospital. He went into cardiac arrest while en route. 

“This gets a bit more complicated in situations of public emergencies like COVID-19, and politicians have spent the past week arguing about whether COVID-19 testing and treatment should be free to everyone, regardless of whether they’re insured,” Jackson says. “Remember that, in addition to the nearly 30 million uninsured Americans, most undocumented immigrants in our country also lack health insurance. Many will also lose their insurance as the economy plummets from this emergency and their jobs, as the ‘bridge’ coverage available through COBRA (a federal law that allows you to temporarily keep your insurance after you leave a job) tends to be cost-prohibitive.”

This means it’s far too expensive for people to maintain. A record 3.3 million Americans filed for unemployment following a slew of shelter-in-place orders as the severity of COVID-19 became clear and efforts to quell the spread intensified. In a country where a person’s ability to access health insurance often depends on their employment status, millions of additional Americans could be left without insurance and in the midst of a public health crisis. 

If you do find yourself in need of medical treatment during this pandemic, or any time, it’s important to know how hospitals find ways around laws that prohibit discrimination due to lack of insurance, and what your rights are as a patient.

“One of the most common instances of discrimination I see is that women’s pain is underestimated and thus not deemed an ‘emergency,’” Jackson says. “Other common sources of discrimination include: The assumption that a patient with a documented history of severe mental illness is behaving erratically for a mental health-related reason rather than a physical health emergency; the assumption that certain racial and ethnic groups are in the emergency room for minor issues and exaggerating so that they can get it covered; or the assumption that a patient who is prescribed opioids is presenting in the emergency room just to get more pills, and that they aren’t really in severely emergent pain or acutely ill.” 

If you believe you have been a victim of health insurance-related discrimination, Jackson says you should first demand to see a physician, as most initial screenings are conducted by a triage nurse. It’s also beneficial, if at all possible, to have someone accompany you to the emergency room, to act as a patient advocate on your behalf. Later, Jackson urges you to contact the Centers for Medicare and Medicaid Services (CMS), an arm of the federal government that enforces insurance rules, to file a complaint. If you were insured and a provider denied you care under the assumption you were not, it’s also wise to contact your insurance provider. 

During a time of so much uncertainty, knowing how you can, if you should need to, advocate for yourself and others, will play a vital role in us all remaining healthy and safe.