Medicare, Medicaid, Life and Health Insurance/uninsured


QUESTION: I often hear that we are all paying for an uninsured person's visit to the ER. In other words, under the ACA there is no difference. Can you explain who reimburses or pays the ER for the service they perform for an uninsured person? Is there much of a difference between what we are paying for such services under ACA and the way it was before ACA? Thanks.

ANSWER: Hi David

This is a very complicated question with a complicated answer.  I can't offer an exact answer but I can give you a simple one. Most people would agree that the costs of the uninsured are passed on to the insured thru increasing charges. I don't completely disagree but I do know that most facilities have outstanding balances from both insured and uninsured patients which leads to millions of dollars in write offs each year.  The uninsured has the most debt but there is a lot of insured debt as well.  The ACA from what I understand is just what the name says - affordable. Some individuals or families may qualify for free or reduced cost on an insurance plan depending on their income. Of course, this means higher taxes for high earners and large businesses to help pay for much of this.  The idea behind ACA is to lower the financial burden on the entire healthcare industry - patients, physicians, hospitals, and insurers.  I don't know if there will be any immediate changes to how much we pay for services, if any, but maybe in the future we can expect to see some benefit from it. For more information visit

I hope this helps! Thanks for such a great question.

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QUESTION: Thanks. Let me rephrase my comment/question, and it is to get more clarity in my mind as well as get your opinion. Not being an expert on this at all, I suspect the following would hold true: with regard to the oft-heard comment "But you're already paying for it (in higher insurance costs)," that comment is to a certain extent true. However, under ACA, two large costs will be added. 1. Healthy 25-33 year olds who currently do not have health insurance (nor do they wish to) will now be required to pay for it (or be "taxed" for it if they don't sign up). The number of such young people varies but most estimates are in the range of several millions. 2. By bringing government into the picture, government beaurocracy will be added to the cost, including a certain amount of wasteful government spending. Both sides of the issue agree that government spending involves a greater amount of waste than if it was done by the private sector. So, bottom line is, yes, we're already paying for the uninsured when they use the ER, but there will be a difference in the AMOUNT we will be paying. Would you agree that my thesis is reasonably accurate?

ANSWER: You make some interesting points.  I am no expert on ACA but in my career I have seen first hand the amount of patients that present to the ER and there were many 25 - 33 year olds that did not have health insurance.  Many were there for colds, headaches, and other common conditions that could easily be treated by a physician.  An ER has a legal obligation to treat without payment, but physicians can refuse treatment without payment.  If more of these "healthy" age groups were being treated by a physician then a lot of the uninsured ER charges could be avoided.  I'm not stating that this would avoid waste or a lot of government spending but I do understand a need for providing coverage for many different age groups that are uninsured and flood ER's across the country every day.  I refuse to take a political stance on this issue as my concern is that the healthcare industry be financially fit to continue to provide quality care to patients no matter their age or financial situation.

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QUESTION: One more quick follow-up, if you don't mind. This statement seems contradictory: "An ER has a legal obligation to treat without payment, (I understand this) but physicians can refuse treatment without payment. " Explain?

I apologize for the confusion.  Physician medical practices have no legal obligation to treat a patient.  If a patient is uninsured and cannot pay for services upfront, a physician can refuse treatment.  This is why ER's have become a default provider for the uninsured. And since ER charges tend to be triple the charges of a physician office visit, there is a valid reason why health insurance is a financial necessity.  I might also add if the age group you refer to receives preventative care now, they can prevent serious health conditions later which will also help to lower health costs in the future.  Maybe in a few generations, health costs will be stable as a result of a healthier nation of people.

Medicare, Medicaid, Life and Health Insurance

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Joy B. Hicks, MBA, CPM


As a Medical Office Expert, I can answer any question related to the medical office from the prospective of hospital and physician office staff and patients.


I have been in the medical office field for 12 years and also have a blog that provides advice, information, and tips about the medical office.


Certified Practice Manager
AAS Business Administration
BA Health Care Administration
MBA w/ healthcare specialization

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