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February 20, 2013

Policy Responses to Demand for Health Care AccessFrom the Individual to the Population

Author Affiliations

Author Affiliations: Robert Wood Johnson Foundation Clinical Scholars Program (Drs Vickery, Sauser, and Davis) and Departments of Pediatrics and Internal Medicine and Gerald R. Ford School of Public Policy (Dr Davis), University of Michigan, Ann Arbor; and Departments of Family Medicine (Dr Vickery) and Emergency Medicine (Dr Sauser), Department of Veterans Affairs Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor.

JAMA. 2013;309(7):665-666. doi:10.1001/jama.2012.96863

Current debate and disagreements regarding health care obscure strong public sentiment calling for reform of the US health care system. Public support for the 2010 Patient Protection and Affordable Care Act (ACA) is split nearly perfectly along party lines, with recent polls indicating that 45% of Americans favor the law and 40% oppose it.1

A generation ago, Congress reacted to public demand for reform by passing the Emergency Medical Treatment and Active Labor Act (EMTALA), signed into law by President Ronald Reagan in 1986. EMTALA was timely legislation, intended by Congress to impart a social contract between the health care–seeking public and a US health care system that the public progressively distrusted. In reality, EMTALA served as a policy detour that may have misled the public into believing the problem of health care access had largely been solved. As President George W. Bush explained in 2007, “[P]eople have access to health care in America. After all, you just go to an emergency room.”2

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