Trauma Centers Saved Hundreds Of Lives In Boston Last Week, So Why Are We Shutting Them Down?

Trauma centers, the medical facilities that provide the full spectrum of emergency services at all times, are being forced to close their doors. In fact, between 1990 and 2005, over 300 of them were shuttered in states across the country. Considering the fact that last week’s events in Boston demonstrated the life-saving effects of emergency responders and trauma care — since the nearly 300 people who were injured in the bombings have all survived, an incredible feat for the city’s medical professionals — why are we limiting access to this type of emergency relief?

As the Atlantic details, it’s not because there are fewer emergencies. There’s still a big need for trauma centers and emergency departments, particularly since they aren’t just important for terrorist attacks like the bombs at the Boston Marathon; they also treat Americans who are injured in car crashes or other serious accidents. And these types of facilities are especially important for servicing vulnerable Americans, who tend to wind up in the ER at higher rates than more economically privileged people do.

In fact, researchers Renee Hsia and Yu-Chu Shen have found that emergency care is at risk largely because of financial pressures. Many trauma centers can’t afford to continue operating precisely because they’re serving low-income and vulnerable populations. The type of services that they provide are expensive, yet they’re more likely to provide care for Americans who can’t pay anything in return. Of course, those uninsured or Medicaid patients still need health services — so when trauma centers are forced to close, it hits them the hardest:

The populations associated with greater closure are the populations that need these services the most. Medicaid patients are more likely to use the emergency department than privately insured patients. But, contrary to conventional wisdom, these visits aren’t routine. A Center for Studying Health System Change research brief shows that Medicaid patients are three times more likely than privately insured patients to visit for complex or disabling needs. Sometimes there’s no other choice. In a study of physicians who accepted new patients in 2011, 31 percent were unwilling to accept new Medicaid patients.

We also know that African Americans tend to use emergency departments at twice the rate of whites and Hispanics. This difference is the product of other racial disparities in health care, especially insurance coverage. In 2010, 21 percent of African Americans relied on Medicaid programs. Nearly a quarter did not have employer-sponsored health insurance. And nearly one in five African Americans under the age of 65 are without insurance entirely. This is also the product of income disparities. By 2010, African Americans lived below the poverty level at nearly three times the rate of whites. These factors together help explain why African Americans are more likely to lack access to primary care specialists — and why they tend to rely on emergency departments.

This is why emergency departments are sometimes called the “safety net” of the health care system. What happens when the safety net moves farther and farther away from the people it’s supposed to catch?

Unfortunately, emergency care is becoming increasingly expensive for the low-income Americans who rely on it. The average trip to the ER costs 40 percent more than most Americans spend on monthly rent. In fact, medical costs continue to soar across the entire health care industry. Health costs have skyrocketed while workers’ wages have stagnated, and more than one in three people are forced to put off the health care they need because they can’t afford it.

Obamacare hopes to address some of these issues so that emergency care doesn’t have to serve as primary care for so many vulnerable Americans. By emphasizing preventative services, as well as vastly expanding the social safety net to allow states to add additional low-income residents to their Medicaid rolls, the health law seeks to ensure that Americans are regularly accessing care rather than allowing their health issues to devolve into more serious ailments. And Obamacare may also help ensure that trauma centers don’t continue providing essential services without any type of reimbursement, since about 30 million previously uninsured Americans are expected to gain coverage under health plans — and will therefore have some kind of means to pay their medical bills.