This program, if implemented will crush the safety net we provide for Medicaid patients.  EMTALA requires us to see every patient who presents to the ED and provide a medical screening exam.  No one else is required to see Medicaid patients and many do not accept them.  Patients with many if not most of these diagnoses are sick and require care.  A level one complaint in CMS coding books is a mild sunburn that does not require treatment.  I can agree with a level one for that.  But a type one diabetic in DKA?  Those people die.  There are many life threatening illness in the list.  There are many others, that may not be life threatening, but require treatment, medications, and procedures.  To not pay us for the care we provide to these and all patients devalues the service we provide to all.

The recent COVID-19 pandemic has brought to light the disparity in care that people of color and people in poverty receive.  That is not because they get bad care in the ED, it is because they do not have primary care.  Why are you punishing the only physicians who will care for these patients when they are in need?  Everyone else says “go to the ER” or you can have an appointment in 2 weeks.