A 40-Year-Old Law Requires ERs To Treat Everyone — Unless They Opt Out

TUESDAY, June 30, 2026 (HealthDay News) — For 40 years, U.S. emergency departments have been barred from turning away patients who cannot pay. 

But that protection applies only to hospitals that contract with Medicare, and a growing number of for-profit emergency room (ER) operators are opting out, reports STAT.

One of the largest, Houston-based Nutex Health, runs 27 hospitals across 12 states and declines Medicare at most of them, according to STAT. As a result, those facilities are not legally bound by the federal Emergency Medical Treatment and Labor Act (EMTALA) — which requires Medicare-participating ERs to screen and stabilize anyone who arrives, regardless of ability to pay.

Nutex says it screens every patient voluntarily and never lets a dying person go untreated, STAT reported. But several patients said they were asked for money before anyone examined them.

Robert Behounek, 34, went to Albuquerque ER & Hospital, a Nutex facility in New Mexico, last fall with chest pain, trouble breathing and swelling, symptoms that could be signs of a heart attack, according to STAT. 

ER staff told him the visit could cost more than $1,600 up front and that he could not be seen without paying, he told STAT. 

“It was literally just, “No money, you don”t get treatment,” ” he said. Behounek claims no one checked his blood pressure or listened to his chest.

Behounek drove himself to another hospital, where doctors diagnosed systolic heart failure and a minor heart attack, STAT reported. 

In a separate 2023 case, Julie Bliss rushed her 11-year-old daughter to a Nutex hospital near Oklahoma City after the young girl fainted and appeared to have a seizure, reports STAT. 

A staffer stopped the exam over payment, and Bliss handed over a credit card and was charged $100 to start care. Her daughter was later diagnosed with vasovagal syncope, a sudden drop in blood pressure.

Dr. Tom Vo, Nutex”s CEO in Houston, and a former emergency physician, denied that patients are refused care. 

No one is turned away unless a doctor has determined they are not in danger of dying, he told STAT, adding that critically ill patients are treated for free: “If you”re going to die, we treat you.” The company said its records did not support the patients” accounts, according to STAT.

Critics say the arrangement allows operators to charge emergency-room prices while shedding an ER”s core duty to treat everyone. Nutex nearly quadrupled its revenue to $875 million in 2025 by staying out-of-network and routing most bills through the No Surprises Act”s arbitration process, STAT found. 

That incentive, experts say, helps explain why such hospitals tend to open in wealthier, well-insured areas rather than serving as a true safety net.

Dr. Amber Sabbatini, an emergency medicine professor at the University of Washington in Seattle, described the trend as a business model “exploiting the benefits” of emergency care without taking on its obligations, according to STAT.