• Posted June 30, 2026

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

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.

More information

The U.S. Centers for Medicare and Medicaid Services has more information on patients' rights under EMTALA. 

SOURCE: STAT, June 29, 2026