Introduction
Fiscal federalism refers to the division of duties as regards the enactment of various laws and regulations among the various levels of government. There are some instruments of the public that are well addressed by the central government, while others are best addressed by the local government which would understand them best. The idea applies to all types of governments be either devolved or non-devolved ones since in each type there exists a division of authority between the central government and the states or local governments. The federal government uses its authority to enact national laws which are to be implemented in every part of the government, and they usually have implications on the local government’s budget and the running of various public organizations. The paper will focus on one of such federal mandates as it seeks to highlight the effects of these mandates on the local governments.
Emergency Medical Treatment and Active Labor Act
Though many mandates have been enacted by the federal government and which have many effects on public organizations, perhaps the emergency medical and active labor act (EMTALA) seems to have more direct effects. The EMTALA requires that any patient in critical condition should be given medical care regardless of his capability or nationality, and the patient can only be discharged or be transferred when he or she is in stable condition to understand what is taking place (Pozgar, 2010). This mandate does not provide for any financial assistance to the institutions that provide this medical care, leaving it upon the organizations to take care of the financial part without involving the patient in question if the patient is unable to pay.
Organizations Affected
This mandate affects all the institutions which give health services in the US except those that provide care to the elderly and the children. The act has a wide definition that ends up including virtually every hospital, making it almost impossible that a hospital can escape this obligation. Though the hospital may not have facilities to treat the condition of the patient, the mandate regulates that proper arrangements should be made to transfer the patient to a hospital where the condition can be treated (Miller, 2006).
The Effects
Mandates are meant to impact positively on society, though they sometimes end up with negative effects. EMTALA has made it possible for all people to receive life-saving healthcare, therefore improving public health standards, whether one has insurance or not patients who in different circumstances would be left to die (Pozgar, 2010). On the other hand, the mandate impacts negatively on the budget of involved institutions bearing in mind that no mode of reimbursement is provided to the hospitals affected by EMTALA. Most hospitals have undergone losses since most of the bills go unsettled, by patients who claim they are unable to pay and that the bills fall under emergency medical treatment. In conjunction with that, the mandate has led to burdening of those who are capable of paying, because the providers of health services pass on the expenses of those who can not pay. Due to financial strains, some hospitals have been forced to trim down certain facilities, and the result has been congestion in the emergence rooms (Miller, 2006).
Conclusion
Emergency medical treatment and the active labor act are some of the unfunded federal mandates, and like the others, it strains the budgets of public organizations directly affected by them. The federal government comes up with laws and regulations which are meant to benefit both the rich and the poor in society, but it fails to evaluate the effects and how this can be addressed. It is therefore important that evaluation is done on the effects of each mandate on various sectors of the economy, and adequate measures taken before the enactment of the said act.
References
Miller, D. R. (2006). Problems in Health Care Law. Sudbury: Jones & Bartlett.
Pozgar, D. G. (2010). Legal and Ethical Issues for Health Professionals. Sudbury: Jones & Bartlett.