Health and Healthcare
Guide to Laws about Health and Healthcare in the United States
1. Health insurance and Health care costs
Do I have a right to health insurance?
As long as you are not already covered by your employer, you have a right to purchase health insurance from Healthcare.gov (established by the Affordable Care Act aka “Obamacare”). You have this right even if you have a preexisting condition.1Affordable Care Act
Am I required to have health insurance?
As of January 2019, the so called “individual mandate” expired, and people are no longer required to have health insurance. (Note: The individual mandate was repealed by the Tax Cuts and Jobs Act of 2017)2More on the individual mandate: https://www.nytimes.com/2017/12/21/upshot/individual-health-insurance-mandate-end-impact.html But if you did not maintain continuous health insurance through the end of 2018 (with exceptions listed here), you will receive a fine of up to $695 per person ($347.50 per child) or 2.5% of your household income, whichever is higher, which is collected as part of calculating and filing your tax return.3Affordable Care Act However, if you are in California, New Jersey, Massachusetts, Vermont, or DC, you will continue to be required to have health insurance, as these states have passed their own individual mandates.
Can I get free or reduced cost health insurance?
If you qualify based on your income (generally less than $50K per year for an individual, more for families) and certain other factors, you may receive “subsidies” to help pay for your health insurance premiums. See Healthcare.gov for more.
Also if your income is at or below 138% of the federal poverty line (generally about $15K or less per year for an individual), you may be eligible for free or very low cost health insurance (called Medicaid, but some states use a different name, such as “MediCal” in California). Although the Affordable Care Act intended this provision to apply to all states, only about half the states decided to implement it. The states that did not implement the Medicaid expansion each have their own eligibility for free or low cost health care, which is generally harder to qualify for than the 138% poverty line threshold. See Healthcare.gov for more.
If you are legally determined as permanently disabled, or you are at least 65 years old, you likely qualify for low cost health insurance, called Medicare.
See our Guide to Disability for more.
Is my health insurance required to cover certain things?
Yes. Under the Affordable Care Act, plans offered on the individual or small group market must cover the following 10 categories of “essential health benefits“:
- ambulatory patient services (outpatient care, such as doctor’s visits)
- emergency services
- maternity and newborn care
- mental health and substance use disorder services including behavioral health treatment
- prescription drugs
- rehabilitative and habilitative services and devices (rehabilitative = regaining lost skills or functions; habilitative = maintaining, learning, or improving skills or functions)
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric (healthcare for children) services, including oral and vision care.
If I don’t have health insurance, can hospitals refuse to treat me?
Even if you don’t have health insurance, you have the right to hospital emergency care, including childbirth (labor and delivery care), regardless of your ability to pay. Hospitals may not turn away any individual in an emergency.4Emergency Medical Treatment and Active Labor Act (EMTALA), passed in 1985, codified at 42 U.S.C. § 1395 All patients who end up at a hospital with an emergency medical condition have the right to receive treatment sufficient to medically “stabilize” them.
However, the patient may end up with a large bill later on.
Also, this does not apply to independent physicians or to “urgent care” facilities. Urgent cares are generally independent, small storefront medical treatment businesses. They are legally allowed to refuse treatment, and usually they require you to pay before they do anything for you.
Are surprise medical bills illegal?
Is it legal to bill an insured patient higher amounts for out-of-network health care when the patient did not know it was out of network treatment?
Starting January 1, 2022, under the No Surprises Act, patients will pay only what they would have if their care had been performed in network.
Also, patients without insurance who receive an upfront estimate of the cost of their care may not be charged more than $400 over the estimate. If this happens, the patient can bring a case against the health care provider.
2. Right to treatment & Right to refuse treatment
Can a patient be removed from a hospital if they can’t pay?
Hospitals are prohibited from suspending emergency treatment or unnecessarily transferring a patient to another facility while emergency care is being administered. This means that the unfortunate practice of “patient dumping” – removing a patient who is too poor to pay for treatment and taking them to another hospital – is illegal.5Emergency Medical Treatment and Active Labor Act (EMTALA), passed in 1985, codified at 42 U.S.C. § 1395
Do I have the right to refuse medical treatment?
In general, yes you have the right to refuse treatments and to leave a medical facility at any time. But the hospital may require you to sign a waiver so that they have no liability if your condition gets worse.
Some exceptions include if there is a pandemic and you may infect others, you can be “quarantined” and not allowed to leave. Also a person who is mentally unstable MAY be forced to stay or to undergo treatment.
3. Medical records
Do my health care providers or other professionals have the right to share my medical information with others without my permission?
Generally, no. They must protect the privacy of your medical records.6U.S. Code of Federal Regulations, Title 45, Sec. 164.508 The relevant law is called the Health Insurance Portability and Accountability Act, and here is a fun example of a violation.
Also see our Guide to Privacy Law.
Do I have the right to obtain my medical records?
Yes.7U.S. Code of Federal Regulations, Title 45, Sec. 164.524 Under federal law, you have the right to obtain a copy of your medical records from your health care provider within 30 days of requesting it.
- Psychotherapy records
- Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding
Do I have the right to correct mistakes in my records?
Not exactly. You can request that the healthcare provider which created the information amends it, and the provider must do so if he/she agrees that the information is inaccurate or incomplete. However, if the provider does not agree to your request, they may not need to amend the record. That said, you have the right to submit a statement of disagreement that the provider must add to your record.8U.S. Code of Fed Regs, Title 45, Sec. 164.526; Health Insurance Portability and Accountability Act of 1996
4. Medical Aid in Dying
As of June 2019, 7 states + DC currently authorize “medical aid in dying,” giving people the right to request medical assistance in ending your life if you have a terminal illness. In addition to Washington, DC, the states that allow this are: California, Colorado, Hawaii, Maine, Oregon, Washington, Vermont, and Montana. The laws are sometimes referred to as “death with dignity” or “physician assisted dying” or “physician assisted suicide.” To follow this issue, go to TheBrittanyFund.org or DeathWithDignity.org.
See more Laws Related to Death and Dying.
Is cannabis legal for medicinal purposes?
See our Guide to Marijuana Laws.
6. Medical treatment mistakes
Can I sue if my doctor messed up a treatment or didn’t diagnose me properly?
This is a tricky area of law, known as “medical malpractice” or “medical negligence,” so you would need to talk to a lawyer who specializes in this field.
What are my rights if I get injured?
See our Guide to Laws about Injuries.
8. Organ Transplants
Is it illegal to buy or sell an organ, such as a kidney?
Yes, it is illegal under the National Organ Transplant Act of 1984 (NOTA).9found in Title 42, section 274e of the U.S. Code Anyone who buys or sells human organs in the United States could face up to 5 years in prison and/or a fine of up to $50,000.
Can someone be reimbursed for expenses related to organ donation?
Yes. You may be able to get some of your expenses related to an organ donation procedure reimbursed. This includes medical costs, loss of income due to missing work, travel, and housing.
Some states allow organ donors to take tax deductions, while other states offer tax credits of up to $10,000 for donors.
For legal assistance with health or healthcare issues, see your options.
|↑1, ↑3||Affordable Care Act|
|↑2||More on the individual mandate: https://www.nytimes.com/2017/12/21/upshot/individual-health-insurance-mandate-end-impact.html|
|↑4, ↑5||Emergency Medical Treatment and Active Labor Act (EMTALA), passed in 1985, codified at 42 U.S.C. § 1395|
|↑6||U.S. Code of Federal Regulations, Title 45, Sec. 164.508|
|↑7||U.S. Code of Federal Regulations, Title 45, Sec. 164.524|
|↑8||U.S. Code of Fed Regs, Title 45, Sec. 164.526; Health Insurance Portability and Accountability Act of 1996|
|↑9||found in Title 42, section 274e of the U.S. Code|